Home' Australian Pharmacist : Australian Pharmacist June 2015 Contents Australian Pharmacist June 2015 I ©Pharmaceutical Society of Australia Ltd.
Consumers lead to charge to complementary medicines and usually in
the form of tertiary-educated, middle-aged women. Natural therapies
that target their health do well commercially and can be efficacious,
says Steven Chong.
The first Complementary Comment
(Australian Pharmacist February 2015)
used premenstrual syndrome (PMS) as
an example to illustrate The importance
of evidence for a community pharmacist
when faced with a fairly common clinical
inquiry from a customer but it also
demonstrates the typical health issue for
which complementary medicine (CM) is
utilised: highly prevalent, recurring or
chronic, and a broad symptom picture
that makes differential diagnosis difficult,
and multifactorial – much of it ‘natural’ –
in its aetiology.
For all its many individual manifestations,
PMS is a complex neuroendocrine
disorder that can affect up to 30% of
women during their reproductive years
(about 5–10% severely, where it may
be classified as premenstrual dysphoric
disorder or PMDD). Like menopause
to be covered in the next issue, several
traditional natural treatments have
accrued different levels of evidence over
the decades for want of a pharmaceutical
therapy specifically indicated.
The mixed and individual symptom picture,
lack of studies comparing treatments,
and the high (25–30%) response rate to
placebo, all make research efforts the more
difficult and frustrate both pharmacist and
Despite or because of this, the
‘women’s health’ CM category is no small
change when Aztec Pharmacy Scan Data
for the year to December 2013 shows it
worth $67.8 million.
Pharmacists and a doctor from the Medical
University of South Carolina co‐authored
a therapeutic review in American Family
Physician in 20031 cited American Congress
of Obstetrician‐Gynaecologist (ACOG)
guidelines2 when they stated that all PMS
patients be offered non‐pharmacologic
options first‐line, such as education,
supportive therapy (relaxation and CBT)
and behavioural change (e.g. a symptom
diary, adequate sleep during their luteal
phase, exercise or restriction of salt and/
Vitamins A, E and B6, magnesium,
evening primrose oil and even herbal
teas such as raspberry leaf and cramp
bark are all commonly recommended,
however calcium and Vitex agnus-castus
appear to have the strongest evidence
– although much of it is what could be
considered ‘old’, either from the 1990s
Calcium is ranked highly by both ACOG2
EBSCO3 and the AFP review1 because of
a 1993 dietary population study4 and a
large 1998 high‐quality trial found 1200
mg calcium carbonate daily reduced
mood swings, pain, bloating, depression,
back pain and food cravings compared
to placebo.5 Vitamin B6 outranks mineral
combinations, however, according to
the PMS segment within the Aztec data
– worth $849,000 compared to $323,000.
As discussed previously, a European
standardised extract of Vitex agnus-castus
(Ze 440) has shown efficacy in a
2001 double‐blind randomised,
» COMPLEMENTARY MEDICINES
Steven Chong, BA (Communications), is Editor of
Healthy & Heartwise and Pure Animal, Founding
Editor of The Journal of Complementary Medicine
(2002–2009) and a writer for the Australian Journal of
placebo‐controlled trial6 and a 2012
dose‐dependent study in Germany.
Otherwise known as chasteberry, Vitex
agnus-castus products in Australia sold to
the tune of $596,000 in 2013, outstripping
vitamin B6. This study highlighted
an important point about medicine
(including CM) posology: a higher dosage
does not necessarily yield better results
because 20 mg of Ze 440 (160 mg dry
fruit) was more effective than lower and
However, as in so many other fields,
the Chinese are catching up, having
researched another product from
Germany, a 4 mg/day 70% ethanolic
extract (BNO 1095) that corresponds to
about 40 mg of the fruit.8 This extract
was found effective for women with
moderate‐to‐severe PMS in two separate
prospective RCTs, however remains
undistributed commercially in Australia,
although could appear via mail‐order or
1. Dickerson LM, Maz yck P, Hunter MH. Premenstrual
Syndrome. Am Fam Physician 2003;67(8):1743–52 .
2. ACOG Practice Bulletin. Clinical management guidelines
for obstetrician-gynecologists. Number 15, April 2000.
Premenstrual syndrome, Obstet Gyncecol 2000;95:1–9 .
3. EBSCO Information Services 2015. Premenstrual Syndrome
(PMS). Last updated 18 September 2014. URL < http://
30 April 2015.
4. Rossignol AM, Bonnlander H. Premenstrual symptoms and
beverage consumption. Am J Obstet Gynecol 1993;168:1640
5. Thys-Jacobs S, et al. Calcium carbonate and the premenstrual
syndrome: effects on premenstrual and menstrual
symptoms. Premenstrual Syndrome Study Group. Am J
Obstet Gynecol 1998;179:444–52 .
6. Schellenberg R. Treatment for the premenstrual syndrome
with agnus castus fruit extract. BMJ 2001;322:134–7 .
7. Schellenberg R, Zimmermann C, Drewe J, et al. Dose-
dependent efficacy of the Vitex agnus castus extract Ze
440 in patients suffering from premenstrual syndrome.
8. He Z, Chen R, Zhou Y, et al. Treatment for premenstrual
syndrome with Vitex agnus castus: A prospective,
randomized, multi-center placebo controlled study in China.
9. Ma L, Lin S, Chen R, et al. Evaluating therapeutic effect in
symptoms of moderate-to-severe premenstrual syndrome
with Vitex agnus castus (BNO 1095) in Chinese women. Aust
NZ J Obstet Gynaecol 2010;50(2):189–93.
Women’s health –
BY STEVEN CHONG
This column was supported through an
unrestricted grant from Flordis.
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