Effectiveness of Echium amoenum on premenstrual syndrome: a randomized, double-blind, controlled trial.

The short version

This randomized controlled trial with 84 women explored whether Echium amoenum (EA) — a purple-flowered herb known in Persian medicine as "Gol-e-gavzaban" and used since antiquity for mood and nervous-system complaints — could ease premenstrual syndrome (PMS). PMS is the recurring mix of mood, physical, and behavioral symptoms that shows up in the two weeks before a period, affecting an estimated 80-90% of women of reproductive age. EA is a relative of borage traditionally credited with calming and anti-inflammatory effects, governing how the body responds to hormonal shifts across the menstrual cycle. Researchers recruited 84 Iranian college students, aged 20 to 35, who met diagnostic criteria for PMS, and randomly assigned them to take either an EA extract capsule (450 mg per day, split into three doses) or an identical-looking placebo, for 10 days each cycle across two menstrual cycles. Severity was tracked with the Premenstrual Symptoms Screening Tool (PSST), a validated 19-question survey covering mood, physical symptoms, and how much they disrupted daily life, completed before treatment and after each cycle. By the second treatment cycle, women taking EA saw their average PSST score drop from 35.3 to 16.1 — more than double the improvement seen with placebo, which fell only from 31.0 to 28.3 (a reduction 11.6 points greater than placebo, 95% CI -14.7 to -8.5, p<0.001, meaning the difference is very unlikely to be chance). The benefit was already emerging after just one cycle (a 6.2-point edge over placebo, p=0.001). Every symptom tracked — irritability, anxiety, tearfulness, fatigue, and more — improved significantly more with EA than placebo, with anxiety and tearfulness showing the strongest response. Overeating and trouble concentrating improved the least, though still meaningfully more than placebo. Side effects were minimal: three women on placebo reported nausea, compared with none on EA, suggesting the herb was well tolerated over the two-cycle course. For women looking for a non-hormonal option to manage PMS, these findings offer encouraging early evidence that EA can meaningfully reduce symptom severity within one to two cycles, with mood symptoms responding best. That said, this was a single trial in college students over just two cycles, relying on self-reported symptoms, so the results may not generalize broadly. Larger, longer trials examining EA's active compounds and optimal dosing are still needed before it can be recommended with confidence.

Key findings

• In this randomized trial, women who took Echium amoenum (EA), a Persian herbal remedy, saw their premenstrual syndrome (PMS) symptoms drop by more than half over two menstrual cycles, compared to only a small improvement with placebo.
• EA appeared most helpful for mood-related symptoms like anxiety, tearfulness, and irritability, and least helpful for food cravings and concentration problems, though both improved significantly.
• No side effects were reported among women taking EA, while a few women on placebo experienced nausea, suggesting EA was well tolerated.
• Because this was a single trial in college-aged women over just two cycles, larger and longer studies are needed before EA can be confidently recommended for PMS.
• EA grows natively in Iran and is not widely available outside the country, which may limit access for women elsewhere considering this remedy.

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