Evaluation of the effect of Foeniculum vulgare fruit and Echium amoenum flower combination on the severity of physical and psychological symptoms of premenstrual syndrome.

The short version

This triple-blinded randomized trial with 80 women explored whether combining two traditional Persian herbs — fennel (Foeniculum vulgare) fruit and Echium amoenum flower — could ease premenstrual syndrome (PMS), the cluster of physical and mood symptoms that appears in the two weeks before a period. The herbs were chosen because fennel contains phytoestrogens (plant compounds that mimic estrogen) and Echium amoenum has serotonergic effects (influencing serotonin, the neurotransmitter tied to mood and pain sensitivity) — both hormone and neurotransmitter shifts are suspected drivers of PMS. Eighty women aged 18 to 35 with confirmed PMS were randomly split into two groups at clinics in Mashhad, Iran. The treatment group took capsules combining Echium amoenum (2 grams daily) and fennel (1 gram daily) during the second half of their cycle for two consecutive months; the control group took matching placebo capsules. Symptoms were tracked with the Daily Record of Severity of Problems (DRSP), a validated scale covering mood, sleep, and physical symptoms across 11 categories, while overall quality of life was measured with the SF-36 survey before and after treatment. Women taking the herbal combination showed significantly greater improvement than the placebo group across every DRSP symptom category at both one and two months (p<0.05 for all comparisons, meaning the difference was unlikely due to chance). Notably, depression, concentration, appetite, sleep, and sense of control improved only in the herb group — the placebo group saw no change in these — while symptoms like anxiety and irritability improved somewhat in both groups. Quality of life rose meaningfully in seven of eight SF-36 domains, with the total quality-of-life score climbing from about 64 to 80 out of 100 in the herbal group versus no change on placebo. One safety signal emerged: menstrual bleeding volume increased in the treatment group compared to placebo (p<0.05), a side effect worth watching. These results suggest the fennel-Echium combination may offer real relief for PMS, particularly the mood and cognitive symptoms that placebo alone did not touch. However, the two groups differed at the study's start in age, weight, and other factors, which could have influenced the outcome, and the trial was conducted at clinics in a single city. The increased bleeding volume also needs monitoring in future use. Larger, multicenter trials with better-matched groups are needed to confirm the effect and pin down the ideal dose and treatment length.

Key findings

• In this 80-woman randomized trial, a daily combination of fennel (Foeniculum vulgare) fruit and Echium amoenum flower taken during the two weeks before menstruation significantly reduced premenstrual syndrome (PMS) symptoms compared to placebo.
• Mood- and cognition-related symptoms — depression, poor concentration, appetite changes, sleep problems, and feeling out of control — improved only in the herb group, not with placebo, suggesting a genuine treatment effect beyond expectation.
• Quality of life, measured across eight areas of daily functioning, rose substantially in the herbal-treatment group but stayed flat in the placebo group.
• The herbal combination increased menstrual bleeding volume compared to placebo, a documented side effect.
• Because the two study groups differed somewhat in age, weight, and other traits at the start, and the trial was conducted at a single set of clinics in Iran, larger and more tightly controlled studies are needed to confirm these results.

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