Premenstrual Syndrome

Maryam Farahmand et al. (2020) · BMC complementary medicine and therapies

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.

Simin Sadat Motevalli Haghi et al. (2024) · Avicenna journal of phytomedicine

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.