Center for Complementary & Alternative Medicine, Singapore, Singapore.
School of Biomedical Sciences, Charles Sturt University, Bathurst, Australia.
J Womens Health (Larchmt). 2020 Feb;29(2):262-278. doi: 10.1089/jwh.2019.7770. Epub 2019 Aug 29.
Cyclic mastalgia (CM) is premenstrual bilateral and diffuse breast pain that presents cyclically and affects women in their reproductive years. It may associate with latent hyperprolactinemia due to the insufficient inhibitory effect of dopamine on the pituitary gland. Vitex agnus-castus (VAC) is known for its dopaminergic activity and its possible actions on CM and latent hyperprolactinemia. However, the treatment effect of VAC on CM remains unclear. To perform a systematic review and meta-analysis of clinical trials that report on the efficacy of VAC treatment in CM patients, literature search was performed in major research databases. This review includes 25 studies (17 randomized control trials plus eight nonrandomized trials). VAC was effective in relieving breast pain intensity and lowering the increased serum prolactin level in reproductive age CM patients (18-45 years) with or without premenstrual syndromes. Typical dosage was 20-40 mg/day with a treatment duration of 3 months. A conservative meta-analysis included only six studies ( = 718, VAC = 356, placebo = 362) and revealed a moderate effect size (SMD: 0.67, 95% CI: 0.5-0.85) favoring VAC over a placebo. Seven trials demonstrated VAC to be a noninferior alternative to pharmaceutical therapies for CM, including dopamine agonists, nonsteroidal anti-inflammatory drugs, serotonin reuptake inhibitors, and hormonal contraceptives. VAC was safe and associated with only mild and reversible adverse events. However, the risk of bias in most studies was unclear due to insufficient information. VAC is a safe and effective treatment option for CM. More high-quality clinical trials are needed to strengthen the evidence base.
周期性乳房痛（CM）是经前期双侧弥漫性乳房疼痛，呈周期性发作，影响育龄妇女。它可能与多巴胺对垂体的抑制作用不足导致的潜在高泌乳素血症有关。牡荆属（VAC）以其多巴胺能活性及其对 CM 和潜在高泌乳素血症的可能作用而闻名。然而，VAC 对 CM 的治疗效果仍不清楚。为了对报告 VAC 治疗 CM 患者疗效的临床试验进行系统评价和荟萃分析，在主要研究数据库中进行了文献检索。本综述包括 25 项研究（17 项随机对照试验加 8 项非随机试验）。VAC 可有效缓解乳房疼痛强度，并降低有或无经前期综合征的育龄期 CM 患者（18-45 岁）升高的血清泌乳素水平。典型剂量为 20-40mg/天，治疗时间为 3 个月。一项保守的荟萃分析仅纳入了 6 项研究（n=718，VAC=n=356，安慰剂=n=362），结果显示 VAC 的效应量中等（SMD：0.67，95%CI：0.5-0.85），优于安慰剂。7 项试验表明 VAC 是 CM 药物治疗的非劣效替代疗法，包括多巴胺激动剂、非甾体抗炎药、5-羟色胺再摄取抑制剂和激素避孕药。VAC 安全，仅与轻度和可逆的不良反应相关。然而，由于信息不足，大多数研究的偏倚风险尚不清楚。VAC 是 CM 的一种安全有效的治疗选择。需要更多高质量的临床试验来加强证据基础。
