Reference
Ozgoli G, Selselei E, Mojab F, Majd H. A randomized, placebo-controlled trial of Ginkgo biloba L. in the treatment of premenstrual syndrome. J Altern Complement Med. 2009:15(8):845-851.
Design
A single-blind, randomized, placebo-controlled trial.
Participants
Ninety college women with premenstrual syndrome (PMS) living in Tehran were enrolled in the study. Data were collected with a self-administered questionnaire using Beck’s Depression Inventory, a daily symptom-rating questionnaire containing 19 PMS symptoms according to DSM-IV, and items relative to the inclusion criteria included participants’ experiencing the symptoms for at least 2 consecutive cycles before the study and experienced at least 5 of the 19 symptoms for most of the time during the last week before menses. Eighty-five women completed the study.
Study Medication and Dosage: Participants were given 40 mg 3 times daily of a standardized Ginkgo biloba extract or a placebo from day 16 of their cycle to day 5 of their next cycle. The ginkgo was standardized to flavonoid glycoside (24%) and terpene lactone (6%). Ethanol and water were used as the solvents, and the ratio of the extract was 4:1.
Key Findings
Participants took ginkgo or placebo tablets (40 mg) three times per day, from day 16 of the cycle to day 5 of the next cycle, for 2 consecutive cycles. Overall severity of symptoms in the ginkgo group was 34.80% before the treatment and reduced to 11.11% after the treatment. In the placebo group, the baseline severity was 34.38% and dropped to 25.64% after intervention.
Overall both the ginkgo and placebo groups experienced reduction in symptom severity, with the ginkgo group reporting significantly greater reduction.
Overall both the ginkgo and placebo groups experienced reduction in symptom severity, with the ginkgo group reporting significantly greater reduction. Taken separately, the severity of the psychological symptoms was reduced significantly in both groups, but there was a significant difference between the 2 groups, in favor of ginkgo intervention. Physical symptoms were also reduced in both groups, again with a significant difference in favor of the ginkgo group. This study also reported the satisfaction level of participants. Those in the ginkgo group were significantly more satisfied than in the placebo group, with 3.2%, 48.8%, and 20.9% reporting “very satisfied,” “satisfied” and “moderately satisfied,” respectively in the ginkgo group versus 14.3% “satisfied,” 85.7% “moderately satisfied,” and no one “very satisfied” in the placebo group.
Practice Implications
Most menstruating women experience some symptoms of PMS, but only about 5% have significant symptoms that disrupt their lives. To my knowledge, there is only one previously published placebo-controlled trial on the efficacy of ginkgo and PMS. In this study ginkgo was particularly effective in reducing congestive symptoms of PMS, including breast pain or tenderness.1 The results of the current study demonstrate that ginkgo is more effective than placebo in reducing the severity of physical and psychological symptoms in young women in Iran with PMS. In particular, the severity of insomnia, fatigue, bloating, and palpitations decreased in the ginkgo group but not in the placebo group.
Several compounds and mechanisms of ginkgo may be involved in these physical and psychological benefits for PMS. Ginkgo increases blood circulation by maintaining the balance of prostacyclins and thromboxane A2. It is also an inhibitor of monoamine oxidase, which catabolizes many neurotransmitters. It also increases the release of catecholamines and other neurotransmitters and decreases their reuptake, thereby improving mood and depressive symptoms. The flavonoids in ginkgo inhibit the production of inflammatory prostaglandins and therefore produce an anti-inflammatory effect. This could explain the relief of congestive symptoms such as mastalgia, abdominal bloating, and edema. Bioflavonoids, potent active ingredients of ginkgo, are known as stress modulators and possibly associated with the anxiolytic effect of ginkgo. The quercetin contained in ginkgo inhibits histamine release.
The current study confirms the benefits of a standardized extract of ginkgo for the treatment of PMS. Based on the published data to date, standardized extracts of Vitex agnus castus (chaste tree berry), Hypericum perforatum (St. Johns wort), and Ginkgo biloba (ginkgo), appear to be the most effective botanical treatments for PMS. I would encourage women and their practitioners to seek PMS formulas that have, at minimum, these three botanicals in the formulation.
