Just sent this email to Dr Panay, who developed the NAPS treatment guidelines. Hope I got the right email address.
Dear Dr Panay
I came across your name on the NAPS treatment guidelines for PMS, which you have developed. In these you suggest Agnus Castus as a second line treatment after diet and exercise changes. Hurray! So good to see a respected doctor recommending herbal remedies.
Agnus Castus 20mg (standardised extract equivalent to 200mg whole fruit 10:1) literally transformed my life after years of unbelievable period pain and IBS, breast tenderness, irritability and tearfulness.
Before that I had tried a number of contraceptive pills (although I don't need contraception). I was given morphine to manage pain (making it impossible for me to drive to work or function, and as a secondary school teacher this was a disaster). Offered antidepressants (which I refused due to horrendous effects on libido). Finally I was given the Mirena coil, but after a week of ridiculous pain had to have it removed.
I was lost and depressed with the thought the only way forward was to stop ovulation permanently, which I really did not want to do for emotional, sexual and health reasons.
Then I stumbled on article on AC and the research conducted. This was five years ago. I haven't looked back since. My experience is not unique as the women who visit my blog testify
http://julietocallaghan.wordpress.com/2 ... es-agency/http://julietocallaghan.wordpress.com/2 ... t-to-work/However, getting Agnus Castus at the correct dosage has become almost impossible in the UK due to restrictions following the 2011 changes to how herbal medicines are sold. Traditional Herbal Registrations restricts 4mg per tablet and advise only 4-8mg a day. Despite extensive research evidence, notably by Schellenberg 2001 and 2011 that 20mg is the dosage required (and you quote 20mg-40mg on the guidelines).
It seems treatment of PMT is going backwards with this recognised herb basically rendered ineffective. So, as heartening as the guidelines are, they are of little use if GP's can't prescribe Agnus Castus or Red Clover and women can't get the right information about dosage from high street stockists.
Lack of research evidence from RCT's is the reason I have been given for why (despite the EMA monograph for Well Established Use) no suppliers have applied for a Product license to sell 20mg tablets. The reason given by suppliers I contacted is the cost, which is £100,000 for a product license (as opposed to £10,000 for Traditional Herbal Registration) and as Agnus Castus is not patented there is no profit to be made (and recouping of costs).
Clearly you believe Agnus Castus to be effective for mild to moderate PMT (although the women on my blog would argue it is effective for severe symptoms PMDD). I am appealing to you to raise this issue with MHRA and give the guidelines 'teeth' by widely distributing them to GP's (through your professional networks) and pushing for Agnus Castus and Red Clover to be prescribable.
Thank you for reading this and I really hope your voice can make a difference in spreading the word that Prozac and artificial hormones are not the first thing GP's should turn to when a woman complains of PMT symptoms.