Vitex, Luteal Phase Defect, and Fertility
Updated: Aug 2, 2019
Today, we received our latest shipment of Man Jing Zi, commonly known as Vitex Fruit, so I thought this would be the perfect time to talk about this little gem. Vitex has an interesting story in Traditional Chinese Medicine (TCM) and integrative medicine because of how its clinical application has transformed over the years.
In TCM, Vitex is originally categorized as an “Acrid-Cold Herb to Release the Exterior” – meaning it is commonly used to treat “hot type” upper respiratory infections with symptoms such as headaches and eye pain/redness. Its other traditional applications include eye conditions such as excessive tearing, cataracts, and night-blindness, as well as pain, numbness, and spasms in the extremities.
Today, Vitex has found a second home in the world of integrative medicine because of its benefits for women’s health, especially infertility caused by a shortened luteal phase, known as Luteal Phase Defect (LPD).
How Does Vitex Work?
The current understanding of Vitex and hormonal regulation is its effect on the pituitary gland, specifically the communication loop between the pituitary gland and the ovaries (HPO Axis). Vitex doesn’t directly act on the endocrine system; instead it's believed that it supports the body into balancing itself, specifically in terms of progesterone production. It’s been demonstrated that Vitex mildly inhibits the ovaries’ production of Follicle Stimulating Hormone (FSH) just enough to encourage a shift in the ratio of estrogen and progesterone, in favor of more progesterone.
Progesterone & Luteal Phase Defect
In a woman’s monthly cycle, the luteal phase lasts from ovulation until the first day of menstruation, and ideally lasts 12-14 days. Following the release of an egg (ovulation), the ovaries create a “corpus luteum”, which is a structure that secretes progesterone. This increase in progesterone helps prepare the woman’s body for pregnancy by triggering the endometrium (uterine lining) to thicken, thus allowing an embryo to attach, implant, and grow. If there is no pregnancy, the corpus luteum dissolves, thus triggering the endometrium to shed (menstruation). If there is a successful pregnancy, the corpus luteum will continue to produce progesterone until the placenta takes over about 10 weeks later.
Luteal Phase Defect is believed come from a lack of sufficient progesterone. When progesterone is insufficient, the endometrium doesn’t thicken adequately, the corpus luteum dissolves, and menstruation is triggered. Unfortunately, this means that even in the case of successful fertilization, the thin uterine lining and lack of progesterone will prevent an embryo from implanting, thus preventing the pregnancy from continuing.
Currently, there is no definitive lab test to diagnose Luteal Phase Defect, but is often chosen as the cause of infertility when labs and imaging show low progesterone, luteinizing hormone (LH) , and thin uterine lining. Other associated conditions and symptoms of Luteal Phase Defect include: endometriosis, polycystic ovarian syndrome, thyroid imbalances, spotting between periods, and frequent/early periods.
Vitex & Luteal Phase Defect
As you can see, with Vitex’s ability to support the body in producing more progesterone, Vitex effectively lengthens the luteal phase, allowing sufficient time for the endometrium to thicken and a fertilized embryo to implant and grow.
Vitex & Birth Control
When a woman decides she ready to conceive after being on oral contraception, she may notice it takes a while to restore her natural menstrual cycle. Most oral contraceptives are a combination of estrogen and progestin, which are two hormones that prevent ovulation and prevent the uterine lining from thickening; this is why periods are often lighter when taking oral contraception. After stopping oral contraception, the reproductive system can be a little sleepy from being suppressed. Taking Vitex immediately after stopping oral contraception can help normalize the menstrual cycle and reawaken the body’s natural progesterone production.
Vitex and Traditional Chinese Medicine
As a practitioner trained in Chinese Medicine (TCM), I’m always a little leery of using herbs for conditions outside of their TCM applications. However, in the case of Vitex, the research is demonstrably significant and I can also make sense of why it is helpful for infertility based on examining its traditional applications.
In Chinese Medicine, when we see patients with shortened luteal phases, the common diagnostic patterns include blood deficiency, yang deficiency, yin deficiency, and excess heat. The most common organ imbalances are the kidney, liver, and spleen. Vitex is, by nature, a cold herb that acts on the liver meridian, making it appropriate for infertility patients with liver yin deficiency or excess heat. If you refer to the first paragraph, you’ll also see that Vitex is used to alleviate various eye conditions as well as pain, numbness, and spasms of the extremities. Consequently, all of these symptoms are common symptoms of yin and blood deficiency in the liver. So, it makes sense to suggest that Vitex nourishes blood and cools the liver.
Just like any herb or supplement, Vitex is not appropriate for all causes of Luteal Phase Defect. Because of its cold nature, patients that are diagnosed with cold and/or yang deficiency would not benefit from using Vitex, and it actually may exacerbate their imbalance. From a Western perspective, because Vitex gently inhibits FSH, it’s also not appropriate for individuals who also have poor follicular development.
Fortunately, Vitex is not the only herb we have to support fertility and pregnancy. Both Dr. Helton and myself are extensively trained in using acupuncture, herbal medicine, and life style coaching to help individuals and couples bring new life into the world, and we would love to help you start this journey!