Vitex agnus-castus in Menopause: Phytochemistry, Mechanistic Insights, Clinical Applications, and Safety Perspectives

Herbal remedies are increasingly adopted as alternatives to conventional pharmacological treatments, particularly among women seeking natural approaches to managing menopausal symptoms. This interest is driven by perceptions of greater safety, affordability, and fewer adverse effects associated with medicinal plants. Vitex agnus-castus (VAC), commonly known as chaste tree, is one of the most widely utilized botanical agents for women's health. VAC is rich in diverse bioactive constituents, including flavonoids, iridoids, diterpenes, and essential oils, which collectively contribute to its complex pharmacological profile. Emerging evidence from in vitro, in vivo, and clinical studies suggests that VAC may modulate key neuroendocrine pathways involved in menopause through dopaminergic, phytoestrogenic, opioidergic, and indirect serotonergic mechanisms. These actions are proposed to influence prolactin regulation, estrogen receptor activity, mood stability, vasomotor symptoms, and overall hormonal balance during the menopausal transition. This review synthesizes current knowledge on the phytochemical composition and mechanistic pathways of VAC relevant to menopausal symptom management, alongside an evaluation of its safety and clinical tolerability. Although VAC extracts appear generally safe, effective, and well tolerated, further research is needed to clarify molecular targets, determine optimal dosing strategies, identify responsive patient subgroups, and standardize outcome measures to strengthen evidence-based clinical use.