Agnus Castus: Thank you Dr Nick Panay

NAPS guidelines for GP's
NAPS guidelines for GP’s

I wrote again to Dr Nick Panay last week, Consultant Gynaecologist, Queen Charlotte’s & Chelsea and Chelsea & Westminster Hospitals. I was following up on his promise to raise the issue of why Agnus Castus was not prescribable by GP’s, at the next NAPS (National Association Premenstrual Syndrome) trustees meeting. Dr Panay has developed guidelines for GP’s on how to treat PMS, and one of his recommendations is for women to try 20mg – 40mg of Agnus Castus, if diet and exercises changes do not improve the symptoms (see above). The problem is since changes to the status of herbal remedies from food supplements to medicines, the dose of Agnus Castus can be no more than 4mg per tablet, with the recommended dose of 8mg – to understand why, see this previous blog post and this one and this one and this one.

Dear Juliet

We discussed this at our last trustees meeting.

We are in full agreement with you that Agnus Castus should be prescribable.

However, this would require registration studies and to our knowledge no company would be able/prepared to conduct these at present.

In the meantime NAPS will continue to support the recognition of this product as an effective evidence based therapy for PMS.

I have copied this email to our CEO for information.

Best wishes

Nick Panay

I was really pleased to hear Dr Panay once again endorse Agnus Castus as an effective therapy for PMS. I know this, of course. My life has been transformed by taking one 20mg tablet a day. But I felt NAPS could do more. Below is my rather impertinent reply and Dr Panay’s gracious response:

Dear Dr Panay,

Thank you for your response, although it saddens me that the NHS can’t find a way to fund the research needed, considering the savings it is likely to make if AC was offered by GP’s. I know I placed a lot of cost on the NHS with repeated GP visits, various hormonal treatments, consultant referral, scans, more treatments – I have not visited my GP for PMT symptoms in over 5 years since taking AC. Based on my blog I am not unique in this.

What I struggle to understand is why the RCT studies already conducted in Germany and China are not sufficient evidence for AC to be prescribable in the UK as it is in Germany. I know the China study was rejected by the EMA as it did not contain European participants – although the reason for this exclusion escapes me.

Could you tell me what registration studies? I assume RCT’s – but how many, on what sample size.

I also struggle to understand why a commercial company must fund them when there is new NHS research fund: Increasing research and innovation in health and social care, just being set up that academic researchers could access. Surely this would be something NAPS could consider applying to – I would certainly get involved in any way I can.

I feel strongly that NAPS could take a lead in this and with your authority engage hospital departments to trial AC as part of an RCT.

Possibly I am being naive, but your guidelines should be more than guidelines, they should be the standard by which GP’s assess and manage women coping with PMT. It would have saved me a lot of pain, side effects, time off work and NHS money if my GP had followed them (and been able to prescribe Agnus Castus).

I hope you will consider how to move this simple (if not fraught with complexity) issue forward. Agnus Castus works for many women and they should be able to get access to it. I understand that pharmaceutical companies need to make money, but health and the solutions to health concerns should not rest solely in the hands of commercial interests.

Yours faithfully,

Juliet O’Callaghan

We share your frustration Juliet.

What is required is a European study with around 100 patients, minimum of 3 months to assess symptoms and one year to assess risks and benefits; this would be the gold standard. We will see what we can do about raising funds for such a project … the funds do not necessarily need to come from the pharmaceutical industry but grant money is not easy to come by.

In the meantime, we are working with the International Society for Premenstrual Disorders and the RCOG to make our guidelines the benchmark by which all health physicians manage PMS.

We look forward to your ongoing support.

Best wishes

Nick

What a brilliant response! Dr Panay is looking into how to raise funds for registration studies. If Agnus Castus were prescribable it could pave the way for other herbal remedies, which, since the change in legislation, have been ‘downgraded’ with the dosage in most cases below effective levels.

Thank you Dr Nick Panay. If you can make this happen, then I know many, many women will benefit.

Please add a message of support and encouragement to Dr Nick Panay in the comments below. It can only help.

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24 thoughts on “Agnus Castus: Thank you Dr Nick Panay”

  1. Hi Juliet do you have any news of suppliers anywhere with the correct strength? Where are you getting yours now. Only just starting down this route! Thanks

    1. Thanks Julia – neither prime health or h and b seem to be stocking at moment (thought I would try the expensive option first see if it works) higher nature have it going to cost £1 a day😒
      Pippa

      1. Hi, I am also trying to go down this route but finding it hard to find a place that sells 20mg, and I wondered if you had any luck on where to get this?
        Louise

      2. I get mine from Prime Health Direct, but they seem to be out of stock. Trying phoning Nature’s Aid as they may have old stock. Let me know if you find some. The other option unfortunately is to take 5 4mg tablets, although I am not sure how the tincture works, but some commentators on here have been happy with it at around 40 drops a day.

  2. Hi Juliet – just found your blog. I’ve been taking agnus castus (in the form of Agnucaston from Bionorica) for PMDD since last summer, on the recommendation of my German gynaecologist. It has transformed my life: I now no longer spend one week in four weeping my way through the throes of crushing, suicidal depression. As I’m moving back to the UK soon, I really hope we get some progress in getting decent dosages available soon. Keep up the good work!

  3. Hi Juliet

    I have just found your blog, I have been suffering over 4 years and tried numerous hrt, pills & potions etc, my problems started when I was told to stop the depo jab, at age 45. I currently have the mirena alongside sandrena gel. I want to stop taking hrt, as it is not helping, I would be keen to know if I can take Agnus cactus with the mirena alone. Any advice would be much appreciated.
    Tracey

    1. Hi Tracey, I am not a doctor so I cannot advise you. I am not sure AC would be effective with the Mirena coil and you may find it interferes with the hormones the coil is trying to regulate. I would visit your GP and discuss this. Let us know how you get on.

  4. I have copied this comment from another blog post to here, and hope it will encourage other women to contact Dr Nick and encourage him to get a trial up and running for Agnus Castus, so it can be prescribed by GP’s. Thanks Kathryn

    Kathryn Entwistle
    I’ve just emailed Nick Panay to exhort him to continue the work towards getting Agnus Castus prescribed by mainstream GP’s:

    “Please work with your colleagues and the regulatory medicine bodies to make AC a prescribable treatment for PMT and Menopause symptoms.

    So many women will benefit from this.

    Thank you for your hard work on all our behalfs
    Kathryn Entwistle”

    and this was his encouraging and speedy reply 🙂

    “Thank you for your encouragement Kathryn

    We will do our best!

    Nick Panay
    Consultant Gynaecologist, Queen Charlotte’s & Chelsea and Chelsea & Westminster Hospitals
    Senior Lecturer, Imperial College London
    Chair, National Association for Premenstrual Syndrome
    Co Editor in Chief, Climacteric
    Immediate Past Chair, BMS
    President Elect, O&G Section, RSM”

  5. Hi!
    Thanks for your blog.

    I just wanted to tell you about you about my experience with AC, as I found it to be extremely effective. When I was 35 (in 2012) I developed polycystic ovaries during the months after I stopped taking the Pill (which hides the symptoms of PCOS) and after a few periods my menstrual cycle got longer and longer then ground to a complete halt. I was trying to get pregnant at the time so this was very frustrating. My gynaecologist’s response was to try Clomid. I decided to wait and see if I could get my cycle back on track myself.

    After doing my own research, I started taking AC (800mg a day in capsules which I upped to 1600mg a day after a couple of weeks). I bought it from Viridian, a very good natural medicine company in the UK (unfortunately they seem to have stopped selling AC – I will email them to check). I was also taking Inositol. The results were amazing. Within a week or two I could literally feel my system getting going again. After three months of feeling like my reproductive system had gone to sleep, I started feeling twinges in my ovaries, swollen breasts (may sound unpleasant but I was glad of any symptom at that point) and after four weeks I had a long, heavy period. Then the following month I conceived my daughter. So it really, really worked for me.

    I realise this blog is primarily about PMS, but I thought this might be useful information for women looking on here to find out about dosage for conception as well. And just to give an example of how effective it can be.

    I have just started trying to conceive again, and am taking AC once again (but am having trouble finding a good brand, which is how I ended up on your web page).

    Best wishes

    1. What a fantastic result! I have heard AC can help some women to conceive by regulating the cycle. I am so glad it worked for you.Doctors are so quick to prescribe pharmaceutical drugs like Clomid with considerable side effects and it makes me so cross when there are safer alternatives. Let us know how you get on this time.

    2. Hi i am also trying for baby.i am confused how much AC should take it.IN past i was taking 20mg per day AC (from prime health).should i take 40my per day.please help me.because after taking 20 mg/day i did not see any positive sign.

  6. I am posting this in a help group I run for PMDD on Facebook . PMDD UK . I too must have cost the NHS thousands and spent thousands myself . I wasn’t offered AC once .

      1. Julie , I have already posted your article in our group and several ladies are looking at trying it . Nick Panay & Proffesor John Studd are our saviours in the battle of Severe PMS and PMDD.
        It is sad when asking the ladies in the group that not one GP offered the first section of ideas on the above flow or was pointed to NAPS. .
        The other side of that is the ladies who are way past and should be referred to someone like Nick are just put on Anti depressants and other drug cocktails for years. It’s important we know about Agnus Cactus as these SSRI drugs come with such horrific side effects and actually can cause some (not all) far more issues. Thank you for working to promote . X

  7. Hi Juliet, I’ve bought some prime health agnus castus. For severe PMDD how many of the tablets can I take a day is it two? Also when is the best time of the day to take them and do I take them every day of my cycle?
    Thanks

      1. Hi Juliet please suggest me. I am 40 yrs and trying for baby.i have periods on time but don’t have any bleeding and i have sign depression and can’t have good night sleep at night.i was taking 20mg/day AC from prime health. Should i increase my dose.

      2. Hi Saira, sorry to hear things aren’t great for you right now. I hope you are taking care of yourself and getting support for depression.I am afraid I don’t know how to advise you re: getting pregnant as my research has focused on agnus castus for PMT. Sorry I could not be of more help. Best wishes.

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