Vitex agnus-castus, commonly known as chaste tree or chasteberry, is widely used for managing symptoms of premenstrual syndrome (PMS), including PMS Type P, which is characterized by predominant pain symptoms such as headaches, cramps, and breast tenderness. The use of Vitex for PMS has historical roots in traditional European herbal medicine, but its efficacy is also supported by a growing body of scientific evidence.

Several randomized controlled trials and systematic reviews indicate that Vitex extract can significantly reduce the severity of overall PMS symptoms, particularly those related to pain and breast tenderness (mastalgia). The proposed mechanism involves modulation of prolactin through dopaminergic effects, which may be relevant for PMS Type P, since elevated prolactin can contribute to breast pain and other symptoms.

Notably, a 2017 Cochrane review concluded that Vitex was more effective than placebo for global PMS symptom relief, with moderate evidence for reducing mastalgia, irritability, and mood swings. While most trials focus on general PMS rather than specifically distinguishing PMS Type P, the pain-related symptoms addressed in these studies overlap significantly with the Type P classification.

Overall, scientific evidence supports the use of Vitex for PMS, including pain-dominant subtypes, with an evidence rating of 4 out of 5 due to consistent results from multiple clinical trials and systematic reviews, though more specific studies on PMS subtypes would further clarify its role.