The efficacy of Hypericum perforatum L. for the treatment of premenstrual syndrome: A systematic review and meta-analysis

Objective: Premenstrual syndrome (PMS) occurs in the luteal phase of the menstrual cycle and is characterized by physical, behavioral, and psychological symptoms. Hypericum perforatum L. has shown promising therapeutic effects on this syndrome. This study aimed to systematically review the efficacy of H. perforatum on the treatment of PMS. Materials and Methods: Scopus, PubMed, Web of Science, Cochrane Library, and regional databases (e.g., Magiran, IranDoc, and SID) were searched for studies published from 2000 to September 10, 2023. The randomized controlled clinical trials were included, and the risk of bias was assessed using the Verhagen tool. Heterogeneity was evaluated using the Q test and I² statistics. The pooled standardized mean difference (SMD) with a 95% confidence interval was calculated using fixed-effect or random-effects models. Results: Nine randomized controlled trials involving 1,020 participants met the eligibility criteria and were included in the meta-analysis. H. perforatum was found to significantly reduce anxiety (SMD = -0.21, 95% CI: -0.37, -0.05), depression (SMD = -0.45, 95% CI: -0.74, -0.17), mood disturbances (SMD = -0.36, 95% CI: -0.66, -0.06) and behavioral symptoms (SMD = -0.43, 95% CI: -0.68, -0.19) compared to the placebo. Conclusion: The meta-analysis showed that H. perforatum is more effective than a placebo in alleviating the psychological symptoms of PMS. However, there is a lack of high-quality evidence for some outcomes, highlighting the need for further research. Future studies should also focus on identifying and characterizing the plant’s bioactive phytochemicals, which may lead to the development of novel, natural-based therapeutic agents.