A French study found that standardized Ginkgo biloba extract (EGb 761) was effective against the congestive symptoms of premenstrual syndrome (A. Tamborini and R. Taurelle, Rev. fr. gynécol. obstét., 88: 447, 1993). In a controlled multi-centre double-blind study of 165 women aged 18 to 45 years, patients received either 160 mg per day of EGb 761 (four tablets) or placebo from day 16 of the menstrual cycle to day 5 of the following cycle, over two cycles. Each patient then decided whether to double her dose after the first cycle if she felt the treatment (Ginkgo or placebo) was not sufficiently effective. The characteristics of patients and their premenstrual symptoms were the same in both groups. An observation of one menstrual cycle before the trial commenced confirmed the diagnosis of premenstrual syndrome (PMS). Both the patients and the attending physicians evaluated any change in symptoms and 143 patients completed the trial.

There was a substantial placebo effect, which is typical for PMS clinical trials. However, the group receiving Ginkgo still demonstrated a significant improvement over placebo for several symptoms.

As evaluated by the attending physician, the number of patients who did not experience breast tenderness increased from 2 to 20 in the Ginkgo group and from 8 to 15 in the placebo group, while the number of patients complaining of severe breast tenderness fell from 44 to 15 in the Ginkgo group and from 31 to 14 in the placebo group. Although both groups showed improvement, only for the Ginkgo group did this improvement achieve statistical significance (p < 0.03). Similarly 'breast pain on palpation' by the physician was also significantly reduced. On self-evaluation for 'breast tender or painful', the difference in improvement between Ginkgo and placebo had borderline significance (p = 0.07). However, in patients with more severe symptoms Ginkgo showed a clear advantage over placebo (p = 0.03).

There were marked improvements for the Ginkgo group in other symptoms such as oedema, anxiety, depression, and headaches, but these were not significantly different from the placebo group. Twenty-three patients receiving Ginkgo and 25 receiving placebo doubled their dose in the second cycle (about a third of each group). As a whole these patients had already experienced some symptom relief in the first cycle, but they had assessed this improvement to be insufficient or incomplete. The treatment was well tolerated.


The effectiveness of EGb 761 against congestive symptoms, possibly due to an anti-oedema activity, has already been demonstrated in a double-blind study of patients with idiopathic cyclic oedema (G. Lagrue et al., Presse méd., 15: 1550, 1986). Standardized Ginkgo extract decreases capillary hyperpermeability and strengthens capillary resistance. Its antagonism of the pro-inflammatory platelet activating factor (PAF) may also explain its action against oedema.

Ginkgo may have other applications in gynaecology. A case report of the use of 80 mg per day of EGb 761 (2 ml or 2 tablets) for the successful treatment of cramping resulting from uterine fibroids has been described (D.J. Brown, Townsend Letter for Doctors, August-September 1994, p.981). I have prescribed this treatment with good results for the same condition. Also, dysmenorrhoea is partly an ischaemic pain and Ginkgo is an effective treatment for peripheral ischaemia. Standardized Ginkgo extract may therefore help to ameliorate the pain of dysmenorrhoea.

The British Journal of Phytotherapy.


By Kerry Bone

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