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The four primary systems that affect the first pass effect of a drug are the enzymes of the gastrointestinal lumen, gut wall enzymes, bacterial enzymes, and hepatic enzymes

For example, a 2013 trial found it significantly improved menopause symptoms across multiple categories, including vasomotor, physical, and psychological measures.62 While its primarily studied for menopause, theres some evidence suggesting it may also help with PMS-related discomfort.53 Chasteberry (Vitex) Pycnogenol In a 2011 study, perimenopausal women who took Pycnogenol for two months experienced statistically significant reductions in hot flashes, night sweats, mood swings, irregular periods, reduced libido, and vaginal dryness.9 For PMS symptoms, a 2008 study found Pycnogenol significantly lowered menstrual pain in those with dysmenorrhea.63 Wild yam Wild yam has a long history of traditional use for menopausal and inflammatory symptoms