Systematic Review of Chinese Medicine for Ovarian Endometriosis
International Journal of Pharmacognosy and Chinese Medicine
ISSN: 2576-4772
Eileen Lee, Yongqi Xie, Haiyong Chen and Wei Meng
School of Chinese Medicine, University of Hong Kong, Hong Kong
Abstract
Background: Ovarian endometriosis is a common disease found in women of childbearing age. Existing therapies in
western medicine have limitations in various aspects including management of pain, prevention of recurrence and
promotion of fertility. Numerous Chinese medicine preparations have been shown to possess therapeutic potential in
relieving EMS symptoms and shrinking the OEMS without significant adverse effects, although the clinical efficacy
needs to be further confirmed with large amounts of well-designed experiments.
Objectives and Methods: RCTs of Chinese medicine concerning ovarian endometriosis are included to work out this
systematic review in order to provide scientific evidence for its efficacy and safety.
Results: 16 articles were selected out of 427 literatures for a systematic reviews and a meta-analysis was conducted.
The studies suggest that the ovarian endometriosis patients’ recurrence rate is lower and the pregnancy rate is higher
in the Chinese medicine group, while the total effective rate, change in the size of endometrial cyst and CA125 level in
both Chinese and Western medicine groups shows no statistical significance. Although the result favored the Chinese
medicine group for lower dysmenorrhea rate and less adverse effects, the size of sample data and high heterogeneity
between studies adversely affected the reliability of the results.
Conclusion: Chinese medicine has two advantages over Western medicine in treating ovarian endometriosis, which
are the low recurrence rate and high pregnancy rate. However, due to the limited number of literatures available and
variations in their experimental methods and outcome measures, the conclusive results remain elusive. Larger scales
of randomized controlled trials and more scientific evidence are needed to prove the efficacy and safety of Chinese
medicines for ovarian endometriosis.
Chinese herbal medicine for endometriosis
Andrew Flower 1, Jian Ping Liu, George Lewith, Paul Little, Qing Li
‘ In China, treatment of endometriosis using Chinese herbal medicine (CHM) is routine and considerable research into the role of CHM in alleviating pain, promoting fertility, and preventing relapse has taken place.‘
Abstract
Background: Endometriosis is characterized by the presence of tissue that is morphologically and biologically similar to normal endometrium in locations outside the uterus. Surgical and hormonal treatment of endometriosis have unpleasant side effects and high rates of relapse. In China, treatment of endometriosis using Chinese herbal medicine (CHM) is routine and considerable research into the role of CHM in alleviating pain, promoting fertility, and preventing relapse has taken place.This review is an update of a previous review published in the Cochrane Database of Systematic Reviews 2009, issue No 3.
Objectives: To review the effectiveness and safety of CHM in alleviating endometriosis-related pain and infertility.
Search methods: We searched the Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) and the following English language electronic databases (from their inception to 31/10/2011): MEDLINE, EMBASE, AMED, CINAHL, and NLH.We also searched Chinese language electronic databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Sci & Tech Journals (VIP), Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), and Chinese Medical Current Contents (CMCC).
Selection criteria: Randomised controlled trials (RCTs) involving CHM versus placebo, biomedical treatment, another CHM intervention; or CHM plus biomedical treatment versus biomedical treatment were selected. Only trials with confirmed randomisation procedures and laparoscopic diagnosis of endometriosis were included.
Data collection and analysis: Risk of bias assessment, and data extraction and analysis were performed independently by three review authors. Data were combined for meta-analysis using relative risk (RR) for dichotomous data. A fixed-effect statistical model was used, where appropriate. Data not suitable for meta-analysis were presented as descriptive data.
Main results: Two Chinese RCTs involving 158 women were included in this review. Both these trials described adequate methodology. Neither trial compared CHM with placebo treatment.There was no evidence of a significant difference in rates of symptomatic relief between CHM and gestrinone administered subsequent to laparoscopic surgery (95.65% versus 93.87%; risk ratio (RR) 1.02, 95% confidence interval (CI) 0.93 to 1.12, one RCT). The intention-to-treat analysis also showed no significant difference between the groups (RR 1.04, 95% CI 0.91 to 1.18). There was no significant difference between the CHM and gestrinone groups with regard to the total pregnancy rate (69.6% versus 59.1%; RR 1.18, 95% CI 0.87 to 1.59, one RCT).CHM administered orally and then in conjunction with a herbal enema resulted in a greater proportion of women obtaining symptomatic relief than with danazol (RR 5.06, 95% CI 1.28 to 20.05; RR 5.63, 95% CI 1.47 to 21.54, respectively). Overall, 100% of women in all the groups showed some improvement in their symptoms.Oral plus enema administration of CHM showed a greater reduction in average dysmenorrhoea pain scores than did danazol (mean difference (MD) -2.90, 95% CI -4.55 to -1.25; P < 0.01). Combined oral and enema administration of CHM also showed a greater improvement measured as the disappearance or shrinkage of adnexal masses than with danazol (RR 1.70, 95% CI 1.04 to 2.78). For lumbosacral pain, rectal discomfort, or vaginal nodules tenderness, there was no significant difference between CHM and danazol.
Authors’ conclusions: Post-surgical administration of CHM may have comparable benefits to gestrinone but with fewer side effects. Oral CHM may have a better overall treatment effect than danazol; it may be more effective in relieving dysmenorrhoea and shrinking adnexal masses when used in conjunction with a CHM enema. However, more rigorous research is required to accurately assess the potential role of CHM in treating endometriosis.
Kuntai Capsule Inhibited Endometriosis via Inducing Apoptosis in a Rat Model
Ruihua Zhong, Aying Ma, Jianping Zhu, Guoting Li, Shuwu Xie, Zhao Li, Youlun Gui, and Yan Zhu
This is the text from an Endometriosis News article
Kuntai capsule, a mixture of six traditional Chinese herbs used in alternative medicine, could inhibit the growth of ectopic tissue in endometriosis. This is according to a study conducted in a rat model of the condition and published in the journal Evidence based complimentary and alternative medicine.
For the study titled ‘Kuntai Capsule Inhibited Endometriosis via Inducing Apoptosis in a Rat Model’, a team of researchers led by Yan Zhu, PhD, of the Department of Reproductive Pharmacology at Fudan University in Shanghai, implanted laboratory rats with endometrial tissues and then treated half of them with Kuntai Capsule for three weeks, leaving the other half untreated as control.
They measured the volume of the endometrial tissue they had implanted. They also analyzed apoptosis, or programmed cell death, on the ectopic endometrium.
The results showed that Kuntai Capsule significantly decreased the volume of ectopic endometrium. Moreover, in rats treated with Kuntai Capsule, the level of estradiol decreased. Estradiol is the primary female sex hormone responsible for the development and maintenance of female reproductive tissues. It also plays a key role in the pathogenesis and development of endometriosis.
On the other hand, researchers noted that the levels of TNF-α increased in rats treated with Kuntai capsule. It is known that TNF-α promotes apoptosis by activating downstream signaling proteins. In fact, the expression of proteins involved in apoptosis were increased in a dose-dependent manner in the ectopic endometrial tissue in rats treated with Kuntai Capsule. Interestingly, the levels of these proteins remained unchanged in the normal endometrium.
The authors concluded that Kuntai Capsule inhibits the growth of ectopic endometrial tissue by inducing apoptosis, and could be a promising traditional Chinese medicine to treat endometriosis. Further studies are needed to confirm its efficacy.
Endometriosis affects around 6% to 10% of women worldwide and up to half of them experience abdominal pain, infertility, or both. Surgery is regarded as the best way to treat the condition, but there are a number of disadvantages associated with surgery, including the possibility of recurrence, complications following surgery and the possible risk of infertility.
Efficacy of Acupuncture in the Management of Primary Dysmenorrhea: A Randomized Controlled Trial
Geetha B Shetty , Balakrishna Shetty , A Mooventhan
J Acupunct Meridian Stud 2018 Aug;11(4):153-158
Abstract
Introduction: Dysmenorrhea constitutes one of the most frequent disorders in women of a fertile age. The present study was conducted to evaluate the efficacy of acupuncture in the management of primary dysmenorrhea.
Materials and methods: Sixty females aged 17-23 years were randomly assigned to either a study group or a control group. The study group received acupuncture for the duration of 20 minutes/day, for 15 days/month, for the period of 90 days. The control group did not receive acupuncture for the same period. Baseline, during, and post assessments of both the groups were taken on day 1; day 30 and day 60; and day 90, respectively. Statistical analysis was performed by repeated measures of analysis of variance followed by post hoc analysis with Bonferroni adjustment for multiple comparisons, independent samples t test for visual analog scale score, and Mann-Whitney U test for rest of the variables using statistical package for the social sciences, version 16.
Results: This study showed a significant reduction in all the variables such as the visual analog scale score for pain, menstrual cramps, headache, dizziness, diarrhea, faint, mood changes, tiredness, nausea, and vomiting in the study group compared with those in the control group.
Conclusion: Acupuncture could be considered as an effective treatment modality for the management of primary dysmenorrhea.
Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes
Abstract
Background:
Endometriosis is a chronic, estrogen-dependent, inflammatory disease, whose pivotal symptoms are dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Besides the usual medical treatments, recent evidence suggests there are potential benefits of oral N-acetylcysteine (NAC) on endometriotic lesions and pain. The primary objective of this prospective single-cohort study was to confirm the effectiveness of NAC in reducing endometriosis-related pain and the size of ovarian endometriomas. The secondary objective was to assess if NAC may play a role in improving fertility and reducing the Ca125 serum levels.
Methods:
Patients aged between 18–45 years old with a clinical/histological diagnosis of endometriosis and no current hormonal treatment or pregnancy were included in the study. All patients received quarterly oral NAC 600 mg, 3 tablets/day for 3 consecutive days of the week for 3 months. At baseline and after 3 months, dysmenorrhea, dyspareunia and CPP were assessed using the Visual Analog Scale score (VAS), while the size of the endometriomas was estimated through a transvaginal ultrasound. Analgesics (NSAIDs) intake, the serum levels of Ca125 and the desire for pregnancy were also investigated. Finally, the pregnancy rate of patients with reproductive desire was evaluated.
Results:
One hundred and twenty patients were recruited. The intensity of dysmenorrhea, dyspareunia and CPP significantly improved (p < 0.0001). The use of NSAIDs (p = 0.001), the size of the endometriomas (p < 0.0001) and the serum levels of Ca125 (p < 0.0001) significantly decreased. Among the 52 patients with reproductive desire, 39 successfully achieved pregnancy within 6 months of starting therapy (p = 0.001).
Conclusions:
Oral NAC improves endometriosis-related pain and the size of endometriomas. Furthermore, it decreases Ca125 serum levels and may improve fertility in patients with endometriosis.
