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Research on Chinese medicine and endometriosis

Last updated: 11 March, 2017
by Steven Clavey, Traditional Chinese Gynaecology

Systematic Review of Chinese Medicine for Ovarian Endometriosis

Chinese medicine has two advantages over Western medicine in treating ovarian endometriosis, which are the low recurrence rate and high pregnancy rate.”

International Journal of Pharmacognosy and Chinese Medicine ISSN: 2576-4772

Volume 1 Issue 3 Received Date: September 01, 2017 Published Date: October 09, 2017

Systematic Review of Chinese Medicine for Ovarian Endometriosis

Eileen Lee, Yongqi Xie, Haiyong Chen and Wei Meng* School of Chinese Medicine, University of Hong Kong, Hong Kong

Volume 1 Issue 3 Received Date: September 01, 2017 Published Date: October 09, 2017

 

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 for a systematic review, 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 amount of literature 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.

Keywords: Ovarian endometriosis; Chocolate cyst; Traditional Chinese medicine; Randomized controlled trial; Systematic review

Chinese Herbs for Endometriosis may have comparable benefits with fewer side effects than conventional drug treatment

“These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis, but at present we don’t have enough evidence to generalize the results …” (also see 2012 update of these results below)

28 September 2009

Chinese herbal medicine (CHM) may relieve symptoms in the treatment of endometriosis, according to a study published today. A systematic review by researchers at the University of Southampton found some evidence that women had comparable benefits following laparoscopic surgery and suffered fewer adverse effects if they were given Chinese herbs compared with conventional drug treatments.

Endometriosis is a gynaecological disorder affecting as many as one in six women of reproductive age. It can cause pelvis pain, irregular and painful periods, and infertility. Surgical treatments do not always lead to long-term improvement in symptoms and drug treatments can have unpleasant side effects such as hot flushes, acne and weight gain.

The researchers conducted the first English language systematic review of CHM for treatment of endometriosis. Two trials, which focused on a total of 158 women, were included in the review. In one trial, CHM provided symptomatic relief comparable to that provided by the hormonal drug gestrinone, but with fewer side effects. In the other trail, CHM was more effective than the hormonal drug danazol, and also resulted in fewer side effects.

“These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis, but at present we don’t have enough evidence to generalize the results,” says lead researcher Andrew Flower of the Complementary Medicine Research Unit at the University of Southampton.

The research was conducted in partnership with the Cochrane Centre of Beijing, China and published today by the Cochrane Library.

2012 update of above: https://www.ncbi.nlm.nih.gov/pubmed/22592712

 

Chinese herbal medicine for endometriosis.

In a 2012 update of the previous research, the authors stated:

Post-surgical administration of Chinese herbal medicine 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.”

Cochrane Database Syst Rev. 2012 May 16;(5):CD006568. doi: 10.1002/14651858.CD006568.pub3.

Author information

Flower A1, Liu JP, Lewith G, Little P, Li Q.

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.

 

 

 

A possible explanation of how Chinese herbs may inhibit endometriosis, examined in rats:

Kuntai Capsule Inhibited Endometriosis via Inducing Apoptosis in a Rat Model

https://www.hindawi.com/journals/ecam/2016/5649169/

Here is an excerpt from the study:

“Early in 1985, researchers had established a classical endometriosis model via surgical transplantation to evaluate the efficacy of antiendometriosis candidates [27, 28]. We had applied this model to confirm the effectiveness of biodegradable microspheres containing nomegestrol acetate on suppressing the growth of endometriotic tissues in previous study [21]. Here, we further utilized this model to investigate whether KTC [an ancient Chinese herbal formula from the Shang Han Lun] could inhibit the proliferation of ectopic autografts. For the first time, we found that 0.24 and 0.6 g/kg of KTC remarkably inhibited the growth of endometriotic tissues in a dose-dependent manner and the average growth inhibitory rates of the endometriotic tissues are up to 51.50% and 71.97%, respectively. Moreover, we also demonstrated that KTC did not suppress the growth of eutopic [i.e. normally placed] endometrium inside the uterine cavity of the rat model. It indicates that KTC specifically targets the endometriotic tissues with minimal side effects on normal endometrium.”

Here is what Endometriosis News, a website for women with endometriosis, had to say about this study (https://endometriosisnews.com/2016/09/19/traditional-chinese-medicine-endometriosis/):

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 Complementary 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.

 

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