Do Herbal Products Affect Quality of Life Issues for Women?

Commonly used herbs for women’s health

Adriane Fugh-Berman, M.D. George Washington University School of Medicine,

Department of Medicine and Department of Health Care Sciences,

Washington, D.C.

Black cohosh (Cimicifuga racemosa) and red clover (Trifolium pratense) extracts are commonly used to treat menopausal symptoms. There is some evidence of efficacy for black cohosh, but a recent placebo-controlled trial in women with breast cancer found no effect on hot flashes (Jacobsen). It is unclear whether or not black cohosh stimulates breast or endometrial tissue. Two trials of red clover extract found no effect on hot flashes; there is a theoretical concern that black cohosh may increase bleeding risk (Fugh-Berman 2001).

Various dietary supplements are used to treat PMS. A recent placebo-controlled study of Vitex (V.agnus-castus) found it effective for treating PMS symptoms (Schellenberg).

Herbs are also popular for improving memory or treating depression. Ginkgo (Ginkgo biloba) has been tested for dementia. Most studies have used EGb761, a German standardized leaf extract. A recent meta-analysis of randomized, double-blind, placebo-controlled trials of ginkgo for dementia identified 4 studies, including 424 patients, that met inclusion criteria (Oken). Overall, there was a significant effect (P<.0001) that translated into a 3% difference in the Alzheimer’s Disease Assessment Scale-Cognition. A systematic review of nine randomized, double-blind, and placebo-controlled studies also concluded that ginkgo is more effective for dementia than placebo (Ernst). Ginkgo can cause bleeding, especially in combination with anticoagulants (Fugh-Berman).

St. John’s wort (Hypericum perforatum) has been widely tested for depression. A meta-analysis of 23 controlled trials (20 double-blind) with a total of 1757 patients found that SJW was superior to placebo in 15 placebo-controlled trials (OR 2.67, CI 1.78-4.01) and as effective as standard antidepressants in 8 trials (Linde). More recent trials include a randomized, double-blind, placebo-controlled, multicenter clinical trial of 200 adult outpatients with major depression treated with placebo or a standardized extract of SJW 300 mg t.i.d. ´ 8 weeks; after 4 weeks, if no effect was seen, the dose was increased to four tablets daily (1200 mg) (Shelton). There were no significant differences between groups in most measures. Two recent randomized, double-blind placebo-controlled trials comparing SJW to fluoxetine found the treatments equivalent (Schrader, Harrar). SJW can cause photosensitivity or headaches, and can lower levels of many drugs, including cyclosporine, digoxin, indinavir, and tricyclic antidepressants. Additionally, SJW can increase serotonergic effects in patients taking serotonin reuptake inhibitors (Fugh-Berman 2000).

References:

Ernst E, Pittler MH. Ginkgo biloba for dementia: a systematic review of double-blind, placebo-controlled trials. Clin Drug Invest 1999;17(4):301-308.

Fugh-Berman A, Kronenberg F. Red clover (Trifolium pratense) for menopausal women: current state of knowledge. Menopause 2001;8(5):333-337.

Fugh-Berman A. Herb-drug interactions. Lancet 2000;355:134-138.

Harrer G, Schmidt U, Kuhn U, Biller A. Comparison of equivalence between the St. John’s wort extract LoHyp-57 and fluoxetine. Arzneim-Forsch/Drug Res 1999;49(I);4:289-296.

Jacobson JS, Troxel AB, Evans J, et. al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001; 19: 2739-2745.

Linde K, Ramirez G, Mulrow CD et al. St. John’s wort for depression – an overview and meta-analysis of randomized clinical trials. BMJ 1996;313:253-258.

Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol 1998; 55(11):1409-15.

Schellenberg R for the study group. Treatment for the premenstrual syndrome with agnus castus fruit extract: Prospective, randomised, placebo-controlled study. BMJ 2001;322:134-137.

Schrader E. Equivalence of St John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression .Int Clin Psychopharmacol. 2000;15(2):61-8.

Shelton RC, Keller MB, Gelenberg A et al. Effectiveness of St. John's wort in major depression. JAMA 2001; 285: 1978-1986.