Studies Show Chinese Herbs as Effective or Better than Drugs for Endometriosis with Fewer Side Effects

Endometriosis is a condition where endometrial tissue, which normally lines a woman's uterus, is found outside of the uterus. This tissue can grow and shed during a menstrual cycle and cause pain, heavy menstrual bleeding, and infertility. "Medical treatment of endometriosis ranges from symptomatic management with nonsteroidal anti-inflammatory drugs and analgesics to hormonal manipulations that include continual oral contraceptives, progestins, danazol, and gonadotrophin-releasing hormone agonists. However [according to the below study], the benefits are short lived, and symptoms often return to pretreatment levels within six months. Under the best of circumstances, more than a third of patients have symptom recurrence within two or three years after stopping therapy."

Symptoms of endometriosis have been treated with Chinese medicine for hundreds of years. Treatment involving herbal medicine, acupuncture, and dietary therapy have afforded women reduced pain, lighter periods, and restored fertility. While more severe cases of endometriosis may require surgery, Chinese medicine may offer an effective treatment for many women.

Gerry Harringon, Harmony TCM Weblog

Chinese Herbs Show Promise for Endometriosis

By Charles Bankhead, Staff Writer, MedPage Today
Published: July 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

HOUSTON, July 8 -- Chinese herbal medicine provided relief to symptoms of endometriosis that was equivalent or superior to conventional therapies following laparoscopic surgery, a systematic review indicated.

Action Points

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• Explain to patients that Chinese herbal medicine appeared to relieve postsurgical endometriosis symptoms at least as well as conventional medical therapy.



• The findings were based on a retrospective review of a large database and involved a small number of patients.

Herbal medicine achieved symptom relief comparable to that of gestrinone but with fewer side effects, Andrew Flower, PhD, of Southampton University in Ringmer, England, and colleagues reported in the Cochrane Database of Systematic Reviews. The pregnancy rate was similar with either treatment.

Compared with danazol, Chinese herbal medicine led to better postsurgical symptom control with 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," Dr. Flower said in a statement.

The authors noted that more rigorous research is needed to assess the potential role of Chinese herbal medicine in treating endometriosis. Investigators initially identified 110 studies for their review. However, all but two had to be excluded because of methodologic flaws.

Medical treatment of endometriosis ranges from symptomatic management with nonsteroidal anti-inflammatory drugs and analgesics to hormonal manipulations that include continual oral contraceptives, progestins, danazol, and gonadotrophin-releasing hormone agonists.

Hormonal therapies provide comparable symptom relief and reduction of endometriosis-related lesions, the authors said.

However, the benefits are short lived, and symptoms often return to pretreatment levels within six months. Under the best of circumstances, more than a third of patients have symptom recurrence within two or three years after stopping therapy, the authors noted.

Additionally, the benefits of conventional therapy have to be balanced against potentially serious adverse effects, the authors continued.

Surgery also carries a risk of serious adverse events, such as bowel perforation and peritonitis, and offers no assurance of long-term symptom relief.

"In summary, current treatments all have high rates of recurrence and their short-term benefits have to be balanced with concerns over immediate and longer-term side effects," they said.

Chinese herbal medicine has a clinical history that dates back to ancient times. Among the medical applications is treatment of symptoms associated with endometriosis.

The origin of Chinese herbs' activity in endometriosis is unclear. Suggested mechanisms have included regulation of endocrine and immune systems, improved circulation, and anti-inflammatory activity.

But no English-language systematic review had been conducted to determine whether Chinese herbal medicine has a role in the treatment of endometriosis.

To address that void, Dr. Flower and colleagues searched multiple databases for randomized controlled trials of Chinese herbal medicine versus placebo, conventional medical therapy, another Chinese herb, or as an add-on to conventional therapy.

Of 110 studies originally considered, only two met the authors' inclusion criteria. All 110 studies were conducted in China and were reported in Chinese.

The two studies involved a total of 158 women whose mean age was 30. Diagnostic criteria included laparoscopic diagnosis, American Fertility Society staging, and vaginal or rectal B-ultrasound.

Additionally, all of the patients had been diagnosed according to traditional Chinese medicine as having stagnation of Qi (vital energy) and blood with an underlying kidney deficiency.

All patients had laparoscopic surgery as primary therapy.

One study compared a Chinese herbal medicine enema and gestrinone. In the second trial, patients were randomized to Chinese herbal medicine pills alone, herbal pills plus an herbal enema, or danazol.

Gestrinone led to a symptomatic relief rate of 93.87% compared with 95.6% for the Chinese herbal medicine enema.

During 24 months of follow-up, 69.6% of women assigned to the enema became pregnant, as did 59.1% of patients treated with gestrinone. Neither difference achieved statistical significance.

No adverse events occurred in patients treated with the Chinese herbal medicine enema. In contrast, 13 of 49 patients treated with gestrinone developed acne, while19 had elevated liver enzymes, and 31 had oligomenorrhea.

In the second trial, oral Chinese herbal medicine alone or in combination with an herbal enema led to significantly greater symptom relief compared with danazol (RR 5.06, 95% CI 1.28 to 20.05 and RR 5.63, 95% CI 1.47 to21.54, respectively).

Additionally, the combined Chinese herbal medicine reduced dysmenorrheal pain significantly more than danazol and resulted in a significantly higher rate of disappearance or shrinkage of adnexal masses (MD -2.90, 95% CI -4.55 to -1.25, RR 1.70, 95% CI 1.04 to 2.78, respectively).

Four of 16 patients randomized to Chinese herbal pills alone had dry mouth, and one patient developed acne. Among 24 patients randomized to herbal pills and an herbal enema, two had dry mouth, while 11 developed rectal tenesmus during the first two weeks of treatment, and one patient had weight gain of 3 kg.

Of 18 patients treated with danazol, 13 developed acne, while three had weight gain of 3 kg, two gained 2 kg, one gained 1.5 kg, two had elevated liver enzymes, and four had oligomenorrhea.

The authors reported no relevant financial disclosures.

Primary source: Cochrane Database of Systematic Reviews
Source reference:
Flower A et al. "Chinese herbal medicine for endometriosis" Cochrane Database Syst Rev 2009; DOI: 10.1002/14651858.CD006568.pub2.