Herbal therapeutics (9) Women's health
Many women who experience conditions such as premenstrual syndrome (PMS) or urinary tract infections (UTIs) are interested in trying herbal products and there are numerous such remedies available. In terms of clinical investigation, there has been particular focus on the effects of agnus castus (Vitex agnus-castus L.) for PMS and mastalgia, black cohosh (Cimicifuga racemosa Nutt.) for menopausal symptoms, and cranberry (Vaccinium macrocarpon Ait) for the treatment and prevention of UTIs. These herbs have all been used traditionally in these conditions.
The use of evening primrose (Oenothera biennis L.) oil for the treatment of mastalgia has arisen in a modern context. Several other herbs, such as bilberry (Vaccinium myrtillus L.), St John’s wort (Hypericum perforatum L.) and ginkgo (Ginkgo biloba L.), which have not been used traditionally for specific women’s ailments, have nevertheless undergone preliminary scientific investigation in dysmenorrhoea (bilberry) and PMS (St John’s wort, ginkgo) but require further study.1 The uses of St John’s wort in depression and ginkgo in cognitive disorders were considered in previous articles (PJ, 29 June 2002, pp908–10 and 3 August 2002, pp160–2, respectively). Red clover (Trifolium pratense L.) flowers contain the isoflavones daidzein, genistein and others, which are also found in soya bean. Soya isoflavones have been investigated for their effects in relieving menopausal symptoms although at present evidence is inconclusive (PJ, 6 Jan 2001, pp16–9).
It is beyond the scope of this article to consider the aetiology, classification, diagnosis and treatment of the conditions mentioned above, and pharmacists are advised to consult standard reference texts for this information. Pharmacists are encouraged to probe discreetly, where possible, individual’s reasons for purchasing herbal products used for women’s health complaints, and to apply usual protocols to establish why herbal treatment is considered necessary (eg, as a preventive measure or in response to symptoms), treatments already tried or being used, other action taken, lifestyle factors and so on.
For women presenting with dysmenorrhoea, secondary dysmenorrhoea (pain secondary to serious conditions, such as endometriosis) should be excluded. For some individuals, including those whose symptoms persist or worsen despite treatment and who are not already under medical supervision, referral to a general practitioner may be necessary.
The parts of plants used pharmaceutically in women’s conditions include:
- Fruit (berries) of agnus castus, bilberry and cranberry
- Rhizome and root of black cohosh
- Seed oil of evening primrose
- Leaf of ginkgo
- Herb (aerial parts) of St John’s wort
Monographs for dried and fresh bilberry fruit, ginkgo leaf and St John’s wort herb are included in the European Pharmacopoeia. Cranberry and bilberry are widely used in foods. St John’s wort is a natural source of food flavouring, and evening primrose oil has long been used as a source of essential fatty acids in food supplements. Agnus castus, black cohosh and ginkgo are not used in foods.1 Black cohosh should not be confused with blue cohosh (Caulophyllum thallictroides), an entirely different plant used for different purposes.
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Citation: The Pharmaceutical Journal URI: 10982051
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