Chinese Herbal Medicine and Endometriosis

Chinese herbal medicine may have the same benefits as conventional medicines for women with endometriosis, but with fewer side effects, according to a large review of the research. But better quality studies are needed to be sure.

What do we know already?
Endometriosis is a painful condition affecting some women. Cells from the womb lining (the endometrium) travel to other parts of the body, such as the bowel and the ovaries, and grow into patches of tissue. Every month they grow, then break down, in the same way that the cells lining the womb grow and break down, during a woman’s menstrual cycle. This can be painful and may make it hard for a woman to get pregnant.

Treatments include surgery to remove these patches of endometriosis cells, and hormonal treatments to reduce the growth of the patches, or to stop them coming back after surgery. But endometriosis often comes back after surgery, or after hormone treatment is stopped. Also, some hormone treatments can have unpleasant side effects, including acne and symptoms of the menopause.

Practitioners of traditional Chinese medicine have treated endometriosis using a combination of herbs for many years. But there has been little good-quality research to assess how well these herbal treatments work. A new study by an international team of researchers looked at all the studies that have been published about endometriosis and Chinese herbal medicine, to see what conclusions they could draw.

What does the new study say?
The researchers found more than 100 studies, but say only 2 of them were suitable to assess in their review. The others weren’t reliable.

The two studies had promising results, although they don’t give us enough information. In one study, women who’d had an operation to remove endometriosis patches were given either a hormonal treatment (gestrinone) for 3 months, or Chinese herbal medicine for 3 months, after surgery. Afterwards, more than 9 in 10 women in both groups said they no longer had symptoms of endometriosis, such as pain and tiredness.

In the second study, researchers compared Chinese herbal medicine with another hormonal treatment (danazol). Again, both groups took the treatment for 3 months, but neither group had surgery to remove endometriosis patches first. More than half of the women who took Chinese herbal medicine said they no longer had symptoms of endometriosis after treatment, compared with about 1 in 10 women who took danazol.

Tell me more about the study’s findings
The women in the first study took the herbal medicine both by mouth and in the form of a daily enema (when the rectum (back passage) is washed out). In the second study, half the women taking Chinese herbs took them just by mouth, while the other half took daily enemas as well. The ones having daily enemas as well were more likely to report being free of symptoms.

In the second study, although more women said that overall, their symptoms had gone completely if they’d taken Chinese herbs, other measures didn’t show a clear difference. For example, if you just look at how bad women’s pain was during their periods, on average, there was no difference between the group taking Chinese herbs and the group taking hormone treatments (danazol).

The women taking hormonal treatments said they had more side effects than the women taking Chinese herbs. Acne, weight gain, and irregular periods were the most common side effects.

In both studies, the women’s symptoms were assessed after the 3 month treatment period, so we don’t know whether the improvements would last after the women stopped taking the treatments.

How reliable are the findings?
The review found only 2 studies suitable to be assessed in a scientific way, and they had questions about how reliable these two studies were. So we can’t rely on the findings.

Where does the study come from?
The review of the studies was done by a group of researchers from Southampton University in the UK and Beijing University of Chinese Medicine in China. The original studies were all carried out in China.

What does this mean for me?
It’s always difficult to say how relevant studies are for people in the UK, when they’ve been done in very different countries, with different medical systems. In this case, the original studies were all done in the Chinese healthcare system, with doctors who are used to working in the Chinese medical tradition. Also, the women taking part were all used to being treated with herbal medicine, so perhaps might be more willing to consider treatments like daily herbal enemas, than women used to the Western medical tradition. Even the way that the researchers recorded the results of the treatment differ from the methods that Western doctors use.

Because of this, we can’t really say whether women in the UK are likely to get the same benefits from treatment with Chinese herbs.

What should I do now?
It’s important to bear in mind that herbal medicines can have side effects or can react with other medicines you are taking. Herbal medicines are not regulated in the same way as conventional medicines, and their quality can vary. If you’re considering herbal medicine for endometriosis, talk to your doctor.

Flower A, Liu JP, Chen S, et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews. 2009; Issue 3.

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