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abstract
(blogger's note: 2 sources - see Cochrane plain english version below; not specific to surgical menopause)
BACKGROUND: Chinese herbal
medicine (CHM) usage is expected to increase as women suffering from
menopausal symptoms are seeking alternative therapy due to concerns from
the adverse effects (AEs) associated with hormone therapy (HT).
Scientific evidence for their effectiveness and safety is needed.
OBJECTIVES: To evaluate the effectiveness and safety of CHM in the treatment of menopausal symptoms.
SEARCH METHODS:
We searched the Gynaecology and Fertility Group's Specialised Register
of controlled trials, Cochrane Central Register of Controlled Trials
(CENTRAL; 2015, Issue 3), MEDLINE, Embase, CINAHL, AMED, and PsycINFO
(from inception to March 2015). Others included Current Control Trials,
Citation Indexes, conference abstracts in the ISI Web of Knowledge,
LILACS database, PubMed, OpenSIGLE database, and China National
Knowledge Infrastructure database (CNKI, 1999 to 2015). Other resources
included reference lists of articles as well as direct contact with
authors.
SELECTION CRITERIA:
Randomised controlled trials (RCTs) comparing the effectiveness of CHM
with placebo, HT, pharmaceutical drugs, acupuncture, or another CHM
formula in women over 18 years of age, and suffering from menopausal
symptoms.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed 864 studies for eligibility.
Data extractions were performed by them with disagreements resolved
through group discussion and clarification of data or direct contact
with the study authors. Data analyses were performed in accordance with
Cochrane Collaboration guidelines.
MAIN RESULTS:
We included 22 RCTs (2902 women). Participants were from different
ethnic backgrounds with the majority of Chinese origin. When CHM was
compared with placebo (eight RCTs), there was little or no evidence of a
difference between the groups for the following pooled outcomes: hot
flushes per day (MD 0.00, 95% CI -0.88 to 0.89; 2 trials, 199 women;
moderate quality evidence); hot flushes per day assessed by an overall
hot flush score in which a difference of one point equates to one mild
hot flush per day (MD -0.81 points, 95% CI -2.08 to 0.45; 3 RCTs, 263
women; low quality evidence); and overall vasomotor symptoms per month
measured by the Menopause-Specific Quality of Life questionnaire
(MENQOL, scale 0 to 6) (MD -0.42 points; 95% CI -1.52 to 0.68; 3 RCTs,
256 women; low quality evidence).In addition, results from individual
studies suggested there was no evidence of a difference between the
groups for daily hot flushes assessed by severity (MD -0.70 points, 95%
CI -1.00, -0.40; 1 RCT, 108 women; moderate quality evidence); or
overall monthly hot flushes scores (MD -2.80 points, 95% CI -8.93 to
3.33; 1 RCT, 84 women; very low quality evidence); or overall daily
night sweats scores (MD 0.07 points, 95% CI -0.19 to 0.33, 1 RCT, 64
women; low quality evidence); or overall monthly night sweats scores (MD
1.30 points, 95% CI -1.76 to 4.36, 1 RCT, 84 women; very low quality
evidence). However one study using the Kupperman Index reported that
overall monthly vasomotor symptom scores were lower in the CHM group (MD
-4.79 points, 95% CI -5.52 to -4.06; 1 RCT, 69 women; low quality
evidence).When CHM was compared with hormone therapy (HT) (10 RCTs),
only two RCTs reported monthly vasomotor symptoms using MENQOL. It was
uncertain whether CHM reduces vasomotor symptoms (MD 0.47 points, 95% CI
-0.50 to 1.44; 2 RCTs, 127 women; very low quality evidence).Adverse
effects were not fully reported in the included studies. Adverse events
reported by women taking CHM included mild diarrhoea, breast tenderness,
gastric discomfort and an unpleasant taste. Effects were inconclusive
because of imprecise estimates of effects: CHM versus placebo (RR 1.51;
95% CI 0.69 to 3.33; 7 trials, 705 women; I² = 40%); CHM versus HT (RR
0.96; 95% CI 0.66 to 1.39; 2 RCTs, 864 women; I² = 0%); and CHM versus
specific conventional medications (such as Fluoxetine and Estazolam) (RR
0.20; 95% CI 0.03 to 1.17; 2 RCTs, 139 women; I² = 61%).
AUTHORS' CONCLUSIONS:
We found insufficient evidence that Chinese herbal medicines were any
more or less effective than placebo or HT for the relief of vasomotor
symptoms. Effects on safety were inconclusive. The quality of the
evidence ranged from very low to moderate; there is a need for
well-designed randomised controlled studies.
Plain language summary
Title: Chinese herbal medicines for menopausal symptoms
Background: Menopause usually takes place when a woman is around 51 years of age. Women can experience symptoms such as hot flushes, sweats, poor sleep, joint pains, anxiousness, dry skin and vagina when the organs which produce female hormones slow down. Usually hormone therapy (HT) is prescribed to reduce the symptoms.
Due to concerns on long term use of HT resulting in adverse effects, women have been looking for alternative treatments to relieve their symptoms. Chinese herbal medicines (CHM) is one of the popular choices. Although CHM has been used for a very long time clinically, its effectiveness and long-term safety remained unanswered from a scientific perspective.
Study characteristics: This review examined 22 randomised clinical trials where 2902 women took part in the studies; 1499 in the CHM group and 1403 in the control group which might include a placebo (non-active compound made to look, taste and smell the same as the study compound) or a drug or HT or another CHM formula (different from the one being tested). Most of the studies had a trial period for 12 weeks. The data are current to March 2015.
Key results: We found insufficient evidence that CHM were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Adverse effects were not well reported, some women taking CHM reported mild diarrhoea, breast tenderness, gastric discomfort and an unpleasant taste. Effects on safety were inconclusive.
Quality of the evidence: The quality of the evidence ranged from very low to moderate. The studies did not produce good quality evidence to allow the authors to draw a conclusive statement regarding the effectiveness or safety of CHM.
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