The Use of Herbs and Dietary Supplements in Gynecology: An Evidence-Based Review

Abstract and Introduction

Consumers frequently use herbs and dietary supplements to treat chronic conditions that are poorly responsive to prescription drugs or when prescription drugs carry a high side effect burden. Women may use herbs and supplements for chronic gynecologic conditions, such as menopause, premenstrual syndrome, dysmenorrhea, cyclic mastalgia, and infertility. This review is an evidence-based evaluation of herbs and supplements for these conditions. Therapies that carry a higher level of support from randomized controlled trial evidence include black cohosh for menopause; vitamins B₁ and E for dysmenorrhea; calcium, vitamin B₆, and chasteberry for premenstrual syndrome; and chasteberry for cyclic mastalgia. There were too few trials involving herbs and supplements in infertility to warrant a solid recommendation, but chasteberry, antioxidants, and Fertility Blend have some preliminary support. Midwives may want to consider these alternatives in addition to more traditional treatment options when meeting with patients.

Sales of dietary supplements in the United States rose from $15.7 billion in 2000 to $18.7 billion in 2002.^[1] According to a recent telephone survey of 8470 Americans, the use of herbs and other natural products, excluding vitamins and minerals, increased from 14.2% in 1998 to 1999 to 18.8% in 2002.^[2] Product users were more likely to be women, of white ethnicity, who have high levels of education and income.^[2] In general, herbs and supplements appeal to Americans because they are perceived as being natural with fewer side effects than prescription and over-the-counter medicines.^[1] Consumers believe that these products may help them to live longer and will generally improve overall health and well-being.^[1] These supplements are frequently used to treat chronic medical illnesses in which therapeutic options are limited, costly, or carry a high side effect profile.^[1] Women experiencing symptoms of menopause, premenstrual syndrome, dysmenorrhea, mastalgia, and infertility may seek alternative therapies and medical providers who are open to using them.

Certified nurse-midwives and certified midwives (CNMs/CMs) are likely to assist women in the management of gynecologic conditions that extend beyond pregnancy. The use of herbs in pregnancy is common among nurse-midwives. In a national survey, 52% of respondents used herbs for cervical ripening and induction or augmentation of labor.^[3] It is likely that herbs and supplements may also be employed in the management of gynecologic conditions.

Dietary supplements are currently governed by the Food and Drug Administration under the Dietary Supplement Health and Education Act. The act defines a supplement as "a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following: a vitamin, mineral, herb or other botanical, amino acid, a dietary substance used by man to supplement the diet by increasing the total dietary intake or a concentrate, metabolite, constituent, extract or combination of any of the ingredients described above."^[1] Dietary supplements are regulated as foods and can be marketed to consumers without providing support for claims of efficacy and safety. The Food and Drug Administration has limited authority over these supplements and can only remove a product from the market if it can show proof of posing "an unreasonable risk of injury or illness" to consumers through postmarketing surveillance.^[1] Health care providers who use dietary supplements in their practice should be aware of these limitations.

Some herbs may be discussed below with reference to the recommendations of the German Commission E.^[4] The Commission is a group of German researchers, who in conjunction with members of industry, compiled recommendations regarding the safety and efficacy of more than 300 herbal products. Herbs were "approved" for certain indications if they showed reasonable proof of efficacy and safety. However, "approval" for a certain indication does not necessarily imply evidence from randomized controlled trials (RCTs).

This article takes an evidence-based approach in reviewing the use of herbs and dietary supplements for management of symptoms associated with menopause, dysmenorrhea, PMS, mastalgia, and infertility.

J Midwifery Womens Health. 2006;51(6):402-409. © 2006 Elsevier Science, Inc.

Cite this: The Use of Herbs and Dietary Supplements in Gynecology: An Evidence-Based Review - Medscape - Nov 01, 2006.