Gynecologic Indications for Herbal Remedies

Abstract

Herbal remedies are used in the treatment of menstrual irregularities, premenstrual syndrome (PMS), dysmenorrhea, and menopausal complaints in cases where stronger-acting drugs are not indicated or are declined by the patient. Two medicinal plants stand out in the frequency with which they are prescribed for gynecologic complaints: chasteberries (used chiefly for PMS) and black cohosh rhizome (used principally for menopausal complaints) (Schwabe and Rabe, 1998). Table 7.1 also lists four other herbs recommended by the German Commission E as having gynecologic indications. It can be seen that the range of recommended dosages (column 3 in Table 7.1) is greater for gynecologic herbal remedies than for any other class of phytomedicenes. Some of the dosages are many times lower than the traditional single dose of about 1-4 g of crude drug (i.e., dried herbal material) taken in a cup of medicinal tea. There is an urgent need for pharmacologic and clinical studies to investigate the dose-dependency of the actions and efficacy of these herbal drugs. Historically, most herbal remedies for gynecologic problems were classified as em-menagogues. Hippocrates mentioned a number of herbs that were reputed to induce menstruation or increase menstrual flow. It was recognized in ancient times that regu-lar menstruation was important in the preservation of health, and conversely a variety of ailments were attributed to the absence or irregularity of menstrual bleeding. Classic emmenagogic herbs included locally irritating essential oils and a number of cathar-tics. With the estrogens and progestins available today, there is no longer a need to use plant drugs for this indication, and indeed the risks of many herbal drugs (abortion in undetected pregnancy) would contraindicate their use. Herbal remedies continue to be of benefit in PMS, a symptom complex that com-monly appears several days before the onset of menstrual bleeding. Many women expe-rience an array of physical and behavioral symptoms that usually subside with the start of menstruation. The physical symptoms are mostly congestive in nature and consist of painful breast swelling and tension (mastodynia); abdominal discomfort with fullness, bloating, and constipation; and edema that typically involves the ankles, the area around the eyes, and the hands. Behavioral symptoms are also a common feature of PMS.