herbal medicines and women's health
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Herbal Medicines and Women's Health. British Pharmaceutical Conference 2005 Elizabeth M Williamson. Scope of talk. General overview of the most important herbs used by women (excluding those covered earlier in more detail), where available for self-medication or to purchase OTC - PowerPoint PPT PresentationTRANSCRIPT
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Herbal Medicines and Women's Health
British Pharmaceutical Conference 2005
Elizabeth M Williamson
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Scope of talk
General overview of the most important herbs used by women (excluding those covered earlier in more detail), where available for self-medication or to purchase OTC
Assessment of evidence available Any problems reported or anticipated when
taken with conventional drugs
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Issues of particular importance to women – and not always for health reasons!
Hormonal: premenstrual syndrome (PMS), dysmenorrhoea, menorrhagia
Menopausal symptoms, including osteoporosis Child-birth, pregnancy and lactation Life-style: stress, memory loss (which may be
linked with hormonal changes) Appearance: weight-loss, cosmetic issues (again
linked to causes above)
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Herbs used in hormonal conditions
PMS: evening primrose oil, St John’s wort, agnus castus
Dysmenorrhoea: dong quai, raspberry leaf, cramp bark
Menorrhagia (refer to GP or specialist): agnus castus, horsetail etc. Check iron levels.
Menopause: phytoestrogens, black cohosh, agnus castus, dong quai, St John’s wort (for depression), sage (for flushing and sweating)
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Herbs and products: for PMS, menorrhagia and menopause
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Herbs used during pregnancy and lactation
Pregnancy; for morning sickness: ginger* Late pregnancy; to prepare for child-birth:
raspberry leaf*Lactation; to enhance: shatavari (wild
asparagus*), agnus castus, fennel, fenugreek
Lactation; to suppress: sage, peppermint*will be further discussed
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Herbs and products:pregnancy and lactation
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Herbs used to treat varicose veins
To increase venous tone and strengthen blood vessels: horse-chestnut*, butcher’s broom*
To promote blood flow: red vine leaf*, bilberry, ginkgo, yarrow and hawthorn
To soothe itching: topically applied calendula, witch hazel etc
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Herbs and products: varicose veins
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Herbs used to slow memory loss!
General memory and cognition enhancement: sage*, lemon balm*, ginkgo*
Shown to help in post-menopausal memory problems: soya*, ginseng*, ginkgo*
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Herbs and products: memory and cognition
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Life-style issues: weight loss
Boldo: traditionally used – no mechanism of action postulated
Kelp: to ‘speed up’ metabolism and provide nutrients (e.g. iodine)
Ephedra*: for appetite suppression and to speed up metabolism
‘Detox’ mixtures
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Herbs and products: ‘helping’ with weight loss
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Herbs ‘suitable’ for self-medication?
Women usually look after the health needs of the family
Many herbal products are purchased OTC, as opposed to consulting a general practitioner, pharmacist or medical herbalist
Pharmacist ideally placed to advise… …..if they know about herbal medicines! NB: medical herbalists use many more on an
individual basis
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A closer look at some of these
Some work!Some don’t!….and some are dangerous….
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Pregnancy: ginger (Zingiber officinalis) for morning sickness?
Contains: gingerols and shogaols (phenolics) Evidence for efficacy? Yes, but limited. Safe? Current thinking is that up to 5 days can
be recommended, and doses limited (1-2g daily, in divided doses)
Concerns about possible mutagenicity, but no clinical evidence in support
Some authorities suggest only up to normal food levels (approx 1g daily)
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Childbirth – is Raspberry leaf (Rubus idaeus) useful?
Contains: flavonoids, unknown actives Raspberry leaf widely available Evidence for efficacy? Very limited – conflicting
reports from 2 Australian studies But how do you measure it?! Pharmacological studies show weak uterotonic
effect Safety???
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Herbs used in lactation
No clinical evidence for any, but traditional usage by herbalists widespread for all
For shatavari (Asparagus racemosus) some pharmacological studies in rats and er… buffaloes - showed increase in milk flow
Remember constituents may pass into breast milk
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Varicose veins and ‘heavy legs’: saponin-containing herbs
Horse Chestnut (Aesculus hippocastanum) and Butcher’s Broom (Ruscus aculeatus), both used internally and externally
Evidence: good! (Internal use in pregnancy not recommended due to absence of research, but a small study of horse-chestnut reported no adverse events after 2 weeks)
Safety: no clinical reports of toxicity
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Varicose veins: flavonoid and anthocyanin-containing herbs
Red Vine (Vitis vinifera)– leaf extract, both internally and externally. Contains flavonoids and anthocyanins. Evidence: reasonable –several clinical studies to support
Bilberry, hawthorn, ginkgo: little evidence in varicose veins, but some rationale for use
Safety: no reports as yet of interactions Internal use in pregnancy not recommended due to
absence of research
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Memory enhancement
Evidence available for ginkgo (Ginkgo biloba), soya (Glycine max), ginseng (Panax ginseng) in menopausal women – but the extent of their usefulness is not yet established
May be related to various types of activity – e.g. oestrogenicity, increase in cerebral blood flow, stimulant effects etc
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Weight loss
No clinical evidence for any, except ephedra, (Ephedra sinica, Ma Huang)
Contains ephedrine, a sympathomimetic (amphetamine-like) biogenic amine
Banned in the US Responsible for some deaths Detox mixtures usually diuretic herbs with extra
nutrients or minerals
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Relevant herb-drug interactions 1
Agnus castus: theoretical possibility of interacting with dopaminergic receptors
Bilberry – none reported, none expected Boldo: report (unproven) of interaction with warfarin Butcher’s Broom: none reported Dong quai: 1 case with warfarin (reduced prothrombin
time) Evening Primrose oil: inhibits CYP3A4, 1A2, 2C9, 2D6
and 2C19 in vitro – however, similar fatty acids are common in many foods
Ginger: inhibits CYP3A4, 1A2, 2C9 and 2D9 in vitro – but no clinical reports
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Relevant herb-drug interactions 2
Ginseng: conflicting reports on CYP enzymes; weak inhibition of P-glycoprotein; avoid with MAOIs, warfarin, nifedipine and cancer chemotherapy
Horse chestnut: none reported Raspberry leaf: none reported Red Vine: none reported St John’s wort: oral contraceptives, Sage: none reported Soya: conflicting reports, but avoid with oestrogens and
anti-oestrogens for obvious reasons
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Conclusions
Women are very likely to take herbal medicines Only a few are well researched (see previous
presentations) Some are effective, some not Most appear to be safe The interaction profile of most is favourable –
although St John’s wort has the usual caveats Unfortunately slimming herbs don’t work!
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Reference sources
Principles and practice of Phytotherapy. Mills S and Bone K, Churchill Livingstone, UK, 2000
Potter's Cyclopedia of Herbal Medicines, E M Williamson, C W Daniels, UK. 2003
Interactions between Herbal and Conventional Medicines. E M Williamson (2005) Expert Opinion in Drug Safety 4 (2) 355-378
Major Herbs of Ayurveda. Dabur Research Foundation. Ed: E M Williamson; Elsevier 2002
Herbal Medicines 2nd Edition. Barnes, Anderson and Phillipson. Pharmaceutical Press 2002
Natural Standard Herb and Supplement Reference.Evidence-Based Clinical Reviews. Mosby 2005