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Summary
Gynecological Herbs
introduction:
Traditionally, a large number of different herbs have been used to affect different aspects of the activity of the female reproductive tract. Historically, there is a legacy of confusion and little agreement even among contemporary authorities about the precise meaning of different designations and classifications of herbs used in gynecology. For a review of author discrepancies see The Phytoestrogen Debate by Peggy Wilbur, and for a historical review of herbs used in gynecological conditions see A Comparative Review of Eclectic Female Regulators by Francis Brinker. Endocrine-like activities of herbs used for gynecological purposes do not necessarily correspond with traditional terminology which is therefore reviewed briefly below. Better general surveys of herbs used gynecologically in modern herbal therapeutics may be found in books by herbalists Amanda McQuade-Crawford and Ruth Trickey.
From the perspective of drug-herb interactions, herbs with identifiable hormone-like activities on the hypothalamic-pituitary-gonadal axis (HPA) are considered in Interactions™, although detailed studies and reports of interactions between pharmaceutical drugs and these agents are not available.
(Brinker F. Brit J Phytotherapy 1997;4,3:123-145; McQuade-Crawford A. 1997; Trickey R. 1998; Wilbur P. Eur J Herbal Med 1996 2.2:20-26, and 1996 2.3:19-26.)
Food/herb group affecting drug performance: Oral Contraceptives
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Mechanism: Phytoestrogenic constituents of foods and medicinal herbs may interact with steroid sex hormone metabolism, and synergize with exogenous steroid hormones in ERT (Estrogen Replacement Therapy), HRT (Hormone Replacement Therapy).
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Herbal concerns: Despite lack of scientific evidence of adverse interactions, prudence suggests that herbs possessing direct endocrinological effects on the female reproductive tract should be avoided during treatment with ERT (Estrogen Replacement Therapy), HRT (Hormone Replacement Therapy), or GnRH (Gonadotrophic Releasing Hormone) inhibitors.
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Herbal support: Cimicifuga racemosa (Black Cohosh) has been used to support withdrawal from HRT and ERT and to adjunctively treat symptoms of menopause.
Herbs affecting Hypothalamic-Pituitary Axis (HPA):
• phytoestrogens: Phytoestrogens may be defined as plant constituents possessing the ability to mimic the biological effects of beta-estradiol in laboratory tests by their ability to bind to the nuclear estrogen receptor, activate transcriptional response and to promote growth of estrogen dependent MCF7 cells in culture. Phytoestrogenic activity is found among the following five naturally occurring chemical compound groupings which are widely distributed among medicinal and food plants:
• Isoflavonoids (e.g., formononetin, daidzein, genistein, coumestrol, biochanin A)
• Sterols (e.g., beta-sitosterol, stigmasterol)
• Saponins (e.g., diosgenin),
• Lignans (e.g., enterolactone),
• Essential oils (Clary sage, Fennel)
Isoflavonoid phytoestrogenic constituents are nutritionally available in plants from the Fabaceae (bean) family, particularly Glycine max (Soybean). Among medicinal plants, the most important phytoestrogenic plant in common therapeutic use is Cimicifuga racemosa (Black Cohosh).
Comprehensive lists of plants containing phytoestrogenic constituents can be found in various sources such as James Duke's Handbook of Phytochemical Constituents of GRAS Herbs and Other Economical Plants or the related database of the Agricultural Research Service - Phytochemical and Ethnobotanical Databases (
http://www.ars-grin.gov/duke/) and the NAPRALERT database.
(Duke JA.1994; Miksicek R. Mol Pharmacol, 44(1):37-43, 1993.)
In clinical practice, it has long been known that phytoestrogenic medicinal herbs often have both estrogenic and anti-estrogenic actions. This variability in action remains to be elucidated in terms of potency of phytoestrogenic constituents, balance of agonistic and antagonistic tendencies and compounds, short and long term effects, as well as the problem of different methodological approaches used to identify estrogenicity. The functional endocrinological status of the consumer/patient adds to this complexity, although this is well understood by clinicians experienced in the use of these agents. For example, Cimicifuga racemosa (Black Cohosh) may be used to help correct estrogen dominance in pre-menopausal women yet supports estrogenic activity in post-menopausal women.
Herbalist David Hoffmann has recently reviewed developments in phytoestrogen research and considers that the FDA's National Center for Toxicological Research has identified the importance and need for further research in clarifying the roles of bioavailable estrogenic substances in three respects: estrogen agonism, estrogen antagonism, and endocrine disruption (particularly disruption of the development of secondary sexual characteristics and the reduction of sperm counts). The toxicology approach emphasizes the role of xenoestrogens rather then phytoestrogens, but nutritional phytoestrogens are included within the broad scope of future research and possible regulation. At present, only general conclusions can be made about the role of phytoestrogens which (after Hoffman D.) could be summarized:
1. A number of diverse plant constituents contribute significantly to human estrogen exposure at dietary levels.
2. Nutritionally available estrogenic substances can have a significant role in estrogen metabolism.
3. Biological activity of phytoestrogens extends beyond simple estrogen receptor activity to effects on cellular differentiation, proliferation, angiogenesis, enzyme inhibition, growth factor action and other effects which constitute protective activity against cancer.
4. Dietary incorporation of isoflavone rich foods may contribute to the reduction of risk of cancer; in particular, the majority of studies on soy isoflavones have confirmed significant anti-cancer effects.
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Aromatase modifiers: Some flavone and isoflavone constituents can inhibit aromatase. Aromatase is a P450 enzyme that catalyzes the formation of estrogens from androgens in many tissues. The activity is greater for flavone constituents rather than the isoflavone constituents, and while this may account for part of the anti-estrogenic activity of some flavonoid phytoestrogens, other herbs are known to reverse low aromatase activity, the most studied being
Paeonia lactiflora (White peony). In vitro studies have shown the aromatase action of Paeonia to be due to the monoterpene glycoside, paeoniflorin.
(Chen S, et al. J Steroid Biochem Mol Biol 61,3-6:107-115,1997; Takeuchi T, et al. Am J Chin Med 1991;18:73-78.)
See also the following: Nutrients: Flavonoids, Quercitin and Grapefruit Juice
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Direct pituitary agents: While Cimicifuga racemosa and soy products can influence pituitary action by peripheral modulation of LH and FSH via estrogenic effects, other herbs act directly upon the pituitary to modify prolactin, FSH and LH levels. The best known example is Vitex agnus-castus (Chasteberry). Animal studies have demonstrated Vitex inhibits prolactin levels in vitro and in vivo by binding to dopamine D2 receptors in the pituitary. Human studies have shown increase in progesterone levels in corpus luteum insufficiency during Vitex administration.
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Oxytocics: Several plant constituents have been shown to have oxytocic activity, notably caulosaponin and caulophyllosaponin from Caulophyllum thalictroides (Blue Cohosh) which is classified as a traditional emmenagogue. Other oxytocic compounds include sparteine in Cytisus scoparius (Scotch Broom), and quinine from Cinchona species.
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Commentary: Wild Yam and "Natural Progesterone": There has been some confusion concerning products containing Dioscorea villosa (Mexican Wild Yam) that claim to boost endogenous progesterone levels, or to be a form of "natural progesterone". To add to the confusion, some topical preparations actually contain both Dioscorea extract and pharmaceutical progesterone. The following points should be noted:
• The natural steroidal compound diosgenin is in fact estrogenic, not progesteronic.
• Diosgenin has been used as a starter compound in the laboratory synthesis of progesterone patented by Marker in the late 1940's known as the Marker Degradation Process.
• Homologous metabolic pathways do not exist humans, and diosgenin is therefore not a "precursor" for endogenous progesterone synthesis.
(Brinker F. Brit J Phytotherapy 1997;4,3:123-145; Wilbur P. Eur J Herbal Med 1996 2.2:20-26, and 1996 2.3:19-26.)
terminology: herbs directly affecting the uterus:
• Uterine Tonics: Herbs that re-establish normal tone of the uterine muscle and improve overall strength of the organ. Examples: Rubus idaeus (Red raspberry leaf), Angelica sinensis (Dong Quai), Chamaelerium luteum (Helonias, False Unicorn root).
• Uterine Spasmolytics: Herbs that reduce the rate and amplitude of uterine contractions. Examples: Viburnum opulus (Cramp bark), Viburnum prunifolium (Black Haw), Ligusticum wallichii (Chuang Xiong).
• Uterine Emmenagogues: Traditionally defined as herbs that accelerate delayed menses. More accurately, herbs that stimulate uterine contractions and hence may increase expulsive activity of the uterus.These have also been described as abortifacients. Examples: Ruta graveolens (Rue), Artemisia vulgaris (Mugwort), Mentha pulegium (Pennyroyal).
• Uterine Astringents: Herbs that have a vasoconstrictive action on the endometrial circulation. Examples: Achillea millefolium (Yarrow), Alchemilla vulgaris (Lady's mantle), Trillium erectum (Beth root), Capsella bursa-pastoris (Shepherd's Purse).
Herbs
Herbs listed in this section are compiled and edited from electronic databases including Professor Norman Farnsworth's NAPRALERT database at University of Chicago, Illinois, and Dr. James Duke's Phytochemical and Ethnobotanical Databases at the Agricultural Research Service. Textual sources include Michael Moore's Herbal/Medical Contraindications and Francis Brinker's Herb Contraindications and Drug Interactions.
(Moore M. 1995; Brinker F. 1998.)
Plant activities may be based upon widely different assay methods, and may be laboratory, in vitro, in vivo, or human studies. Constituent data is not quantified. Estrogenic constituents are very widely distributed and the following lists are limited to more common medicinal and edible plants. For principal herbs in common therapeutic gynecological use see Summary section of this Herb Group in Interactions™.
Herbs with HPA (Hypothalamic-Pituitary Axis) activty: Oxytocic synergists:
• Asclepias asperula (Immortal)
• Capsella bursa-pastoris (Shepherd's Purse)
• Cinchona spp. (Cinchona bark) *
• Claviceps purpurea (Ergot of Rye) *
• Cytisus scoparius (Scotch Broom)
• Gossypium spp.(Cotton root Bark)
• Leonurus cardiaca (Motherwort)
• Myristica fragrans (Nutmeg)
• Petroselinum crispum (Parsely)
• Senecio aureus (Life Root) *
• Stachys betonica (Wood Betony)
Herbs with HPA (Hypothalamic-Pituitary Axis) activity: Prolactin inhibitors:
• Glycyrrhiza glabra (Licorice root)
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Paeonia lactiflora (Peony)
• Rehmannia glutinosa (Chinese Foxglove)
• Vitex agnus-castus (Chasteberry)
• Chinese herbal formula: Rehmannia Eight
• Chinese herbal formula:
Paeonia and Glycyrrhiza
Herbs with HPA (Hypothalamic-Pituitary Axis) activity: FSH/LH modifiers:
• Cimicifuga racemosa (Black Cohosh)
• Tripterygium wilfordii (Lei Gong Teng) *
• Vitex agnus-castus (Chasteberry)
Herbs with HPA (Hypothalamic-Pituitary Axis) activity: Progestagenics:
• Alchemilla vulgaris (Ladie's mantle)
• Angelica sinensis (Dong Quai)
• Areca catechu (Betel nut)
• Ceanothus americanus (Red Root)
• Vitex agnus-castus (Chasteberry)
Chinese herbal formula: including:
• Angelica sinensis (Dong Quai)
• Astragalus membranaceus (Astragalus)
• Gardenia jasminoides (Zhi zi)
• Leonurus heterophyllus (Chinese Motherwort)
• Panax notoginseng (Pseudoginseng)
• Rubia cordifolia (Madder)
• Scutellaria baicalensis (Baical Skullcap)
Common phytoestrogenic food/herbs containing: Coumestrol
• Brassica spp. (Brussels Sprouts, Cabbage)
• Glycine max (Soybean)
• Medicago sativa (Alfalfa)
• Pisum sativum (Pea)
• Trifolium pratense (Red Clover)
• Vigna radiata (Mungbean)
Common phytoestrogenic food/herbs containing: Biochanin A:
• Baptisia tinctoria (Wild Indigo)
• Medicago sativa (Alfalfa)
• Sophora japonica (Japanese Pagoda Tree)
• Trifolium pratense (Red Clover)
• Vigna radiata (Mungbean)
Common phytoestrogenic food/herbs containing: Daidzein:
• Glycine max (Soybean)
• Phaseolus coccineus (Scarlet Runner Bean)
• Pueraria spp. (Kudzu; Pueraria)
• Trifolium pratense (Red Clover)
• Vigna radiata (Mungbean)
Common phytoestrogenic food/herbs containing: Formononetin:
• Astragalus membranaceus (Astragalus)
• Cimicifuga racemosa (Black Cohosh)
• Glycyrrhiza glabra (Licorice root)
• Medicago sativa (Alfalfa)
• Pueraria spp. (Kudzu; Pueraria)
• Trifolium pratense (Red Clover)
• Vigna radiata (Mungbean)
Common phytoestrogenic food/herbs containing: Genistein:
• Baptisia tinctoria (Wild Indigo)
• Cytisus scoparius (Scotch Broom)
• Glycine max (Soybean)
• Glycyrrhiza glabra (Licorice root)
• Medicago sativa (Alfalfa)
• Pueraria spp. (Kudzu; Pueraria)
• Sophora japonica (Japanese Pagoda Tree)
• Trifolium pratense (Red Clover)
• Vigna radiata (Mungbean)
Common phytoestrogenic food/herbs containing: Beta-Sitosterol:
• Achillea millefolium (Yarrow)
• Allium cepa (Onion)
• Allium sativum (Garlic)
• Aloe vera (Aloe)
• Anethum graveolens (Dill)
• Angelica archangelica (Angelica)
• Angelica sinensis (Dong Quai)
• Arctostaphylos uva-ursi (Bearberry)
• Arnica montana (Arnica)
• Artemisia annua (Sweet Annie)
• Artemisia dracunculus (Tarragon)
• Artemisia vulgaris (Mugwort)
• Asarum canadense (Wild Ginger)
• Asclepias syriaca (Milkweed)
• Aspidosperma quebracho-blanco (Quebracho)
• Astragalus membranaceus (Astragalus)
• Avena sativa (Oats)
• Calendula officinalis (Marigold)
• Capsella bursa-pastoris (Shepherd's Purse)
• Capsicum annuum (Chili Pepper)
• Centaurium erythraea (Centaury)
• Centella asiatica (Gotu Kola)
• Chimaphila umbellata (Pipsissewa)
• Cnicus benedictus (Blessed Thistle)
• Commiphora myrrha (Myrrh)
• Crataegus spp. (Hawthorn)
• Cucurbita pepo (Pumpkin)
• Cytisus scoparius (Scotch Broom)
• Daucus carota (Wild Carrot)
• Echinacea spp. (Echinacea)
• Elettaria cardamomum (Cardamom)
• Eleutherococcus senticosus (Siberian Ginseng)
• Equisetum arvense (Horsetail )
• Fagopyrum esculentum (Buckwheat)
• Foeniculum vulgare (Fennel)
• Fucus vesiculosus (Bladderwrack)
• Glycine max (Soybean)
• Glycyrrhiza glabra (Licorice root)
• Gossypium spp. (Cotton)
• Hordeum vulgare (Barley)
• Humulus lupulus (Hops)
• Hyssopus officinalis (Hyssop)
• Inula helenium (Elecampane)
• Lactuca virosa (Bitter Lettuce)
• Liquidambar orientalis (Oriental Styrax)
• Marrubium vulgare (Horehound)
• Medicago sativa (Alfalfa)
• Melilotus officinalis (Melilot)
• Melissa officinalis (Lemon Balm)
• Mentha spicata (Spearmint)
• Nicotiana tabacum (Tobacco)
• Ocimum basilicum (Basil)
• Oenothera biennis (Evening Primrose)
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Paeonia lactiflora (Peony)
• Panax ginseng (Chinese Ginseng, Korean Ginseng)
• Panax quinquefolius (American Ginseng)
• Pisum sativum (Pea)
• Plantago psyllium (Psyllium seed)
• Ptychopetalum olacoides (Muira Puama)
• Punica granatum (Pomegranate)
• Rehmannia glutinosa (Chinese Foxglove)
• Rosmarinus officinalis (Rosemary)
• Salvia officinalis (Sage)
• Salvia sclarea (Clary Sage)
• Sambucus nigra (Elderflower)
• Sassafras albidum (Sassafras)
• Scutellaria baicalensis (Baikal Skullcap)
• Serenoa repens (Saw Palmetto)
• Smilax spp. (Sarsaparilla)
• Solanum dulcamara (Bitter Nightshade)
• Sophora japonica (Japanese Pagoda Tree)
• Taraxacum officinale ( Dandelion)
• Theobroma cacao (Cacao)
• Tribulus terrestris (Puncture-vine)
• Trifolium pratense (Red Clover)
• Trigonella foenum-graecum (Fenugreek)
• Turnera diffusa (Damiana)
• Urginea maritima (Squill)
• Valeriana officinalis (Valerian)
• Verbascum thapsus (Mullein)
• Viburnum opulus (Crampbark)
• Vinca minor (Periwinkle)
• Viola odorata (Sweet Violet)
• Vitis vinifera (Wine Grape)
• Withania somnifera (Ashwagandha)
• Zea mays (Corn silk)
• Zingiber officinale (Ginger)
(Missing are some NBE supplements)