title: Herbal preparations for uterine fibroids.
abstract: BACKGROUND
  Uterine fibroids are the most common non-malignant growths in women of childbearing age. They are associated with heavy menstrual bleeding and subfertility. Herbal preparations are commonly used as alternatives to surgical procedures.
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of Chinese herbal medicine for treatment of uterine fibroids.
  
  
  METHODS
  The authors with the guidance of the Trials Search Coordinator searched the following electronic databases: the Trials Registers of the Cochrane Menstrual Disorders and Subfertility Group and the Cochrane Complementary Medicine Field, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE, EMBASE, the Chinese Biomedical Database, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), AMED, and LILACS. The searches were up to 11 September 2012.
  
  
  METHODS
  Randomised controlled trials comparing herbal preparations with no intervention, placebo, medical treatment, or surgical procedures in women with uterine fibroids. We included trials of herbal preparations with or without conventional therapy.
  
  
  METHODS
  Two review authors collected data independently. We assessed trial risk of bias according to our methodological criteria. We presented dichotomous data as risk ratios (RR) and continuous outcomes as mean differences (MD), both with 95% confidence intervals (CI).
  
  
  RESULTS
  We included 21 randomised trials (involving 2222 women) and the majority of them had unclear or high risk of bias. There were several different herbal preparations used within the included trials. The average treatment duration was three to six months. The primary outcome of uterine fibroid related symptoms was not reported in any of the included trials. The majority of the trials reported fibroid volume and size of the uterus.Compared with mifepristone, Tripterygium wilfordii extract was associated with a greater reduction in the fibroid volume (MD -23.03 cm(3), 95% CI -28.39 to -17.67; 2 trials) and in uterine size (MD -51.25 cm(3), 95% CI -77.70 to -24.80; 2 trials). There was no evidence of a significant difference between Nona Roguy herbal product and gonadotropin-releasing hormone (GnRH) agonist on the average fibroid volume or the uterine size. The combination of Guizhi Fuling formula and mifepristone was associated with a greater reduction in the fibroid volume (-1.72 [-2.42, -1.02] 7 trials) and in uterine size (MD -31.63 [95% CI -54.58, -8.68] 3 trials)) compared with mifepristone alone. Only 13/21 trials reported on adverse events and no serious adverse effects from herbal preparations were reported.
  
  
  CONCLUSIONS
  Current evidence does not support or refute the use of herbal preparations for treatment of uterine fibroids due to insufficient studies with large sample sizes and of high quality. Further high quality trials evaluating clinically relevant outcomes are warranted.
authors: Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing. hickmenn@bigpond.net.au
authors: Jian Ping
authors: JP
authors: Liu
authors: Hong
authors: H
authors: Yang
authors: Yun
authors: Y
authors: Xia
authors: Francesco
authors: F
authors: Cardini
mesh_terms: D004365:Drugs, Chinese Herbal / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy* / Q000473:pathology; D015735:Mifepristone / Q000627:therapeutic use; D008517:Phytotherapy / Q000379:methods*; D028321:Plant Preparations / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D004365:Drugs, Chinese Herbal; D006727:Hormone Antagonists; D028321:Plant Preparations; D015735:Mifepristone; D007987:Gonadotropin-Releasing Hormone
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