title: Medicinal plants used for menstrual disorders in Latin America, the Caribbean, sub-Saharan Africa, South and Southeast Asia and their uterine properties: a review.
abstract: BACKGROUND
  Menstrual disorders are generally not perceived as major health concerns by global health organizations, despite being disruptive to women׳s daily activities, particularly when access to sanitary facilities or analgesics is limited. Improving menstrual health requires access to safe and effective medication, but many women in Latin America, Africa or Asia prefer traditional medicine above modern remedies (such as contraceptives), as they can cause physical symptoms associated with fertility loss. Many medicinal plants are used for menstrual disorders, but few have been examined for their pharmacological activities related to traditional uses. Plants that have a smooth muscle-relaxant effect could ease menstrual cramps, but there are indications that dysmenorrhea in low-income countries is commonly treated with emmenagogues. This review aims to assess the most salient plants used to treat menstrual morbidity in Latin America and the Caribbean, sub-Saharan Africa, South and Southeast Asia, their uterine properties and adverse effects. To test whether plants used for painful menstruation could have uterine contracting properties, we recorded whether these species were also used to ease birth, induce menstruation, abortion or expel the afterbirth, as these suggest spasmogenic activities.
  
  
  METHODS
  We reviewed the literature documenting traditional plant use in the study area for dysmenorrhea, regulating or inducing menstruation, uterine cleansing, uterine fibroids, expelling the placenta and lochia and for easing childbirth. Thirty genera (59 species) used in at least two continents or frequently throughout one continent, where shortlisted from the 90 most salient plant species emerging from our literature review. Using Medline, we searched for pharmacological properties and/or mechanisms of action relevant to their traditional uses of the shortlisted species. We searched VigiBase™, the WHO global individual case safety report database, on reported adverse drug reactions associated with these species.
  
  
  RESULTS
  More than 2000 plant species are used for menstrual disorders in the study area. The most salient uses are to treat painful menstruation, induce or regulate menses, and induce abortion. Around half (29) of the 59 most salient species have been tested for their pharmacological effects, of which 48% act as uterine spasmolytics and 31% as uterine spasmogenics. Several frequently used species contain toxic constituents, which may put women and their unborn children at serious risk. VigiBase(TM) listed adverse drug reactions for 18 of these species, but few reports came from the study area.
  
  
  CONCLUSIONS
  Research into the risks and benefits of medicinal plants for menstrual complaints should be given a higher priority in reproductive health programs that respect traditional knowledge and practices. Increased data collection is needed on adverse drug reactions among women using herbal medicines for reproductive health, especially in countries with limited reproductive health facilities.
authors: Naturalis Biodiversity Center, Leiden University, P.O. Box 9517, 2300 RA Leiden, The Netherlands. Electronic address: tinde.vanandel@naturalis.nl.
authors: Tinde
authors: T
authors: van Andel
authors: Naturalis Biodiversity Center, Leiden University, P.O. Box 9517, 2300 RA Leiden, The Netherlands; Department of Organismal Biology, Uppsala University, Norbyvägen 18 D, SE-752 36 Uppsala, Sweden; The Natural History Museum, University of Oslo, P.O. Box 1172 Blindern, NO-0318 Oslo, Norway. Electronic address: hugo.deboer@ebc.uu.se.
authors: Hugo J
authors: HJ
authors: de Boer
authors: School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: j.barnes@auckland.ac.nz.
authors: Joanne
authors: J
authors: Barnes
authors: The New York Botanical Garden, 2900 Southern Boulevard, Bronx, NY 10458-5126, USA. Electronic address: ivandebroek@nybg.org.
authors: Ina
authors: I
authors: Vandebroek
mesh_terms: D020834:Ethnopharmacology; D005260:Female; D006801:Humans; D008519:Medicine, Traditional; D008598:Menstruation / Q000187:drug effects; D008599:Menstruation Disturbances / Q000188:drug therapy*; D008517:Phytotherapy / Q000379:methods; D028321:Plant Preparations / Q000009:adverse effects / Q000627:therapeutic use*; D010946:Plants, Medicinal / Q000737:chemistry*; D011247:Pregnancy; D014599:Uterus / Q000187:drug effects
chemical_list: D028321:Plant Preparations
keywords: Adverse drug reactions; Menstruation; Sennaglucosides (PubChem CID: 5199); Traditional medicine; Uterus relaxant; Uterus stimulant; Vigibase(TM); aristolochic acid (PubChem CID: 2236); brazilin (PubChem CID: 73384); leonurine (PubChem CID: 161464); sappanchalcone (PubChem CID: 5319493); trachylobane (PubChem CID: 521405); warifteine (PubChem CID: 5490189); zingerone (PubChem CID: 31211)