Herbs-Supplements In Gynecology-1 | Gynecologic Conditions

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Written by Allen Lawrence, M.D.

The Use of Herbs and Dietary Supplements in Gynecology

The following information is provided for educational purposes to learn more about natural medications, herbs and supplements and how they are used in treatment of gynecologic conditions. This information is directed at informing women looking for information about treating menopause, premenstrual syndrome, dysmenorrhea (painful menstruation), mastalgia (breast pain), problems with fertility and/or infertility.

It is listed by condition and the herb or supplements that might be used by skilled, licensed practitioners. Using herbal medications and/or supplement on your own can be harmful to your health. While herbal medications and supplements have been used successfully for thousands of years, they are best used by individuals who know what they are doing. If you have one of the conditions listed below, you wish to use herbal medications or supplements to treat it, we strongly suggest that learn about these medications and that you do not treat your self. Find an experienced, preferably licenced, practitioner and work with them to attain your desired results.

Herbs and Supplements Used to Treat Dysmenorrhea

Dysmenorrhea is a common symptom in young women. It is a leading cause of absenteeism from work and school. Primary dysmenorrhea is caused by the release of prostaglandins PGE2 and PGF2, which cause inflammation, pain, and spastic uterine contractions. Secondary dysmenorrhea may be related to endometriosis, which is caused by retrograde menstruation, resulting in the implantation of endometrial tissue in pelvic and extrauterine areas, causing pain, uterine bleeding, and infertility.

Many herbs and dietary supplements are suggested as useful in the treatment of primary and secondary dysmenorrhea. These include black cohosh, chastetree, dong quai, black haw (Virburnum prunifolium), crampbark (Viburnum opulus), omega-3 fatty acids, vitamin E, thiamine (vitamin B1), niacin (vitamin B3), and magnesium. Few of these have been well studied.

Black haw and crampbark do have animal studies suggesting a uterine relaxant effect, which might be beneficial in humans. Black haw contains oxalic acid and should not be used in women with a history of kidney stones.

Evidence-based support for niacin is weak. One study done in the 1950s suggested improvement in menstrual cramps in 90% of women who took 100 mg of niacin twice daily and every 2 to 3 hours during cramping. This frequency, may cause flushing and create niacin to be a less than desired choice.

Vitamin E may create a reduction in prostaglandins by inhibiting arachidonic acid release. Two small studies involving about 200 young women showed a significant reduction in pain when vitamin E 150 to 500 IU/day was administered a few days before and during menses. Another study involving 278 women, ages 15 to 17, given 400 IU/day vitamin E or a placebo 2 days before and 3 days during menses for four cycles. It suggested that pain severity, pain duration, and blood loss were significantly lessened. Because vitamin E can have antiplatelet properties, it should be used cautiously in women taking anticoagulants. Recent studies suggest that high-dose vitamin E (greater than 400 IU/day) may contribute to a slight increase in mortality and heart failure. Thus, daily intake should be limited to 400 IU or less. Vitamin E is available as a synthetic (d-l-alpha-tocopherol, also referred to as alpha-tocopherol or SRR-tocopherol) or natural (d-alpha tocopherol or RRR-tocopherol) formulation. The natural formulation is more bioavailable and, thus, greater in potency by a ratio of 1.36 to 2:1. Therefore, 400 IU of natural vitamin E is not equivalent to 400 IU of synthetic vitamin E.

Magnesium has been shown to provide significant improvements in pain. However, because of taking magnesium to rapid diarrhea is created. Magnesium should always be started at a low dosage 20 mg /day and increased slowly 100 to 200 mg /day increases over several weeks to avoid problems with diarrhea. Magnesium is an excellent laxative and is harmless at dosages less than 2000 mg daily. Magnesium has many other health and wellness benefits as it lowers blood pressure, relaxes, treats constipation, strengthen the heart, and protects against osteoporosis.

Fish Oil - Omega-3 Fatty Acids: The American diet is rich in omega-6 fatty acids (vegetable oil, eggs, and margarine) and poor in omega-3 fatty acids (fish, canola oil, and wheat germ). Omega-6 fatty acids contribute to the formation of proinflammatory fatty acids and compounds, whereas omega-3 fatty acids lead to the formation of less inflammatory which are effective in decrease painful menses.

An increased intake of fish oil in amounts of 1 to 2 g/day is also likely to reduce dysmenorrhea. along with cardiovascular risks such as elevated triglycerides. Since omega-3 fatty acids have antiplatelet properties, they must be used cautiously in women taking anticoagulants. Omega-3 fatty acids have few negative side effects, however they can cause bad breath, stomach upset, and loose stools. The commercial stability of fish oil preparations can vary markedly, from 1 to 200 days, depending on susceptibility to lipid peroxidation. Unfortunately, vitamin E, which may be added to fish oil preparations to decrease oxidation, does not improve its stability. Once opened, most preparations will be stable for only 10 to 14 days. As such, it is better to increase ones dietary intake of fish, rather than taking supplements.

Herbs and Supplements Used to Treat PMS and Breast Tenderness and Pain

Some 85% to 90% of perimenopausal women experience regular premenstrual symptoms consisting of changes in mood, depression, irritability, water retention, fatigue, breast tenderness, and dysmenorrhea. Breast tenderness (mastalgia) occurs cyclically (associated with menstruation) or noncyclically. Cyclic mastalgia is more common (67% of the time) and easier to treat.

Calcium for PMS: The Nurses' Health Study found that intake of calcium in foods, but not in supplements, was associated with decrease in PMS symptoms. Women with the highest dietary intake (average of 1283 mg/day) had the lowest risk for PMS. Women who consumed whole milk more than once a week had a slight increase in the risk of developing PMS while women who consumed skim or low fat milk two to three times per day or four or more times per day had the lowest risk.

This study found some benefit from calcium supplement intake creating a reduction in PMS symptoms. Calcium 1000-1200 mg daily for three cycles showed an approximate 50% reduction in symptom scores. The mechanism of action for calcium in PMS is unclear but may be tied to hormonal fluctuations in estradiol during ovulation and the luteal phase. Because calcium is relatively free of side effects, it is an attractive option for women suffering from PMS.

Magnesium: Adding 600 to 1000 mg of magnesium in an amino acid chelated form can help significantly to reduce PMS symptoms. The amount of magnesium used is often dependant on the amount of calcium used. While authorities suggest 2 magnesium molecules to each calcium molecule, in actually this is difficult to do because of the low levels of magnesium in the American diet. Therefore 1:1 is often acceptable. Calcium causes constipating, magnesium opposes this causing diarrhea when taken in the right amounts for that woman, the net result is normal regular bowel movements, one after each meal, a sign of excellent bowel health.

Vitamin B6 is typically given in doses ranging from 50 to 500 mg/day. It appears to have some diuretic capacity and is believed to act within the liver to lower estrogen levels. Vitamin B6 should be used cautiously with the use of serotonin reuptake inhibitors for PMS. Given the benign nature of vitamin B6 in these dosages, it is also an attractive option for PMS.

Chasteberry (Vitex Agnus Castus) has been approved for the treatment of PMS and specifically, mastalgia. Some women with PMS and breast pain have elevated prolactin levels. Chasteberry inhibits prolactin release through dopamine receptor stimulation. For cyclic mastalgia, chasteberry has demonstrated significant benefits over placebo with daily use for 2 to 3 months. All of these trials in this study used a preparation known as Mastodynon, which contains chasteberry along with Caulophyllum thalictroides, Cyclamen, Ignatia, Iris, and Lilium tigrinum. This product is not available in the United States. For PMS alone, chasteberry has shown mixed results.

Side effects for chasteberry are characterized as mild and reversible. The most frequent adverse effects were upset stomach, headache, menstrual disorders, acne, itching, and rash. Chasteberry has not been reported to have any major drug interactions.

Primrose Evening Oil has shown no significant value and cannot be recommended for this indication at this time.