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Vasomotor hot flash is the most common and distressful complication of menopausal women. Its treatment is the most frequent clinical challenge. As a result, an effective and harmless therapy is needed. This double-blind controlled clinical trial was conducted to determine the effects of licorice roots on the relief and recurrence of hot flash in menopausal women referring to the healthcare centers affiliated to Shahid Beheshti Medical University in 2010. Ninety menopausal women complaining of hot flash were selected by reviewing their records in healthcare centers and randomly divided into 2 licorices (3 capsules daily containing 330 mg licorice abstract) and placebo (3 capsules daily containing 330 mg starch) groups over the 8 weeks of intervention and 4 weeks of follow-up. Two weeks prior to the intervention, the severity as well as frequency of hot flashes and the foods taken were asked and documented with questionnaires and data sheets. Data within and between the groups were analyzed by ANOVA with repeated measurements and t-test respectively. Means of age and body mass index (BMI) of the subjects in licorice and placebo groups were 53 ± 3.2, 52.69 ± 2.8, 24.71 ± 3.2 and 23.61 ± 3.3, respectively. The groups were similar in terms of intervening variables. The frequency of hot flash decreased significantly in the experimental (than the placebo group) and this lasted for 2 weeks after the administration of the capsules. The severity of hot flash decreased in the licorice group as well. This decrease was also seen in the placebo group in the first week of the intervention. Decreased hot flash in the placebo group was only significant after the 1st week of intervention compared to the previous period. Recurrence of frequency and severity of hot flashes occurred 2 weeks after the termination of therapy. The significant decrease in the placebo group after the 1st week of the intervention may be attributed to the psychological effects of placebo. Licorice roots decreased the frequency and severity of hot flashes. The administration of this harmless, inexpensive herb well accepted by the menopausal women together with the appropriate and continuous physical activities and consumption of dairy products are recommended for relieving this complication.
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Original Article
Effects of Licorice on Relief and Recurrence of Menopausal Hot Flashes
Fatemeh Nahidia* , Elham Zareb, Faraz Mojabb and Hamid Alavi-majdc
aDepartment of Midwifery and Reproductive Health, School of Nursing and Midwifery,
Shahid Beheshti University of Medical Sciences, Tehran, Iran. bSchool of Pharmacy and
Pharmaceutical Sciences Research Center, Shahid Beheshty University of Medical Sciences,
Tehran, Iran. cDepartment of Biostatistics, School of Paramedical, Shahid Beheshti University
of Medical Sciences, Tehran, Iran.
Abstract
Vasomotor hot ash is the most common and distressful complication of menopausal women.
Its treatment is the most frequent clinical challenge. As a result, an effective and harmless
therapy is needed. This double-blind controlled clinical trial was conducted to determine the
effects of licorice roots on the relief and recurrence of hot ash in menopausal women referring
to the healthcare centers afliated to Shahid Beheshti Medical University in 2010.
Ninety menopausal women complaining of hot ash were selected by reviewing their
records in healthcare centers and randomly divided into 2 licorices (3 capsules daily containing
330 mg licorice abstract) and placebo (3 capsules daily containing 330 mg starch) groups over
the 8 weeks of intervention and 4 weeks of follow-up. Two weeks prior to the intervention, the
severity as well as frequency of hot ashes and the foods taken were asked and documented
with questionnaires and data sheets. Data within and between the groups were analyzed by
ANOVA with repeated measurements and t-test respectively.
Means of age and body mass index (BMI) of the subjects in licorice and placebo groups
were 53 ± 3.2, 52.69 ± 2.8, 24.71 ± 3.2 and 23.61 ± 3.3, respectively. The groups were similar
in terms of intervening variables. The frequency of hot ash decreased signicantly in the
experimental (than the placebo group) and this lasted for 2 weeks after the administration of
the capsules. The severity of hot ash decreased in the licorice group as well. This decrease
was also seen in the placebo group in the rst week of the intervention. Decreased hot ash
in the placebo group was only signicant after the 1st week of intervention compared to the
previous period. Recurrence of frequency and severity of hot ashes occurred 2 weeks after the
termination of therapy.
The signicant decrease in the placebo group after the 1st week of the intervention may be
attributed to the psychological effects of placebo. Licorice roots decreased the frequency and
severity of hot ashes. The administration of this harmless, inexpensive herb well accepted by
the menopausal women together with the appropriate and continuous physical activities and
consumption of dairy products are recommended for relieving this complication.
Keywords: Menopause; Menopausal women; Vasomotor hot ash; Post menopausal hot
ash; Herbal medicine; Licorice.
Copyright © 2012 by School of Pharmacy
Shaheed Beheshti University of Medical Sciences and Health Services
Iranian Journal of Pharmaceutical Research (2012), 11 (2): 541-548
Received: March 2011
Accepted: October 2011
* Corresponding author:
E-mail: nahidifateme@yahoo.com
Nahidi F et al. / IJPR (2012), 11 (2): 541-548
542
the menopausal signs and symptoms; however,
little is known about its effects (12). Its root is
the effective part for the treatment of cough,
sore throat and peptic ulcer or as a laxative and
antihistaminic agent (13). With respect to the
lack of enough evidence regarding the effects
of the herb and since it is abundant, cheap and
accepted in Iran, this study was conducted to
determine the effects of licorice on frequency
and severity of hot ashes in menopausal women
referring to the healthcare centers afliated to
Shahid Beheshti Medical University in 2010.
Experimental
The study was a double-blind randomized
placebo-controlled clinical trial. Ninety
menopausal women referring to the healthcare
centers afliated to Shahid Beheshti Medical
University were selected through purposive
sampling method as the researchers reviewed
medical records of families to nd the subjects,
their addresses and telephone numbers. The
women were then invited by the community
health workers to participate in a session and
if not, the researchers themselves went to
their homes and tried to obtain their written
informed consent by introducing themselves and
describing the aims and methods of the study.
Then, each subject one by one in turn was
assigned to a group to form 2 equal licorice and
placebo groups. The subjects were supposed to
have the following situations:
Be literate or have a literate person at home;
Be between 45-60; Having a body mass index
(BMI) below 29; Experiencing amenorrhea for
at least 1 year or at most 3 years; Suffering from
hot ash and using no drug or hormone to relieve
it; Having no known disease in their medical
records; Taking no antidepressants or sedatives;
Be married or lost their husbands not sooner
than 1 year; Experiencing no stressful event (e.g.
death of close family members, divorce etc.) in
the past 6 months; Not be vegetarian; Having no
allergy to herbs; Having no history of estrogenic
cancers in themselves or their close relatives.
The age, duration of amenorrhea frequency
and the severity of hot ash as intervening the
variables were matched.
Data collection tools included 3
Introduction
Hot ash is the primary symptom of
menopause and most of the women suffer
from it in different levels. It denotes sudden
redness of skin, neck and chest with a feeling
of hotness in the trunk ending up with severe
perspiration (1). Vasomotor hot ash is the most
common cause for seeking help in menopausal
women (2). Forty percent of premenopausal
and 85% of menopausal women complain about
vasomotor disorders. It occurs more at nights,
leading to arousal (1). Its pathophysiology is
unknown; however, the decrease and cessation
of estrogen secretion plays a signicant role,
causing alterations in cerebral mediators and
instability of temperature regulation center in
hypothalamus (3).
Hot ash and sweating have no inherent risk
for health and are not life-threatening. However,
they cause discomfort and trouble, affecting
daily activities of living (4). Hot ash affects
on work, social activities, leisure time, mood,
concentration, relationship with others, sexual
activities, enjoyment from living and quality
of life (5). The most common intervention
is hormone replacement therapy (HRT) with
many advantages including 70-80% decrease in
hot ashes (6). The administration of systemic
estrogen is the most effective method to relieve
hot ash and sleep disorders resulted from it (2).
However, such complications as heart attack,
coronary artery diseases, myocardial infarction,
thromboembolic events and breast cancer have
resulted from it (7).
With respect to the risks of HRT, it should be
used at the lowest dose and shortest duration (2).
In addition, estrogen is contraindicated in 10% of
women; accordingly, HRT is utilized in less than
20% of women (8). In Iran, ndings of a study
showed that only 8.75% of menopausal women
used HRT (9). In recent decades, such alternative
therapies as nutrition, exercise, aromatherapy,
homeopathy, relaxation and herbal medicine
have been increasingly utilized in a surprising
manner with an effective relief of menopausal
complications (10). Herbal products relieve both
physical and psychological symptoms with usual
estrogenic effects (11).
Licorice is an herb administered for relieving
Effects of Licorice on Relief and Recurrence of Menopausal Hot Flashes
543
questionnaires, 2 information forms, a scale,
a meter band and a sphygmomanometer.
Questionnaire 1 included demographic items,
menstruation history, gestation history, exercise,
frequency as well as the severity of hot ash
and coping strategies with it, which was
completed before the therapy. Questionnaire 2
contained clients’ activities during the past week
including exercise, unpleasant events and coping
strategies with hot ash, which was completed
by the researchers at the end of each week.
Questionnaire 3 assessed hot ash severity based
on a visual linear scale (pain ruler), which was
asked by the researchers at the end of each week.
Information form 1 was completed by the
subjects who had documented their daily food
intake 2 weeks before taking the herb until the
end of the intervention. Information form 2,
related to the frequency as well as the severity
of hot ash, was also completed by the subjects
2 weeks before the intervention until 12 weeks
after it and was weekly collected. Content
method was used for the validity of the tools.
For validity of the scale, a standard one was used
and for its reliability, it was tested with a 2 Kg
standard weight and after each ten measurement,
calibrated via the same weight. For height
measurement, a nonexible meter band resisting
to temperature changes was used.
Neither the researchers nor the subjects
were aware of the content of capsules since
the capsules were coded by a pharmacist. Herb
capsules contained 330 mg licorice root abstract
while placebo capsules had 330 mg starch with
the same shape. The subjects took them for 8
weeks 3 times a day (morning, noon and night).
To assess recurrence, the subjects were followed
up for 4 weeks after the capsule administration.
Following the therapy and follow-up stages,
data were extracted from the forms and analyzed
through ANOVA with repeated measurements
for within-group comparisons and t-test for
comparisons between the groups with SPSS
package.
Results and Discussion
No significant difference was found
between the groups in terms of age, BMI,
occupation, occupation of spouse, education,
family income, menarche, time of the last
menstruation, onset of hot flash, number of
live children, cold liquids, daily stress and
anger, coping strategies and measures to
decrease or relieve hot flash (Table 1).
Mean frequencies of hot flash in licorice
and placebo groups before, during and after
the therapy are presented in Table 2. T-test
showed no significant difference between
the groups before the therapy in terms of
the frequencies. Mean frequencies of hot
flash reached from 7.70 ± 0.45 before the
therapy to 6.43 ± 0.94 at the end of the 8th
week and returned to 7.66 ± 1.02 at the 4th
week of follow-up. ANOVA with repeated
measurements showed significant differences
between the mean frequencies before the
therapy, the 1st to the 8th week of therapy and
the first 2 weeks after it (follow-up period) (p
< 0.001); however, no significant difference
was found between the frequencies before the
therapy and the last 2 weeks of follow-up. In
other words, frequencies of daily hot flash
significantly decreased over 8 weeks of the
therapy and 2 weeks after it compared to those
before the intervention. In fact, the effects of
phytoestrogen in licorice root remained until
2 weeks after the therapy. In contrast, the
mean frequencies in the placebo group before,
during and after the intervention showed no
significant difference.
Hot flash severity changes before, during
and after the therapy are presented in Figure
1. T-test showed no significant difference
between the means of hot flash severity in
the 2 groups before the therapy. Hot flash
severity decreased in both groups from the
beginning of the therapy, i.e. the means of hot
flash severity in licorice and placebo groups
were 10.1 ± 1.9 and 10 ± 1.7 before as well
as 9.4 ± 2.1 and 9 ± 1.8 in the 1st week of
the therapy respectively. T-test showed no
significant difference between the groups at
this stage (p < 0.002). In addition, the test
showed a significant decrease in licorice and
in placebo groups before and 1 week after
the intervention. However, the decrease was
continued until 2 weeks after the therapy in
the licorice group while it was only significant
in the placebo group in the 1st week of therapy
Nahidi F et al. / IJPR (2012), 11 (2): 541-548
544
Group
Variable Licorice (n = 45) Placebo (n = 45)
Age 53 ± 3.19 52.69 ± 2.80
BMI 24.71 ± 3.17 23.61 ± 3.30
No. of children 3.4 ± 1.2 3.1 ± 0.4
Age of menarche 13.3 ± 1.1 12.8 ± 1.5
Last menstruation 1.9 ± 0.9 2 ± 1.0
Live children 3.1 ± 1.9 3.5 ± 2.1
Occupation
Household 37 (82.2%) 36 (80%)
Employed 4 (9.1%) 3 (6.7%)
Home occupation 4 (8.9%) 6 (13.3%)
Occupation of spouse
Businessman 28 (62.2%) 28 (62.2%)
Employee 4 (9.1%) 7 (15.4%)
Worker 7 (15.5%) 7 (15.6%)
Jobless 6 (13.2%) 3 (6.8%)
Education
Illiterate 4 (8.9%) 2 (4.4%)
Primary 11 (24.4%) 9 (22.2%)
Secondary 5 (11.1%) 15 (33%)
High school or higher 25 (55.5%) 19 (41.4%)
Residence
Private 13 (28.9%) 21 (46.7%)
Rental 27 (60%) 17 (37.7%)
Relatives 5 (11.1%) 7 (15.6%)
Family income
< 250,000 15 (33.3%) 13 (28.8%)
250,000-500,000 14 (31.1%) 16 (35.6%)
500.000-1000,000 16 (35.6%) 16 (35.6%)
Discomfort and angriness
Always 3 (6.7%) 6 (13.3%)
Occasionally 39 (86.6%) 35 (77.8%)
Never 3 (6.7%) 4 (8.9%)
Coping strategies
Fight 2 (4.4%) 1 (2.4%)
Entertainment 15 (33.3%) 17 (37.7%)
Coping 19 (42.3%) 16 (35.5%)
Impatience 9 (20%) 11 (24.4%)
Exercise
Yes 22 (48.9%) 13 (28.3%)
No 23 (51.1%) 32 (71.7%)
Onset time of hot ash
1-2 year 43 (95.6%) 41(91.2%)
2-3 year 2 (4.4%) 4 (8.8%)
Cool liquids
Yes 13 (28.9%) 9 (20%)
No 10 (22.2%) 10 (22.2%)
Occasionally 22 (48.9%) 26 (57.8%)
Interventions to relieve or decrease
Yes 5 (11.2%) 7 (15.5%)
No 40 (88.8%) 38 (84.4%)
Table 1. Distribution of the subjects in terms of intervening factors in the 2 groups.
Effects of Licorice on Relief and Recurrence of Menopausal Hot Flashes
545
and from the 2nd week to the end of follow-
up stage, no significant difference was found
compared to the beginning of the study.
Changes of hot ash severity in the subjects
of both groups before, during and after (follow-
up stage) the therapy is presented in Table 3.
As shown, 22.7% of the subjects in the licorice
group had experienced severe hot ash before
the intervention while it was reduced to 2.3%
after the course of therapy. At the end of 4 weeks
follow-up, 24.4% of the subjects suffered from
severe hot ash. In addition, 31.1% of the
subjects in the licorice group experienced mild
hot ash while at the end of 8 weeks of therapy,
64.4% of women and, after follow-up, 24.4%
of them suffer from it. In the placebo group,
35.5% of the subjects before the therapy and
40% of them after 4 weeks of intervention had
mild hot ash; the corresponding gures for
severe hot flash were 24.4% and 15.6%.
Discussion
Findings showed that licorice root is effective
in reducing the frequency and severity of hot
ash. Comparing the mean frequencies of hot
ash in the weeks before the therapy, 8 weeks
of therapy and 4 weeks of follow-up through
ANOVA with repeated measurements, there
was found a signicant difference in the licorice
group and no difference in the placebo group.
In other words, licorice could decrease daily
hot ash frequencies during 8 weeks while
no decrease was found at the same period in
the other group. In addition, the signicant
difference in the licorice group was seen from
the 1st week, increased signicantly in time and
continued until the 2nd week after the therapy as
the recurrence took place from this stage.
Independent t-test showed no signicant
difference between the mean frequencies of daily
hot ash before the therapy in 2 groups, denoting
their similarity in this regard. Abbaspour (2003)
found that the mean frequencies of 24 h hot ash
before and after soya consumption reached from
10.38 to 5.45 in the experimental group and from
10.41 to 9 in the control group during 4 weeks,
and the difference became signicant from the
3rd week (14). In comparison with our results, it
seems that the effects of licorice occur sooner.
Besides, our results are congruent with the
ndings of Jafari et al. who found a reduction
in hot ash and an improvement in the quality
of life through studying the phytoestrogens in 2
derivatives of isoavone of red clover (Trifolium
pratenes) (15).
Kazemian et al. (2006) studied the effects
of phytoestrogen in valerian on hot ash over
2 months. Before and 1 month after as well as
before and 2 months after therapy, a signicant
Group
Time of treatment Licorice (n = 45) Placebo (n = 45) Test result
before the therapy 7.70 ± 0.45 7.73 ± 0.4 NS
1st week of therapy 7.46 ± 0.57 7.71 ± 0.32 p < 0.002
2nd week of therapy 7.35 ± 0.45 7.70 ± 0.23 p < 0.001
3rd week of therapy 7.09 ± 0.56 7.71 ± 0.38 p < 0.001
4th week of therapy 6.84 ± 0.74 7.70 ± 0.39 p < 0.001
5th week of therapy 6.79 ± 0.76 7.71 ± 0.49 p < 0.001
6th week of therapy 6.70 ± 0.85 7.74 ± 0.63 p < 0.001
7th week of therapy 6.56 ± 0.92 7.76 ± 0.49 p < 0.002
8th week of therapy 6.43 ± 0.94 7.75 ± 0.55 p < 0.001
1st week of follow up 6.44 ± 0.94 7.77 ± 0.52 p < 0.001
2nd week of follow up 6.48 ± 0.95 7.72 ± 0.36 p < 0.001
3rd week of follow up 7.56 ± 0.99 7.69 ± 0.35 NS
4th week of follow up 7.66 ± 1.02 7.75 ± 0.39 NS
Test result over time p < 0.001 NS
Table 2. Mean frequencies of daily hot ash before the therapy, over 8 weeks and 4 weeks after it in the 2 groups.
Nahidi F et al. / IJPR (2012), 11 (2): 541-548
546
diffe
rence was found in the frequency and
severity of hot ash (16). Nahidi et al.
(2006) indicated that the phytoestrogen in
Pimpinella anisum is effective on hot ash
frequency of menopausal women from
the 2nd week of therapy in urban and rural
areas of Qazvin (17). Nahas et al. (2004)
found a complete relief of hot ash in 44%,
a relative relief in 26% and no relief in
20%. In placebo group, 12%, 28% and 60%
were completely, relatively or indifferently
relieved respectively (18). With respect to the
long duration of therapy in these 2 studies,
it is expected that licorice, if taken longer,
may have better effects. Whether licorice can
completely relieve, hot ash needs further
investigation. However, the effect of it for
reducing the hot ash frequency is evident in
this study and the assessment of recurrence
after therapy has not been reported before.
Comparing the means of hot ash severity
before, during and after the therapy through
the ANOVA with repeated measurements,
indicated the signicant and nonsignicant
differences in the intervention and placebo
groups respectively. In the licorice group, a
signicant difference was found in hot ash
severity from the 1st week and the difference
continued to increase signicantly until
the 2nd week after the therapy as recurrence
occurred following the 2nd week of follow-
up. In the placebo group, this difference was
only signicant in the 1st week, which may
be attributed to the psychological effects of
the intervention. However, the difference did
not last since then. In addition, t-test showed
no signicant difference in hot ash severity
between the groups before and in the 1st week
of therapy, which indicated the congruity of
the groups before the therapy and similarity
of estrogenic effects of licorice root as well
as psychological effects of placebo in the 1st
week of intervention.
In the study of Nahidi et al. (2006), the
phytoestrogen effect of Pimpinella anisum
on hot ash severity was well indicated (17).
This was also shown by Jafari et al. (2003)
who studied the effects of 2 derivatives
of red clover (Trifolium pratenes) on hot
ash severity (15). In addition, Hiric and
colleagues (2006) found a similar decrease
in studying the effects of humulus lupulus on
hot ash. Kazemian et al. (2006) studied the
phytoestrogen effects of valerian on hot ash
severity and found a signicant difference
before and after 1 month as well as before
and after 2 months of therapy. They also
found a signicant decrease in their placebo
group (16). The same was found in the study
of Nahas et al. regarding the useful effects
of isoavone of soya in women prohibited
from hormone therapy (18). Albertazi also
studied the effects of soya on hot ash and
found a 45% decrease in intervention group
compared with a 30% decrease in placebo
group, denoting the psychological effects of
placebo (6). The signicant effect of placebo
is a constant and remarkable nding of most
studies regarding hot ash. The new aspect
of the present study is the assessment of
recurrence over 4 weeks after the therapy,
which occurred after 2 weeks.
No side effect related to licorice was
reported by the subjects. Three women in the
Groups Time
Hot ash severity Before the treatment (n = 45) During the therapy (n = 45) After the therapy
Licorice
Mild 14 (31.1) 29 (64.4) 11 (24.4)
Moderated 21 (46.6) 15 (33.3) 23 (51.1)
sever 10 (22.2) 1 (2.3) 11 (24.4)
Placebo
Mild 16 (35.5) 20 (44.4) 18 (40)
Moderate 18 (40) 15 (33.3) 20 (44.4)
Sever 11 (24.4) 10 (22.3) 7 (15.6)
Table 3. Distribution of the subjects in terms of hot ash severity based on the pain ruler scale before and during the therapy and after
the follow-up in both groups.
Effects of Licorice on Relief and Recurrence of Menopausal Hot Flashes
547
intervention group reported blotting in the
2nd 4 week of therapy, which was relieved by
discontinuation of the capsules. The women
were then referred for further check-ups. This
may be attributed to the estrogenic effect
of licorice root. Since the subjects had no
signicant difference in terms of duration
in hot ash, the length of menopause,
frequency as well as severity of hot ash and
life style, stressful factors, exercise and diet
were controlled before and during the study.
To avoid the interfering effects of foods
containing phytoestrogens with licorice, the
subjects were asked to provide a food diary to
control this intervening variable. This can give
more condence in the effects of licorice on
frequency and severity of hot ash. Therefore,
licorice as an herb containing phytoestrogen
can be prescribed for menopausal women
suffering from hot ash.
As a result, prior to any intervention for
hot ash, consultation with this group is
essential to make them familiar with different
therapeutic measures including hormonal,
chemical and herbal agents. In addition,
all advantages and disadvantages of the
measures should be provided for them to
have the right of choice. With respect to the
signicant effects of life style changes on
health, the administration of licorice should
be accompanied with necessary instructions
for daily exercise, coping strategies with
stress, cool liquids, cold living environment
and foods containing phytoestrogen for
menopausal women. These can be effectively
used to relieve hot ash as it inuences on
different aspects of physical, psychological,
familial and social life.
Blood estrogen levels before, during and
after the study were not measured. In addition,
the severity of hot ash was assessed only by
women’s expressions.
With respect to inadequate evidence
regarding licorice and controversies concerning
the effects of phytoestrogens in comparison
with hormonal drugs, further studies are
warranted. Furthermore, measuring the blood
estrogen levels can better indicate the effects of
phytoestrogen in licorice on hot ashes.
Acknowledgments
We express our deep gratitude toward all
dear colleagues and subjects taking part in
this study for their sincere cooperation. We
are also thankful of Pharmaceutical Sciences
Research Center for providing facilities and
opportunities to conduct this study.
Means of hot ash severity
Licorice
Placebo
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
11
10
9
8
7
6
5
Figure 1. Means of hot ash severity 2 weeks before the therapy, 8 weeks during and 4 weeks after it in 2 groups.
Nahidi F et al. / IJPR (2012), 11 (2): 541-548
548
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This article is available online at http://www.ijpr.ir
... [43] [ 45,43] Licorice Contains Phytoestrogens [46] Reduce hot flashes. [47,48] Double-blind randomized clinical trial. [47] Randomized, double-blind, placebo-controlled trial. ...
... [47] Randomized, double-blind, placebo-controlled trial. [48] [ [46][47][48] Anise Contains Phytoestrogens [49] Reduce hot flashes. [49] Placebo-controlled randomized clinical trial. ...
... [47] Randomized, double-blind, placebo-controlled trial. [48] [ [46][47][48] Anise Contains Phytoestrogens [49] Reduce hot flashes. [49] Placebo-controlled randomized clinical trial. ...
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Background: Menopause is an important physiological phenomenon in women's lives. Women's concern about taking the hormone treatment to ease menopausal symptoms is increasing. Over the past decade, the use of complementary and alternative medicine for the treatment of menopausal problems instead of hormone therapy has increased. Objective: This study aimed to investigate the role of herbal medicine, acupressure, and acupuncture in the menopausal symptoms. Methods: Data source: related articles were searched from internal scientific databases and external databases of "Web of Scopus, Cochrane, PubMed, Science Direct, Ovid, and Google scholar." Study eligibility criteria: The keywords such as menopause, menopausal symptoms, complementary menopausal medicine, acupuncture in menopause, herbal medicine in menopause, and acupuncture in menopause were searched in the studies from 1987 to 2019. Exclusion criteria were inadequate information in the study, lack of access to full-text articles, animal studies, and reports. At the end of the search, 145 articles out of a total of 400 articles were reviewed. Results: In various studies, different herbs such as licorice, valerian, soy, sage, ginseng, etc., were used to improve menopausal symptoms. In addition, acupuncture and acupressure were used to reduce menopausal symptoms. Conclusion: The efficacy and use of complementary and alternative medicine, along with other classical medicine care, can be a new model for improving menopausal symptoms in women. It is recommended that further clinical and review studies be conducted to develop complementary and alternative medicine.
... It is contraindicated to take licorice extracts along with oral contraceptives and steroids, primarily prednisolone and hydrocortisone (Batiha et al. 2020). Daily administration of more than 15 g may lead to a surge in blood pressure, mineralocorticoid and hyperkalemia (Kaur et al. 2010;Nahidi et al. 2012). To date, there is no clinically established dosage limit of different Glycyrrhiza constituents, efficiently alleviating the inherently associated side effects. ...
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Glycyrrhiza glabra Linn (licorice) has been widely studied because of the possible ethnopharmacological benefit. It was among the essential Ayurvedic medicines studied for immunomodulatory, antiviral, antibacterial, antioxidant, hepato-protective activities. Nowadays, licorice's root parts have been evaluated to contain numerous bioactive components responsible for the treatment of respiratory tract infections and influenza-like illnesses. Most importantly, several investigations have now assessed the multiple mechanisms by which these biomolecules could attack the essential proteins and enzymes responsible for SARS-CoV-2 cellular entry and interaction. Our findings gathered that the metabolites of Glycyrrhiza glabra could interfere with COVID-19 cellular entrance and replication by blocking all five key proteins and enzymes essential for the survival and attachment of the virus. In addition to their ability to neutralise, the inflammatory cytokines storm reaction following the COVID-19 viral infection. This review was designed to digest the potential pharmacological importance of Glycyrrhiza glabra and its likeness in combating the pandemic COVID-19.
... Results showed that licorice seems more effective than HRT in improving hot flash duration [47]. Similar results were recorded in another study demonstrating that administration of this harmless, inexpensive herb decreased the frequency and severity of hot flashes [48]. Molecular and physiological effects of licorice root administered to ovariectomized mice revealed that licorice reduces body weight gain, overall fat deposition, liver steatosis, and expression of hepatic lipid synthesis genes [49]. ...
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Introduction: The importance of women's health and the quality of life after menopause is a critical issue. To prevent disability and menopause complications as well as avoid the side effects of hormone replacement therapy (HRT), in this study, licorice hydroalcoholic extract (Glycyrrhiza uralensis roots) was evaluated as a natural remedy. Methods: Seventy-two female Sprague-Dawley rats were divided into six groups: control group, Sham-operated group, Glycyrrhiza (Gly) 30% group, and ovariectomized group as well as two ovariectomized groups treated with Gly 10% and Gly 30%. Normal saline and different treatments were administered orally for 8 weeks. At the end of the study, calcium, alkaline phosphatase, estrogen, and progesterone levels in the ovariectomized rats were determined. Moreover, the stereological and histopathological changes in uterine tissue in all groups were determined. Phytochemical analyses were also performed to determine the total phenolic content and antioxidant potential of the extract. Result: The hydroalcoholic extract of licorice root exhibited considerable effect to improve calcium, estrogen, and progesterone levels in the ovariectomized rats. Also, hydroalcoholic extract of licorice root successfully decreases the amount of alkaline phosphatase (ALP) level. The stereological and histopathological findings confirmed the therapeutic potential of this extract. The considerable effects of hydroalcoholic extract of licorice root could be due to high amounts of phytoestrogens with similar estrogen-like structures. Considerable total phenolic content and antioxidant activity were also seen in licorice root extract. Conclusion: Hydroalcoholic extract of licorice root due to containing high amounts of phytoestrogens with similar chemical structures to estradiol notably improves biochemical parameters as well as stereological and histopathological markers of uterine tissues in ovariectomy rats, so it could be a potential agent for prevention and/or treatment as hormone replacement therapy in healthy middle-aged and/or older women.
... All the above-mentioned cases were included in a table for conveniently completing hot flash registration forms. The reliability of the tool was reported in other studies [12,13]. On this scale, the intensity of night sweats was categorized into mild, moderate, and severe degrees. ...
Article
Full-text available
Objectives: Menopause is associated with complications that could decline women's health during this period. Therefore, some of its complications, such as hot flashes and night sweats, must be treated or alleviated. Methods: This randomized controlled trial included postmenopausal women who were referred to health centers in Hamadan from May 2018 to April 2019. The hot flash and night sweat questionnaires were completed by the researcher a week before and 8 weeks after the intervention. The intervention group took one capsule (1,000 mg) of evening primrose oil twice daily, while the control group received the same amount of placebo. Finally, the results were analyzed using Stata 13. Results: The mean scores of duration, frequency, and severity of hot flashes did not significantly decrease in both groups after the intervention compared with before the intervention, and no statistically significant difference was observed (P > 0.05). However, the intervention group had lower frequency and severity of night sweats after the intervention than the control group, with statistically significant differences (P < 0.05). Conclusion: Evening primrose oil effectively decreased the frequency and severity of night sweats.
... It check duration, intensity and frequency of hot flashes and night sweats. And it was a tool developed by the U.S. Food and Drug Administration, and was frequently used by Newton et al. [11] and Nahidi et al. [12] in different studies. The reliability of this checklist was confirmed in previous studies. ...
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Full-text available
Objectives: Hot flashes and night sweats are the most common and annoying consequences of menopause. The present study aimed to investigate the effect of a combined herbal capsule (black cohosh, soy, potato, chaste tree, and burdock) on hot flashes and night sweats in postmenopausal women. Methods: The present study was a randomized clinical trial conducted on postmenopausal women who were referred to Hamadan health centers in 2018-2019. The patients were distributed randomly in two groups of 85 individuals using the permuted block technique. The intervention group received the Menohelp capsule 550 mg twice daily for eight weeks and those in the control group received placebo. Data was obtained using a demographic questionnaire and a night sweat checklist one week before and eight weeks after the intervention. Data analysis was done using Stata 13. Results: Data analysis revealed that means of hot flashes duration, frequency and intensity did not significantly decrease in the postintervention phase as compared to the pre-intervention phase in both the groups (P > 0.05). Comparative analyses of frequency and intensity of night sweats in the two groups revealed that both variables decreased after intervention with the Menohelp capsule (P < 0.05). Conclusions: This study revealed that combined herbal medicine (Menohelp) was effective in reducing the frequency and intensity of night sweats. Therefore, it can be used to reduce night sweats in postmenopausal women.
... The cultivation of this plant is widely spread in southern Europe and some parts of Asia particularly in China. Licorice has many therapeutic advantages such as relieving the menopausal hot flashes (Nahidi et al., 2012), anti-allergic (Shin et al., 2007), anti-inflammatory and anti-cancer effects (Zhou et al., 2009). ...
Article
We investigated the anti-cancer activity of Licochalcone A (LCA), extracted from licorice root. LCA inhibited the proliferation of HePG2 cells with IC50 (65.96 μM) for 24 h and IC50 (44.13 μM) for 48 h and caused significant morphological changes and also led to intracellular ROS generation. LCA affected HePG2 cell growth by terminating cell cycle development at G2/M transition and further induced the apoptosis process. The mRNA expression of genes involved in cell cycles such as Survivin, Cyclin B1, and CDK1 were reduced; while, Weel, P21, Cyclin D1, and JNK1 showed increased mRNA expression. Two pathways consisting of internal and external factors were responsible for LCA -induced apoptosis. The anti-cancer action involved increased mRNA expression of DR3, DR5, caspases-3, caspases-8, caspases-10, Fas, Bad, Bax, Bcl-2, Bak, and PUMA; besides, decreased level of PKCε, p70S6K, and Akt. This study provides mechanistic explanation for anti-cancer activity of LCA and also suggests its potential role in the treatment of hepatoma cancer.
Article
Background : The potential clinical effects of licorice (Glycyrrhiza spp.) and its extracts have been investigated since ancient times. It is uncertain if pseudohyperaldosteronism, with consequent arterial hypertension, is the only endocrine effect produced by licorice, and a role in the reproductive system has been proposed. This review aimed to summarize the current knowledge on the pharmacological effects of licorice on the male and female reproductive systems. Method : Overall, 1462 records were extracted from electronic databases and systematically examined. 28 studies were included in the final analysis. Results : Preclinical and clinical studies revealed an estrogen-like activity of licorice components, especially flavonoids, isoflavonoids and chalcones, showing a potential role of licorice in ameliorating symptoms associated with estrogen insufficiency. Preclinical studies also displayed weak antiandrogen properties and beneficial effects of licorice on gonadal function in both sexes, while clinical studies yield to poor and conflicting results, depending on the type and dose of licorice. Conclusions : Licorice consumption can affect the reproductive system. However, its role needs to be further explored, especially due to the great variability of bioactive compounds used in existing studies.
Chapter
Licorice (Glycyrrhiza glabra) has many of the benefits and risks of corticosteroid drugs. The physiological effects of licorice include anti-inflammatory, antioxidant, antiallergic, antimicrobial, laxative, and ulcer-healing properties. It has many applications in traditional herbalism including bronchitis, chest congestion, hepatitis, peptic ulcer disease, constipation, menopause, Addison’s disease, general inflammation, infections, and prostate cancer. Licorice may be beneficial for mucositis, pharyngitis, asthma, dyslipidemia, hepatoprotection, peptic ulcer disease (non-DGL only), functional dyspepsia, polycystic ovary syndrome, menopause, Parkinson’s disease, hyperpigmentation, and eczema. This chapter examines some of the scientific research conducted on licorice, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of licorice’s use in treating ENT, pulmonary, cardiometabolic, gastrointestinal, genitourinary, neurologic, dermatologic, adrenal, and inflammation disorders. Finally, the chapter presents a list of licorice’s active constituents, different Commonly Used Preparations and Dosage, and a section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
Article
The tendency to use herbs to manage menopausal symptoms has increased in recent years. The purpose of this study was to evaluate the effect of Silybum marianum (L.) compared with placebo in women with hot flashes. Eighty women were randomly allocated into two equal groups (S. marianum extract [400 mg/d] or placebo capsules). Hot flashes frequency and severity were evaluated in 12 weeks with the Greene Climacteric Scale (GCS) and the Hot Flash Related Daily Interference Scale (HFRDIS). The data were analyzed in SPSS software using t‐test, Mann–Whitney, chi‐square test and repeated measure analysis. Hot flashes frequency and severity decreased from 4.32 ± 0.20/day to 1.31 ± 0.15/day and from 5.25 ± 0.22 to 1.62 ± 0.08, respectively, during the study in test group (p < .001) which were significantly better than effects of placebo in all steps of study (p < .001). Significant decreases in GCS and HFRDIS scores were also detected in S. marianum group compared with placebo after 4, 8 and 12 weeks (p < .001). The results showed that S. marianum can decrease frequency and severity of hot flashes significantly. Considering the safety and high consumption of this herbal medicine worldwide, its use in women with menopausal symptoms can be helpful.
Article
Full-text available
Glycyrrhiza glabra (G. glabra) has been used as a flavoring and sweetener agent, in addition to its therapeutic properties. It is rich in phytoestrogen and may prevent osteoporosis caused by estrogen deficiency; however, there is no evidence for its effects on proliferation and osteogenesis in mesenchymal stem cells. So, we were encouraged to investigate whether the ethyl acetate extract of licorice root as a source of phytoestrogen can act similar to estrogen in cell culture. Furthermore, the analysis of the licorice extract (LE) based on HPLC-DAD-ESI-MS indicated that LE comprises phytoestrogen compounds, such as glabridin and glabrene. In this study, the effects of LE on proliferation of human bone-marrow mesenchymal stem cells (hBM-MSCs) were investigated using MTT assay. In addition, its effects on the osteogenesis were evaluated using alkaline phosphatase activity (ALP), calcium deposition, and bone specific gene expression such as ALP, osteocalcin, Runx2, and BMP-2. The quantitative gene expression was studied by real-time RT-PCR. Our results showed a significant increase in proliferation in presence of LE in concentration 10-50 µg/mL. The differentiation of hBM-MSCs increased in doses of LE (10-25 µg/mL) compared to the control group. The effects of LE were similar to those of 17β-estradiol (E2) (10⁻⁸ M) and were abolished by ICI 182,780 an antagonist of estrogen receptor (ER) (10⁻⁷), indicating that the stimulatory effects of LE occur through estrogen receptor-mediated mechanism. Taking these into account, LE may be a potential candidate for prevention of osteoporosis in menopausal women. © 2018, Iranian Journal of Pharmaceutical Research. All rights reserved.
Article
Only 10% to 20% of Asian women experience hot flashes, contrasting with up to 80% of women in Western countries. One possible explanation is that the isoflavones present in soy, prominent in the Asian diet, influence bodily responses to altered hormonal levels at the time of menopause. Isoflavones are structurally related to estrogens and can bind to estrogen receptors, acting as either partial agonists or antagonists in different tissues. This study examined the efficacy and safety of 2 dietary supplements derived from red clover. Using a double-blind, placebo-controlled design, 252 menopausal women 45 to 60 years of age who had 35 or more hot flashes each week were randomly assigned to receive Promensil, providing 82 mg of total isoflavones per day; Rimostil, providing 57 mg; or a placebo. Follow up continued for 12 weeks. These women were a mean of 3.3 years past menopause and had an average of 8 hot flashes per day. In 246 women completing the 12-week trial, hot flashes were 41% less frequent than at baseline with Promensil therapy and 34% less frequent with Rimostil. Placebo patients had an average reduction of 36%, not significantly different from the effect achieved in either active treatment group. Promensil reduced hot flashes more rapidly than did placebo. Women in all groups were still having more than 5 hot flashes per day after the 12-week trial period. Per-protocol results and intention-to-treat analyses yielded similar findings. There were indications that women with relatively high body mass indices could have benefited more from phytoestrogen supplementation. The clinical results could not be related to urinary isoflavone excretion. Neither supplement was significantly associated with adverse events. Neither of the isoflavone supplements evaluated in this trial had a clinically significant effect in reducing hot flashes in these women, who were studied shortly after menopause.
Article
Many women are interested to use complementary and alternative medicines for relief from their menopausal symptoms. The prevalence of herbal medicinal product use among menopausal women highlights the need for investigation into these interventions. The goal of this study was to evaluate the benefit of herbal medicinal products for the treatment of menopausal symptoms by performing a systematic review of clinical trials. Literature searches of four computerized databases were done to identify randomized clinical trials of herbal medicinal products for the treatment of menopausal symptoms. Manufacturers of herbal products were contacted, and our own files were also searched. There were no restrictions on the language of publication. Trials were considered if the outcome measures related to the physical or psychological impact of menopause, whether by compendium scores, questionnaires, or women's symptom diaries, excluding studies describing artificially induced menopause. This review was not concerned with biochemical or pathological data. Eighteen randomized clinical trials that fit our criteria were identified. These studies investigated black cohosh (n = 4), red clover (n = 4), kava (n = 3), dong quai (n = 1), evening primrose oil (n = 1), ginseng (n = 1), and combination products (n = 4). Trial quality was generally good, with 16 of 18 studies scoring 3 or more (maximum 5) on the Jadad Scale. There is no enough evidence for any herbal medical product in the treatment of menopausal symptoms. However, the evidence for black cohosh is promising. The studies involving red clover show it may be of benefit for more severe menopausal symptoms. There is some document for the use of kava, but safety concerns mean this herbal product is not a therapeutic option at present.
Article
Hot flushes affect approximately 75% of postmenopausal women and are one of the most distressing symptoms that women experience as they enter the menopause.The treatment of hot flushes is a common clinical challenge. Hormone replacement therapy (HRT) effectively reduces vasomotor symptoms by 80-90%, however, many patients may be unable or unwilling to undergo hormonal treatment. Publication of the results of the Women's Health Initiative (WHI) and the Million Women Study (MWS) has led to considerable uncertainties about the role of HRT among health professionals and women. The estrogen and progestin arm of the Women's Health Initiative and other recent reports suggest that HRT may increase the risk for coronary heart disease events, strokes, venous thromboembolism, and invasive breast cancer. Many expert groups recommend that combination hormonal therapy for the management of vasomotor symptoms should be limited to the shortest duration consistent with treatment goals and benefits versus risks for individual women. All of these concerns have generated interest in non-hormonal treatment of hot flushes. Such therapies, readily available for the menopausal patient could become a therapeutic nightmare -especially when taken without physician supervision. Data for these therapies are limited, and most of the studies have been conducted in women with a history of breast cancer. In this review we discuss the evidence underlying the commonly used non-hormonal therapies for hot flushes in terms of efficacy and safety.
Book
Established for more than thirty years as one of the world's most widely read gynecology texts, Clinical Gynecologic Endocrinology and Infertility is now in its Eighth Edition. In a clear, user-friendly style enhanced by abundant illustrations, algorithms, and tables, the book provides a complete explanation of the female endocrine system and its disorders and offers practical guidance on evaluation and treatment of female endocrine problems and infertility. Major sections cover reproductive physiology, clinical endocrinology, contraception and infertility. This edition has a modern full-color design.A companion website includes the fully searchable text, image bank and links to PubMed references.
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To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.
Article
To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.