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The effect of ginseng on sexual dysfunction in menopausal women: A double-blind, randomized, controlled trial
Abstract
Objectives:
Sexual problems constitute a largely-overlooked problem for women during menopause. The present study was conducted to determine the effect of Ginseng on sexual function (primary outcome), quality of life and menopausal symptoms (secondary outcomes) in postmenopausal women with sexual dysfunction.
Design:
This randomized controlled trial was conducted on 62 women who were randomly assigned to the intervention/control groups using block randomization.
Intervention:
The intervention group received 500 mg of Panax Ginseng and the control group received placebo twice daily for four weeks.
Main outcome measures:
Standard questionnaires including the Female Sexual Function Index (FSFI), the Menopause-Specific Quality of Life (MENQOL) and the Greene Menopausal Symptom Scale were completed before and four weeks after the intervention.
Results:
There were no statistically significant differences between the two groups in terms of demographic characteristics and the baseline scores of sexual function, quality of life and menopausal symptoms (P > 0.05). After the intervention, the mean total score of FSFI (Adjusted Mean Difference = 6.32, 95% CI = 3.48 to 9.16, P < 0.001) was significantly higher in the intervention group compared to the control group. The mean total score of quality of life (AMD=-20.79, 95% CI=-25.83 to -15.75, P < 0.001) and menopausal symptoms (AMD=-8.25, 95% CI=-10.55 to -5.95, P < 0.001) were significantly lower in the treatment group than the control group.
Conclusion:
Ginseng has significant effects in improving sexual function and quality of life and mitigating menopausal symptoms. As a multipotent plant, Ginseng can be a suitable alternative for conventional therapies to promote the health of menopausal women.
... Of the 527 eligible studies, 17 RCTs were eligible [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], and 2 duplicate reports [19,25] among the final 15 included were removed ( Fig. 1 and Table 1). There were 2 ongoing trials ( Table 2). ...
... There were 2 ongoing trials ( Table 2). Eleven of the included studies were conducted in Korea [12,15,16,18,[20][21][22][23][24]26,27], one study was from Sweden [13], one study was from the USA [28], and two studies were from Iran [14,17]. Ten studies used Korean red ginseng (KRG) [12,15,16,18,[20][21][22][23]26,27], one study used fermented KRG [24], two studies used American ginseng (Ginsena and another commercial supplement) [13,28], and the other two studies used Panax ginseng [14,17]. ...
... Eleven of the included studies were conducted in Korea [12,15,16,18,[20][21][22][23][24]26,27], one study was from Sweden [13], one study was from the USA [28], and two studies were from Iran [14,17]. Ten studies used Korean red ginseng (KRG) [12,15,16,18,[20][21][22][23]26,27], one study used fermented KRG [24], two studies used American ginseng (Ginsena and another commercial supplement) [13,28], and the other two studies used Panax ginseng [14,17]. Thirteen RCTs used a parallel group design [12-14,16-18,20-24, 27,28], and two used a crossover design [15,26]. ...
Purpose
This systematic review aimed to update the evidence of ginseng on menopausal women's health care.
Methods
We searched seven databases (PubMed, AMED, EMBASE, the Cochrane Library, RISS, and KoreaMed) from their inception to April 2022 and included all placebo-controlled RCTs comparing any type of ginseng in menopausal women. The methodological quality of all studies was assessed using the Cochrane Risk of Bias Tool 2.0.
Results
We included 15 RCTs with our inclusion criteria. The majority of studies considered bias a concern. Ginseng reduced menopausal symptoms in three studies (n = 515; standardized mean difference (SMD): −0.40, 95% confidence interval (CI): −0.73 to −0.07, P = 0.02) and lowed hot flashes (n = 515; SMD: −0.34, 95% CI: −0.66 to −0.01, P = 0.04). The meta-analysis of three other studies failed to show that ginseng was beneficial for sexual function (n = 491; SMD: 0.31, 95% CI: −0.30 to 0.92, P = 0.32). Three RCTs showed positive effects of ginseng on the quality of life score (n = 515, SMD: −0.31, 95% CI: −0.61 to −0.01, P = 0.05). In two studies, ginseng failed to produce significant effects on the vaginal maturation index and vaginal pH. Another three RCTs failed to demonstrate a beneficial effect of Korean red ginseng (KRG) on endometrial thickness.
Conclusion
This study demonstrated that ginseng can significantly reduce hot flashes, menopausal symptoms, and quality of life in menopausal women. In contrast, neither KRG nor ginseng appeared to have any direct effect on sexual dysfunction, hormones or biomarkers, or endometrial thickness. More rigorous RCTs are needed to overcome the current limitations.
... The NHMRC evidence hierarchy was used to assess the level of evidence of the included studies. Seventeen studies were rated level II (randomized controlled trial; RCT) (Abedi et al., 2018;Akhtari et al., 2014;Brooks et al., 2008;Chung et al., 2015;Darvish-Mofrad-Kashani et al., 2018;de Souza et al., 2016;Del Giorno et al., 2010;Eliasvandi et al., 2018;Ferguson et al., 2003;Ghorbani et al., 2019;Khayatan et al., 2019;Malakouti et al., 2017;Meston et al., 2008;Oh et al., 2010;Postigo et al., 2016;Shabanian et al., 2018;Vale et al., 2018), whereas two studies adopted a crossover design (Brooks et al., 2008;Chung et al., 2015), two studies were rated level III-2 (cohort study) (Palacios et al., 2019;Waynberg and Brewer, 2000) and one study was rated level IV (cross-sectional study) (Cai et al., 2014). The risk of bias was determined using a modified McMaster Critical Appraisal Tool for quantitative studies and was measured in percentage as per criteria fulfilled (see Supplementary Table S1). ...
... The risk of bias was determined using a modified McMaster Critical Appraisal Tool for quantitative studies and was measured in percentage as per criteria fulfilled (see Supplementary Table S1). Eleven studies were rated >90% (Abedi et al., 2018;Akhtari et al., 2014;Cai et al., 2014;Darvish-Mofrad-Kashani et al., 2018;de Souza et al., 2016;Eliasvandi et al., 2018;Ghorbani et al., 2019;Khayatan et al., 2019;Malakouti et al., 2017;Oh et al., 2010;Palacios et al., 2019), six studies were rated 80-90% (Brooks et al., 2008;Del Giorno et al., 2010;Ferguson et al., 2003;Meston et al., 2008;Postigo et al., 2016;Vale et al., 2018) and each one of the three studies was rated 70-80% (Shabanian et al., 2018), 60-70% (Chung et al., 2015), and <60% (Waynberg and Brewer, 2000). All of the included RCTs reported how randomization was carried out. ...
... Seventeen studies found that there were changes in the total score on the scale used to measure female sexual function, and 11 studies reported significant changes when exposed to a natural product (Abedi et al., 2018;Akhtari et al., 2014;Brooks et al., 2008;Cai et al., 2014;Darvish-Mofrad-Kashani et al., 2018;Eliasvandi et al., 2018;Ferguson et al., 2003;Ghorbani et al., 2019;Malakouti et al., 2017;Palacios et al., 2019;Postigo et al., 2016). This indicates that exposure to a specific natural product causes changes in the total score of the female sexual function scale, resulting in FSD improvement. ...
Background
: Female sexual dysfunction (FSD) includes female orgasmic disorder, female sexual interest or arousal disorder, and genito-pelvic pain or penetration disorder. FSD affects 40% of women worldwide, but it is understudied and likely undertreated. Natural products are frequently used by women to treat FSD, but scientific evidence of their efficacy is lacking.
Objective
: This systematic review and meta-analysis focused on the study of the efficacy of natural products on FSD.
Study design
: Systematic review and meta-analysis of existing studies on natural products in the treatment of FSD.
Methods
: The literature search included MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trial databases for studies published from January 2000 to February 2020. The quality and the level of evidence of the studies were assessed. The association between natural products and FSD was summarized using standardized mean differences (SMD) with a 95% confidence interval (CI).
Results
: A total of 536 studies were identified, with 20 of them meeting the criteria. According to this meta-analysis, Tribulus terrestris showed a significant positive effect in improving overall female sexual function (SMD = 1.12, 95% CI = 0.46 - 1.79, p = 0.001) and individual sexual arousal (SMD = 1.03, 95% CI = 0.22 - 1.84, p = 0.013), sexual desire (SMD = 1.08, 95% CI = 0.52 - 1.63, p = <0.001) and sexual orgasm (SMD = 0.51, 95% CI = 0.02 - 1.00, p = 0.040) domains compared to placebo. Panax ginseng was found to be effective in treating sexual arousal (SMD = 0.54, 95% CI = 0.11 - 0.97, p = 0.014) and sexual desire (SMD = 0.59, 95% CI = 0.27 - 0.90, p < 0.001) compared to placebo. Meanwhile, other natural products reviewed in this study, such as Trifolium pretense, did not differ significantly from placebo in terms of improving FSD.
Conclusion
: Preliminary evidence suggests that Tribulus terrestris and Panax ginseng may be effective as alternative treatments for FSD in a clinical setting.
... [67] [ [65][66][67] Gin seng Contains Phytoestrogenic properties. [68] Ginsenosides in ginseng have various biological and pharmacological activities. [69] Improve sexual function and arousal and improve hot flashes. ...
... [70] Improve sexual function and quality of life and reduce menopausal symptoms and enhance menopausal women's health. [68] Reduce oxidative stress by increasing antioxidant enzyme activity in postmenopausal women. [69] Improvement of menopausal symptoms and reduce the risk of cardiovascular disease [71] antidepression. ...
... [70] Randomized, double-blind, placebo-controlled. [68,69,71] Clinical trial. [72] [ [68][69][70][71][72] of complementary and alternative medicine, we can mention herbal medicine, acupuncture, and acupressure for the treatment of menopausal symptoms. ...
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 helps to strengthen the adrenal system, which is affected by hormonal changes during menopause. 98,99 ...
... Red ginseng, scientifically named Panax ginseng C. Meyer, is one of the most common forms of ginseng, which contains phytoestrogens and is widely used in East Asia (20). In a 2019 study by Ghorbani et al, looking at the effect of ginseng on the sexual function of menopausal women, sexual function increased in all areas (desire, arousal, orgasm, satisfaction, lubrication, and pain) (P < 0.001) (21). In a 2016 study by Kim et al, the MRS in the ginseng group decreased from 12.45 ± 8.79 to 8.32 ± 6.75, while it decreased from 10.23 ± 7.30 to 9.26 ±7.51 in the placebo group. ...
Sexual function is one of the most important aspects of menopausal women, and its disorder
is a common condition among this group of women. The long-term side effects of hormone
replacement therapy to improve this disorder have led women to seek alternative therapies.
The purpose of this review is to summarize clinical trials of herbal medicines that improve
the sexual function of menopausal women. In this review article the content was searched
in 6 databases to identify double- and triple-blind clinical trial studies from January 2000 to
April 2020. The search was conducted in English and Persian. Studies were considered if they
were related to menopausal woman, sexual function and its various domains. A total of 479
articles were reviewed, 31 of which were included in the study after reviewing the full text.
In this study, 3 articles on ginseng, 4 articles on fennel, 2 articles on Fenugreek, 3 articles on
bindii, 3 articles on Red clover, 1 article on Schisandra, 2 articles on Hops; 3 articles about
Black cohosh, 2 articles about soy, 2 articles about Ginkgo biloba, 1 article about Nigella sativa,
1 article about neroli oil, 1 article about maca, 1 article about Date pollen, 1 article about
Aphrodite and 1 article on the combination of St John’s wort and vitex were evaluated. Red
ginseng, fennel, bindii, Red clover and Black cohosh have the greatest effect on improving
the sexual function of menopausal women, and people can be encouraged to use these plants.
... Red ginseng, scientifically named Panax ginseng C. Meyer, is one of the most common forms of ginseng, which contains phytoestrogens and is widely used in East Asia (20). In a 2019 study by Ghorbani et al, looking at the effect of ginseng on the sexual function of menopausal women, sexual function increased in all areas (desire, arousal, orgasm, satisfaction, lubrication, and pain) (P < 0.001) (21). In a 2016 study by Kim et al, the MRS in the ginseng group decreased from 12.45 ± 8.79 to 8.32 ± 6.75, while it decreased from 10.23 ± 7.30 to 9.26 ±7.51 in the placebo group. ...
Sexual function is one of the most important aspects of menopausal women, and its disorder is a common condition among this group of women. The long-term side effects of hormone replacement therapy to improve this disorder have led women to seek alternative therapies. The purpose of this review is to summarize clinical trials of herbal medicines that improve the sexual function of menopausal women. In this review article the content was searched in 6 databases to identify double-and triple-blind clinical trial studies from January 2000 to April 2020. The search was conducted in English and Persian. Studies were considered if they were related to menopausal woman, sexual function and its various domains. A total of 479 articles were reviewed, 31 of which were included in the study after reviewing the full text. In this study, 3 articles on ginseng, 4 articles on fennel, 2 articles on Fenugreek, 3 articles on Bindii, 3 articles on Red clover, 1 article on Schisandra, 2 articles on Hops; 3 articles about Black cohosh, 2 articles about soy, 2 articles about Ginkgo biloba, 1 article about Nigella sativa, 1 article about neroli oil, 1 article about Maca, 1 article about Date pollen, 1 article about Aphrodite and 1 article on the combination of St John's wort and vitex were evaluated. Red ginseng, fennel, bindii, Red clover and Black cohosh have the greatest effect on improving the sexual function of menopausal women, and people can be encouraged to use these plants. A B S T R A C T
... Seo et al. [174] found that ginseng can reduce oxidative stress by increasing the activity of antioxidant enzymes in postmenopausal women. Ghorbani et al. [175] found that ginseng can significantly improve sexual function and quality of life and reduce menopausal symptoms in menopausal women. The use of ginseng preparations by patients with type 2 diabetes can help to maintain good blood glucose control and safely improve plasma glucose and plasma insulin regulation [176]. ...
Panax ginseng (Meyer) and Panax notoginseng (Burkill), belonging to the family Araliaceae, are used worldwide as medicinal and functional herbs. Numerous publications over the past decades have revealed that both P. notoginseng and P. ginseng contain important bioactive ingredients such as ginsenosides and exert multiple pharmacological effects on nervous system and immune diseases. However, based on traditional Chinese medicine (TCM) theory, their applications clearly differ as ginseng reinforces vital energy and notoginseng promotes blood circulation. In this article, we review the similarities and differences between ginseng and notoginseng in terms of their chemical composition and pharmacological effects. Their chemical comparisons indicate that ginseng contains more polysaccharides and amino acids, while notoginseng has more saponins, volatile oil, and polyacetylenes. Regarding pharmacological effects, ginseng exhibits better protective effects on cardiovascular disease, nerve disease, cancer, and diabetes mellitus, whereas notoginseng displays a superior protective effect on cerebrovascular disease. The evidence presented in this review facilitates further research and clinical applications of these two herbs, and exploration of the relationship between the chemical components and disease efficacy may be the critical next step.
... This observation held consistent with the MEN-QOL scores, and a reduction in menopausal symptoms was also significant. (Ghorbani et al., 2019). ...
Ethnopharmacological relevance:
Female Sexual Dysfunction is a complex condition with biopsychosocial origins. With limited FDA approved treatment options, plants traditionally used as aphrodisiacs may be a therapeutic option.
Aim:
To distinguish the plants commonly used in female aphrodisiac products (AP) on the market, and to evaluate their ethnobotanical and clinical evidence as a basis for their inclusion.
Methods:
This study is a narrative review of 42 plants commonly found in AP on the market. Most species listed have anecdotal use as aphrodisiacs throughout history; therefore, a systematic search was done for clinical evidence. The primary outcome assessed is the clinical efficacy of plants in the treatment of libido desire disorders.
Results:
Little evidence from the literature to substantiate claims of plants currently on the market as AP for female libido.
Conclusions:
Studies of plants used as ingredients for AP are severely lacking. There is no plant currently used in any AP with a strong enough clinical finding to be recommended for libido/desire disorders. Further research should aim to develop and validate in vitro models corresponding to the neurobiological underpinnings evident in FSD as markers for further studying in vivo efficacy in animal models before moving on to humans.
Background: Sexual performance is among the most important aspects of postmenopausal women's life. The long-term side effects of hormone replacement therapy during menopause have led women towards the use of complementary therapies to improve sexual performance. This systematic review was conducted to investigate the effectiveness of complementary therapies in improving the sexual performance of postmenopausal women. Methods: In this systematic review, studies in English and Persian languages were searched in national (SID, Magiran, and IranMedex) and international databases (PubMed, Science Direct, Embase, Cochrane Library, and Google Scholar) until 2023. The search keywords were selected based on the Medical Subject Heading (MeSH) and included "Sexual Dysfunctions", "Menopause", "Complementary medicine", "Alternative medicine" combined with Boolean operators (OR and AND). Finally, quality assessment and data extraction were performed independently by two researchers using Cochran's standard tool. Findings: Finally, 22 articles with a total sample size of 1617 participants were selected. The types of the articles were randomized and non-randomized clinical trials. Studies showed that aroma therapy, combined inhalation aromatherapy, and herbal compounds, including combined herbal capsules containing red ginseng extract, saffron, red clover and black cohosh, date palm pollen and Althaea officinalis improved sexual performance in menopausal women. Furthermore, performing activities, including yoga, Benson relaxation and CBT had the greatest effect on sexual performance. Conclusion: Based on the results of the present study, most complementary medicine treatments were effective in improving the sexual performance of postmenopausal women.
Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women.
Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied.
Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women.
Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors.
Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO 2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study).
Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).
Background
Ginseng has been used as a traditional medicine for treatment of many diseases and for general health maintenance. Previously, we showed that ginseng did not demonstrate estrogenic property in ovariectomized mouse model. However, it is still possible that disruption of steroidogenesis leading to indirect hormonal activity.
Methods
The hormonal activities were examined in compliance with OECD guidelines for detecting endocrine disrupting chemicals: test guideline (TG) No. 456 (an in vitro assay method for detecting steroidogenesis property) and TG No. 440 (an in vivo short-term screening method for chemicals with uterotrophic property).
Results
Korean red ginseng (KRG) and ginsenosides Rb1, Rg1, and Rg3 did not interfere with estrogen and testosterone hormone synthesis as examined in H295 cells according to TG 456. KRG treatment to ovariectomized mice did not show a significant change in uterine weight. In addition, serum estrogen and testosterone levels were not change by KRG intake.
Conclusion
These results clearly demonstrate that there is no steroidogenic activity associated with KRG and no disruption of the hypothalamic-pituitary-gonadal axis by KRG. Additional tests will be performed in pursuit of cellular molecular targets of ginseng to manifest mode of action.
Background
A reduction in ovarian hormones, which is distinctive of menopause, often involves signs and symptoms that compromise the quality of life and health of women. The transient manifestations are changes in the menstrual cycle, vasomotor symptoms, neuropsychological symptoms, and genitourinary changes. In some cases, the hormonal changes can evolve to nontransitory manifestations, which include urinary incontinence, changes in metabolism, osteoporosis, and cardiovascular diseases. Hormone replacement therapy is the treatment of choice to alleviate transient symptoms of menopause; however, there are many limitations, contraindications, and situations in which the risks of adverse effects are high, such as coronary artery disease, stroke, venous thromboembolism, dementia, type 2 diabetes, and the increased incidence of breast cancer.
Objective
This work aims to highlight important medicinal plants for the treatment of the transient symptoms of menopause, with less side effects than traditional hormone replacement therapy.
Results
There is sufficient information regarding the efficacy and safety for the use of the following plant species in the treatment of transient symptoms of menopause: Actaea racemosa, Glycine max, Trifolium pratense, Salvia officinalis, Humulus lupulus, Panax ginseng, Vitex agnus-castus, and Trigonella foenum-graecum. Additionally, the search indicated the chemical classes related to the benefits of the selected species, adverse effects, and interactions with other drugs.
Kadın yaşamında önemli bir yere sahip olan menopoz dönemi, kadınların yaşam kalitesini bozarak tedavi olmalarını gerektiren semptomlara neden olmaktadır. Bazı kadınlar, semptomların yönetiminde medikal tedavileri yan etkileri nedeniyle kullanmak istememektedir. Medikal tedavilerden daha güvenilir ve doğal gördükleri için fitoterapi (bitkisel tedaviler) gibi geleneksel ve tamamlayıcı tedavi uygulamalarını (GETAT) seçmekte ve son yıllarda bu yöntemlere ilgi giderek artmaktadır. Menopoz semptomlarının yönetiminde fitoterapi kullanımıyla ilgili hemşirelerin bilgi sahibi olmaları ve kadınlara doğru bir şekilde danışmanlık vermeleri sağlık açısından oldukça önemlidir. Derlemede, kadınların menopoz semptomlarının yönetiminde sıklıkla başvurdukları fitoterapi yöntemleriyle ilgili çalışmaların kanıt düzeylerinin incelenmesi amaçlanmıştır.
Introduction:
Menopause is a critical period of the woman life, characterized by a peculiar modification in estrogens concentration and accompanied by different signs and symptoms. To prevent and contrast unfavorable consequences of menopause, different therapeutic approach could be evaluated. The hormone replacement therapy (HRT) is the most known, but it has several contraindications. The increasing interest in phytotherapy introduces the necessity for endocrinologist involved in menopause to suggest different therapeutic approach, considering the state of health of patient and the real efficacy of the drug. We aim to outline the main phytotherapy treatments to choose in menopause.
Evidence acquisition:
Phytotherapy involves the use of plants or plant extracts for the treatment of diseases thanks to the activities of their compounds and metabolites. In particular, many of them have an estrogen-like activity and are identified as phytoestrogens, because thanks to their chemical structure are able to bind the estrogen receptors and carry out biological estrogenic or anti-estrogenic activities. The supplementing diet with these compounds can ensure an advantage on various aspects of the climacteric syndrome and some of them also have a beneficial impact on cardiovascular risk, bone health and sleep complaint. These substances can be used with safety due to their good tolerability and low rate of side effects. There are no known serious adverse events associated with their consumption, but as a precaution, its use is not recommended during pregnancy and in association with hormonal therapies or in women with hormone responsive-cancers.
Conclusions:
Phytotherapy has to be considered an interesting tool in the treatment of sign and symptoms in selected menopause woman.
Background
Female sexual dysfunction (FSD) is a common complaint among postmenopausal women, which is largely because of the genitourinary syndrome in these women (GSM).
Aim
Considering the phytoestrogenic effects of chamomile, the present study was primarily aimed to investigate the effect of chamomile vaginal gel on the sexual function of postmenopausal women. The side effects of these drugs were evaluated as a secondary outcome of the study.
Methods
This randomized double-blind clinical trial and placebo-controlled study was conducted on postmenopausal women with sexual dysfunction (FSFI ≤26.55). To this aim, 96 postmenopausal women were randomly assigned into three groups (n = 32 each) including women receiving (i) chamomile vaginal gel 5%, (ii) conjugated estrogen vaginal cream, and (iii) placebo vaginal gel, for 12 weeks (ie, every night in the first 2 weeks, and 2 nights per week in the next 10 weeks, each night 1 g was used). The sexual function was measured using female sexual function index (FSFI) before and after the intervention. Data analysis was performed by chi-square, one-way ANOVA, descriptive statistics, analysis of covariance (ANCOVA), and paired t test using SPSS software version 22. P < .05 was considered statistically significant.
Outcomes
The main study outcome measure was evaluate the effects of vaginal administration of chamomile gel in comparison with conjugated estrogen cream and placebo gel on postmenopausal FSD using the FSFI.
Results
The findings showed that chamomile vaginal gel in compared to placebo vaginal gel caused a significant improvement in all six sexual function domains and the total FSFI score (effect size = +2.9 [95% CI, +2.1 to +3.6], P < .001). Also, there was no significant difference between the chamomile vaginal gel and conjugated estrogen vaginal cream groups in terms of the total score and all sub-domains of sexual function with the exception of orgasm (effect size = +0.13 [95% CI, −0.36 to +0.63], P = .02) and sexual satisfaction (effect size = 0 [95% CI, −0.49 to +0.49], P = .04). Two women in the chamomile group and one in the placebo group experienced a burning sensation (P = .345).
Clinical Implications
This treatment can be considered as a treatment option for postmenopausal women with sexual dysfunction who have contraindications to the use of hormone therapy.
Strengths & Limitations
This study is the first study to investigate the effectiveness of chamomile vaginal gel on sexual function in postmenopausal women. However, in this study, treatment duration was 12 weeks and no follow up was performed beyond this time
Conclusion
Based on the results of this study, the use of vaginal chamomile gel improved sexual function in postmenopausal women.
Bosak Z, Iravani M, Moghimipour E, et al. Effect of Chamomile Vaginal Gel on the Sexual Function in Postmenopausal Women: A Double-Blind Randomized Controlled Trial. J Sex Med 2022;XX:XXX–XXX.
Zusammenfassung
Blattextrakte von Damiana (Turnera diffusa) werden in der Therapie des Mangels oder Verlusts von sexuellem Verlangen eingesetzt. Zur Erhebung der Veränderung der empfundenen klinischen Symptomatik wurde eine multizentrische, nicht-interventionelle Studie (NIS) bei Frauen (n=70) durchgeführt. Nach achtwöchiger Einnahme eines pflanzlichen Arzneimittels mit Damiana-Extrakt (675 mg täglich) zeigten die Patientinnen (n=35; 46,1±10,9 Jahre) eine signifikante Zunahme beim weiblichen sexuellen Funktionsindex (Female Sexual Function Index (FSFI-d); p<0,01) und dessen Domänen. Währenddessen sank der Score der weiblichen sexuellen Belastungsskala (Female Sexual Distress Scale–Revised (FSDS-R)) signifikant (p<0,01) bei tendenzieller Zunahme der Lebensqualität (Münchner Lebensqualitäts-Dimensionen Liste (MLDL)). Die Ergebnisse der NIS legen nahe, dass das Arzneimittel einen positiven Beitrag auf die individuelle Symptomatik sowie den empfundenen persönlichen Leidensdruck leisten kann und können daher als Basis für konfirmatorische klinische Studien dienen.
Dünya Sağlık Örgütü cinsel sağlığı: “Sadece hastalık, işlev bozukluğu veya sakatlığın olmaması değil, fiziksel, duygusal, zihinsel ve sosyal yönden cinsellikle ilgili iyilik hali” olarak tanımlamaktadır. Bireylerin, çiftlerin ve ailelerin genel sağlığı ve refahında önemli bir yere sahip olan cinsel sağlığı etkileyen faktörler arasında cinsel işlev bozuklukları yer almaktadır. Dünyada ve Türkiye’de birçok birey cinsel işlev bozukluklarını yaşamaktadır. Erkeklerde erken boşalma, sertleşme bozukluğu; kadınlarda ise orgazm bozukluğu, cinsel ilgi/uyarılma bozukluğu gibi cinsel işlev bozuklukları bulunmaktadır. Cinsel işlev bozuklukları, çiftlerin ilişki kalitesini olumsuz etkilemekte, hem kadın hem de erkekte anksiyete ve depresyona neden olabilmektedir. Günümüzde, cinsel işlev bozuklukları tedavisinde, medikal tedavinin yanı sıra geleneksel ve tamamlayıcı tedavi uygulamalarının kullanım sıklığı da tıp hekiminden veya batı tıbbından memnun olmama, tıbbi ilaçların yan etkilerinden kaçınma, doğal yöntemleri tercih etme gibi nedenlerden dolayı giderek artmaktadır. Ulusal Tamamlayıcı ve İntegratif Sağlık Merkezi bu yöntemleri doğal ürünler, zihin ve beden uygulamaları ve bu grupların hiçbirine tam olarak uymayan diğer tamamlayıcı sağlık yaklaşımları olarak ayırmıştır. Cinsel işlev bozukluklarının tedavisinde bu geleneksel ve tamamlayıcı tedavi uygulamalarından yararlanılmasına rağmen çok azının etkinliği kanıt düzeyi yüksek çalışmalarda gösterilmiştir. Bu derlemede kadın ve erkeklerde görülen cinsel işlev bozukluklarında yararlanılan geleneksel ve tamamlayıcı tedavi uygulamalarıyla ilgili yapılan çalışmaların kanıt düzeyleri incelenmiştir.
There are several types of ginseng, including Asian (Panax ginseng) and American ginseng (Panax quinquefolius), both of which are considered adaptogens. For both plants, the active constituents come from the roots. Based on available clinical evidence, Asian ginseng would be the preferred ginseng for congestive heart failure, menopause, or erectile dysfunction, whereas American ginseng would be preferred for diabetes, cognitive enhancement, and prevention or treatment of upper respiratory infections. This chapter examines some of the scientific research conducted on ginseng, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of the herb’s use in treating ophthalmological, ENT, cardiovascular, cardiometabolic, genitourinary, neurologic, and immune disorders, among others. Finally, the chapter presents a list of ginseng’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.
Menopause symptoms affect the various dimensions of women's lives and they can lead to reduction of their quality of life. Phytoestrogens can be used as an approach to diminish these symptoms.
The aim of the study was to investigate the effect of phytoestrogens on the improvement of genitourinary symptoms in postmenopausal women.
This is a systematic review article. PubMed, EMBASE, Web of Science, Scopus, ProQuest and Science Direct databases were systematically searched from the 2000 -2020. All clinical trials were included. The quality of the selected papers was evaluated by the CONSOT checklist.
34 eligible high-quality papers were reviewed. Various forms of phytoestrogens such as Fennel, PuerariaMirifica, Hop plant (Humuluslupulus L.), Glycine Max (L.) Merr, soy, red clover, black cohosh, ginsing, Cimicifugaracemosa, Genistein, Diadzein and Isoflavone in the form of a food supplement, enriched powder, gel, cream and vaginal suppository could improve menopausal genitourinary symptoms. The recovery rate in vaginal use of these phytoestrogens was greater than other consumptions.
The use of phytoestrogens as a safe, low-risk and almost accessible method for women can relieve genitourinary symptoms and promote the satisfaction and quality of life of postmenopausal women.
O objetivo do presente estudo foi analisar os efeitos da utilização de fitoterápicos por mulheres saudáveis sobre os sinais e sintomas do climatério e menopausa. Trata-se de uma revisão integrativa, cuja operacionalização possibilita a síntese do conhecimento já produzido no período de janeiro de 2015 a dezembro de 2019, a coleta de dados foi realizada por meio das seguintes bibliotecas virtuais: SciELO e BVS com acesso através das bases de dados BDENF, LILACS e MEDLINE via Pubmed. Foram analisados 24 artigos que demonstraram que os fitoterápicos são efetivos para a redução dos sinais e sintomas vasomotores, neuropsíquicos, disfunção sexual, alterações urogenitais e distúrbios metabólicos decorrentes da menopausa. Dentre os fitoterápicos mais utilizados observou-se as isoflavonas de soja, foeniculum vulgare, trigonella foenum-graecum e o tribulus terrestris. Os fitoterápicos abordados apresentaram resultados significativos para as queixas climatéricas manifestadas em mulheres saudáveis, podendo desta forma ser uma boa alternativa terapêutica para o seu tratamento específico.
Genitourinary syndrome of menopause (GSM) is found to be the most important cause of genitopelvic pain disorders among menopausal women. The term GSM includes genital symptoms (dryness, burning and irritation), sexual symptoms (lack of lubrication, discomfort or pain) and urinary symptoms (urgency, dysuria and recurrent urinary tract infections). Indeed, estrogen deprivation has a profound physiological impact throughout the body leading to changes in many organs and systems; it engages the whole genitourinary system, and the bladder and lower urinary tract are no exception. The GSM lead often to sexual complains at different levels (desire, arousal, lubrication, orgasm, satisfaction) and the physician need to consider all factors that worsen the patient’s quality of life (QoL), also sexual one. The usage of estrogen therapy is controversial in the treatment of both urinary incontinence and pelvic floor disorders, while several positive effects on sexual function have been reported in surgical therapies. Thus, the therapeutic strategies need a multidisciplinary management and an accurate diagnostic evaluation, in order to verify not only physiological issues but also psychological and relational consequences of the urogynecological complain on patient quality of life.
Ginseng has been traditionally used for several millennia in Asian countries, including Korea, China, and Japan, not only as a nourishing and tonifying agent but also as a therapeutic agent for a variety of diseases. In recent years, the various effects of red ginseng including immunity improvement, fatigue relief, memory improvement, blood circulation improvement, antioxidation, mitigation of menopausal women's symptoms, and anticancer an effect have been reported in clinical as well as basic research. Around the world, there is a trend of the rising consumption of health functional foods on the level of disease prevention along with increased interest in maintaining health because of population aging and the awareness of lifestyle diseases and chronic diseases. Red ginseng occupies an important position as a health functional food. But till now, international ginseng monographs including those of the World Health Organization have been based on data on white ginseng and have mentioned red ginseng only partly. Therefore, the red ginseng monograph is needed for component of red ginseng, functionality certified as a health functional food in the Korea Food and Drug Administration, major efficacy, action mechanism, and safety. The present red ginseng monograph will contribute to providing accurate information on red ginseng to agencies, businesses, and consumers both in South Korea and abroad.
Background:
Millions of people with chronic illness suffer from fatigue. Fatigue is a complex, multidimensional symptom with poorly understood causes, wide variations in severity among individuals, and negative effects on multiple domains of daily life. Many patients with fatigue report the use of herbal remedies. Ginseng is one of the most widely used because it is believed to improve energy, physical and emotional health, and well-being.
Objective:
To systematically review the published evidence to evaluate the safety and effectiveness of the two types of Panax ginseng (Asian [Panax ginseng] and American [Panax quinquefolius]) as treatments for fatigue.
Design:
PubMed, CINAHL (Cumulative Index to Nursing and Allied Health), Ovid MEDLINE, and EMBASE databases were searched using Medical Subject Heading and keyword terms, including ginseng, Panax, ginsenosides, ginsenoside* (wild card), fatigue, fatigue syndrome, cancer-related fatigue, and chronic fatigue. Studies were included if participants had fatigue, had used one of the two Panax ginsengs as an intervention, and had scores from a self-report fatigue measure. Two reviewers independently assessed each article at each review phase and met to develop consensus on included studies. Risk of bias was assessed using version 5.3 of the Cochrane Collaboration Review Manager (RevMan), and results were synthesized in a narrative summary.
Results:
The search strategy resulted in 149 articles, with 1 additional article located through review of references. After titles, abstracts, and full text were reviewed, 139 articles did not meet inclusion criteria. For the 10 studies reviewed, there was a low risk of adverse events associated with the use of ginseng and modest evidence for its efficacy.
Conclusions:
Ginseng is a promising treatment for fatigue. Both American and Asian ginseng may be viable treatments for fatigue in people with chronic illness. Because of ginseng's widespread use, a critical need exists for continued research that is methodologically stronger and that includes more diverse samples before ginseng is adopted as a standard treatment option for fatigue.
Introduction
Menopause results in metabolic changes that contribute to increase risk of cardiovascular diseases: increase in low density lipoprotein (LDL) and triglycerides and decrease in high density lipoprotein (HDL), weight gain are associated with a correspondent increase in incidence of hypertension and diabetes. The aim of this study was to evaluate the effect of a preparation of isoflavones, calcium vitamin D and inulin in menopausal women.
Material and methods
We performed a prospective, randomized, placebo-controlled, parallel-group study. A total of 50 patients were randomized to receive either oral preparations of isoflavones (40 mg), calcium (500 mg) vitamin D (300 UI) and inulin (3 g) or placebo (control group). Pre- and post-treatment assessment of quality of life and sexual function were performed through Menopause-Specific Quality of Life Questionnaire (MENQOL) and Female Sexual Function Index (FSFI); evaluations of anthropometric indicators, body composition through bioelectrical impedance analyser, lumbar spine and proximal femur T-score and lipid profile were performed.
Results
After 12 months, a significant reduction in MENQOL vasomotor, physical and sexual domain scores (p < 0.05) and a significant increase in all FSFI domain scores (p < 0.05) were observed in treatment group. Laboratory tests showed significant increase in serum levels of HDL (p < 0.05). No significant changes of lumbar spine and femur neck T-score (p > 0.05) were found in the same group.
Conclusions
According to our data analysis, isoflavones, calcium, vitamin D and inulin may exert favourable effects on menopausal symptoms and signs.
Background
Ginsenosides are the main ingredients of Korean red ginseng. They have extensively been studied for their beneficial value in neurodegenerative diseases such as Parkinson's disease (PD). However, the multitarget effects of Korean red ginseng extract (KRGE) with various components are unclear.
Methods
We investigated the multitarget activities of KRGE on neurological dysfunction and neurotoxicity in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)–induced mouse model of PD. KRGE (37.5 mg/kg/day, 75 mg/kg/day, or 150 mg/kg/day, per os (p.o.)) was given daily before or after MPTP intoxication.
Results
Pretreatment with 150 mg/kg/day KRGE produced the greatest positive effect on motor dysfunction as assessed using rotarod, pole, and nesting tests, and on the survival rate. KRGE displayed a wide therapeutic time window. These effects were related to reductions in the loss of tyrosine hydroxylase–immunoreactive dopaminergic neurons, apoptosis, microglial activation, and activation of inflammatory factors in the substantia nigra pars compacta and/or striatum after MPTP intoxication. In addition, pretreatment with KRGE activated the nuclear factor erythroid 2–related factor 2 pathways and inhibited phosphorylation of the mitogen-activated protein kinases and nuclear factor-kappa B signaling pathways, as well as blocked the alteration of blood–brain barrier integrity.
Conclusion
These results suggest that KRGE may effectively reduce MPTP-induced neurotoxicity with a wide therapeutic time window through multitarget effects including antiapoptosis, antiinflammation, antioxidant, and maintenance of blood–brain barrier integrity. KRGE has potential as a multitarget drug or functional food for safe preventive and therapeutic strategies for PD.
Aging is an irreversible physiological process that affects all humans. Numerous theories have been proposed to regarding the process from a Western medicine perspective; however, ancient Chinese medicine practices and theories have increasingly gained attention, particularly ginseng, a grass that has been studied for the anti-aging properties of its active constituents. This review seeks to analyze current data on ginseng and its anti-aging properties. The plant species, characteristics, and active ingredients will be introduced. The main part of this review is focused on ginseng and its active components with regards to their effects on prolonging lifespan, the regulation of multiple organ systems including cardiovascular, nervous, immune, and skin, as well as the anti-oxidant and anti-inflammatory properties. The molecular mechanisms of these properties elucidated via various studies are summarized as further evidence of the anti-aging effects of ginseng.
Aim:
The aim of this paper was to evaluate the effects of the association between palmitoylethanolamide (PEA) and α-lipoic acid (LA) on quality of life (QoL) and sexual function in women affected by endometriosis-associated pelvic pain.
Methods:
Fifty-six women constituted the study group and were given PEA 300 mg and LA 300mg twice daily To define the endometriosis-associated pelvic pain, the visual analogic scale (VAS) was used. The Short Form-36 (SF-36), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess the QoL, the sexual function and the sexual distress, respectively. The study included three follow-ups at 3, 6 and 9 months.
Results:
No changes were observed in pain, QoL and sexual function at the 3rd month follow-up (P=NS). By the 6th and 9th month, pain symptoms (P<0.001) and all categories of the QoL (P<0.001) improved. The FSFI and the FSDS scores did not change at the 3rd month follow-up (P=ns). On the contrary, at the 3rd and 9th months follow-ups they improved with respect to the baseline (P<0.001).
Conclusion:
The progressive reduction of the pain syndrome reported by women over the treatment period could contribute to improve the QoL and sexual life of women on PEA and LA.
Introduction: Measuring the quality of life among menopause women is one of the efficiency proofs in health education; hence, this study was conducted to determine the effect of structured educational program by support group on quality of life among menopause women. Methods: In a single blind field study from August to December 2011 in Saadatmandy health care center of Robat Karim town, 110 menopause women meeting inclusion criteria were selected through convenience sampling method. After taking the consent form, they were randomly allocated to either of the control or support group (55 subjects in each group). The support group was divided into 6 groups (5 groups of 9 and a group of 10 subjects). The educational program was performed in predetermined day of the week and for 10 consecutive sessions of 120 minutes.The scores for quality of life level achieved before the educational program and a month after that were compared using Menopause specific quality of life questionnaire (MENQOL). No intervention was done in control group. Results: The execution of structured educational program by support group in intervention group indicated a statistically significant difference in quality of life level among menopause women (reduction of symptoms from 153
.76±38.61 to 113.31±24.35 score, P<0.001). No significant change was found in quality of life scores achieved by control group. Conclusion: Structured educational program by support group could be used as an appropriate strategy which helps menopause women to promote their health and encounter with menopause symptoms in a healthier manner and in conclusion promote their quality of life, so this educational program could be applied in health intervention and health care programs in our country. Keywords: Structured educational program, support group, quality of life, menopause women, health education Addresses: 1 Instructor, Department of Midwifery, School of Nursing and Midwifery, Alborz University of Medical Sciences, Alborz, Iran. Email: mansoyazd@yahoo.com 2 () Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Email: Keshavarz_m@tums.ac.ir 3 Assistant Professor, School of Health, Tehran University of Medical Sciences, Tehran, Iran. Email: effat_mer@yahoo.com 4 Instructor, Department of Biostatistics, School of Management and Medical Information, Tehran University of Medical Sciences, Tehran, Iran. Email: fatemeh_h@yahoo.com
Archive
The study evaluated the effect of DHA 625 mg in women who experience menopausal symptoms, on sexuality and quality of life (QoL), and on the auditory brainstem response (ABR). Forty-two perimenopausal women were enrolled. The Kupperman Index (KI) was used to evaluate menopause symptoms. The Short Form-36 (SF-36), Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function, and sexual distress, respectively. Auditory evoked potentials to measure the ABR. The study had one follow-up at 6 months. The women reported an improvement in the KI total score (p < .001). Moreover, women reported QoL improvements in all the psychological categories (p < .001), but not in physical categories (p = NS). FSFI and FSDS total scores increased (p < .01) and the FSDS score decreased (p < .01), mainly due to arousal (p < .03) and lubrication (p < .05) sexual aspects. The ABR wave latencies were lower than the baseline values (p < .05). DHA could be effective in modulating some perimenopausal symptoms in women and, consequently could contribute to improve their QoL and sexual life. Finally, DHA seems to have a direct activity on the neuronal conduction time into the audiological system.
Objective:
To evaluate the efficacy of low concentrations of vaginal estriol gel in postmenopausal women with pelvic static disorders before and after vaginal surgical treatment, assessing vaginal health, sexual function, and quality of life (QoL).
Methods:
Women affected by genital prolapse were enrolled. Vaginal health, QoL, and sexual function were investigated at baseline (T0), before surgery (T1), and 13 weeks after surgery (T2). At baseline, participants were randomized 1:1. Women in group A (38 women) were treated daily with vaginal gel containing 50??g estriol for 12 weeks and women in group B (37 women) did not receive any estrogen treatment. After this period and before surgery, a first examination was carried out (T1). One week after surgical treatment, group A underwent randomization 1:1 to group A1 repeating estriol vaginal gel for 12 weeks, and group A2 discontinuing the estrogen treatment. The second follow-up examination (T2) was performed at the 13th week after surgery.
Results:
All aspects of vaginal health improved in group A on estriol before surgery with respect to baseline (P?<?0.001). After surgery, 17 participants of group A1, 16 of group A2, and 30 of group B completed the study. Group A1 (on estriol plus surgery) further improved with respect to the presurgery estriol treatment (P?<?0.01). Moreover, group A2 (T2) experienced a worsening of vaginal health versus intragroup presurgery estriol treatment (P?<?0.01), and versus intergroup surgical estriol treatment (P?<?0.05). QoL improved in women only after surgery, with (P?<?0.01) or without (P?<?0.05) estriol treatment. Finally, the sexual function of participants on estriol before surgery did not change. On the contrary, it improved after surgery in both participants on estriol (P?<?0.001) and without estriol (P?<?0.01). Moreover, surgical estriol participants had a better score than surgical no-estriol participants (P?<?0.05).
Conclusions:
Estriol vaginal gel (0.005%) administration significantly improved the vaginal health of natural postmenopausal women before and after vaginal surgery. Both sexual health and QoL also significantly improved after surgery.
Objectives:
To investigate the effects of a combined oral contraceptive (COC) containing 17β-estradiol (E2) 1.5 mg and nomegestrol acetate 2.5 mg (NOMAC/E2) on the sexual health of women affected by low sexual desire due to COCs containing ethinylestradiol.
Materials and methods:
Eighty-three women (age range 19-32) participated in the study. Sex hormone-binding globulin (SHBG), total testosterone (TT), and free androgen index (FAI) were measured. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and distress, respectively. Hormonal levels were measured and questionnaires were administered before the women switched COC NOMAC/E2 usage (baseline) and at the 3-month (first) and 6-month (second) follow-ups.
Results:
SHBG reduction (p < 0.001), TT (p < 0.05), and FAI increases (p < 0.001) were observed during the first and second follow-ups with respect to baseline values. Sexual desire increased from baseline to the first and second follow-ups (p < 0.001). At baseline, the total FSFI score was 22 ± 1.5 and the FSDS score was 16.6 ± 1.3, both indicating sexual dysfunction with sexual distress. At the first follow-up, the total FSFI score and the FSDS score increased toward sexual health values, being 28.3 ± 1.6 and 12.1 ± 1.5, respectively (p < 0.001). At the second follow-up, the FSFI score had risen to 30.6 ± 1.3 (p < 0.001) and the FSDS score had dropped to 8.3 ± 1.4 (p < 0.001).
Conclusions:
COCs containing E2 are an innovation that could help women to not suffer from low sexual desire during hypoandrogenic COC usage.
Background:
The aim of this systematic review was to update, complete, and critically evaluate the evidence from placebo-controlled randomized clinical trials (RCTs) of ginseng for managing menopausal women's health.
Methods:
We searched the literature using 13 databases (MEDLINE, AMED, EMBASE, the Cochrane Library, 6 Korean Medical, and 3 Chinese Databases) from their inception to July 2016 and included all double-blind RCTs that compared any type of ginseng with a placebo control in postmenopausal women. The methodological quality of all studies was assessed using a Cochrane risk of bias tool.
Results:
Ten RCTs met our inclusion criteria. Most RCTs had unclear risk of bias. One RCT did not show a significant difference in hot flash frequency between Korean red ginseng (KRG) and placebo. The second RCT reported positive effects of KRG on menopausal symptoms. The third RCT found beneficial effects of ginseng (Ginsena) on depression, well-being, and general health. Four RCTs failed to show significant differences in various hormones between KRG and placebo controls except dehydroepiandrosterone. Two other RCTs failed to show effects of KRG on endometrial thickness in menopausal women. The other RCT also failed to show the effects of American ginseng on oxidative stress markers and other antioxidant enzymes.
Conclusion:
Our systematic review provided positive evidence of ginseng for sexual function and KRG for sexual arousal and total hot flashes score in menopausal women. However, the results of KRG or ginseng failed to show specific effects on hot flash frequency, hormones, biomarkers, or endometrial thickness. The level of evidence for these findings was low because of unclear risk of bias.
Purpose
The aim of the study was to evaluate the effects of nutraceuticals containing Equol, Resveratrol, Quecitine and Passiflora (Zemiar®, Avantgarde, Pomezia, Rome, Italy) on quality of life (QoL) and sexual function in perimenopausal women.
Methods
Sixty perimenopausal women having vasomotor symptoms and being in the −1, +1a of the STRAW system (amenorrhea for longer than 60 days and FSH < 20 UI/L) were enrolled. The modified Kupperman Index (KI) was used to evaluate menopause symptoms. The Short Form-36 (SF-36), Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function and sexual distress, respectively. The study had two follow-ups at 3 and 6 months.
Results
The women reported an improvement in the KI total score from the baseline (35 ± 4) to the 1st (21 ± 3, p < 0.05) and the 2nd (18 ± 2, p < 0.01) follow-ups. At the 1st follow-up, the women reported QoL improvements in some functions (p < 0.05); at the 2nd follow-up, they reported improvements in all categories (p < 0.001). At baseline, the total FSFI score was 23.1 ± 1.2 and the FSDS score was 18.1 ± 1.4, both indicating sexual dysfunction with sexual distress. FSFI and FSDS total scores did not change at the 1st follow-up (p = NS). On the contrary, at the 2nd follow-up, the FSFI score had risen to (27.6 ± 1.5) (p < 0.001) and the FSDS score had dropped to (11.3 ± 1.2) (p < 0.001).
Conclusions
Nutraceuticals can be effective in modulating the perimenopausal symptoms in women. The progressive reduction of the vasomotor symptoms reported by women over the nutraceutical usage could contribute to improve their QoL and sexual life.
This study investigated whether Korean red ginseng (KRG) extracts could improve sexual function in premenopausal women. Forty-one premenopausal women participated in this placebo-controlled, double-blind, and crossover clinical study with administration of either three ginseng capsules (1 g per capsule) or placebo daily. After 8 weeks of medication of KRG or placebo, medication was changed for the subjects to placebo or KRG after 2 weeks of washout period. The efficacy of KRG extracts was measured by using Female Sexual Function Index (FSFI).
Results
. Twenty-three women completed the study. Total FSFI scores increased after KRG treatment (from
20.13
±
2.87
to
23.98
±
4.10
,
p
=
0.015
) and placebo treatment (from
20.06
±
2.64
to
23.78
±
3.28
,
p
=
0.003
). However, this change was not significantly different between the two groups (
p
=
0.702
). KRG treatment significantly improved sexual desire, arousal, orgasm, and satisfaction domains; however, there was no treatment effect compared with placebo. There was a case of gastric discomfort after taking KRG extracts. Oral administration of KRG extracts improved sexual function in premenopausal women; however, there were no statistical significant changes compared to placebo. It implies that KRG extracts have a substantial placebo effect in premenopausal women with sexual dysfunction.
Background and purpose: Sexual health is a state of physical, mental and social well-being in relation to sexuality. This study aimed to determine the status of sexual function, its dimensions, and its socio-demographic predictors in women of reproductive age in Tabriz, Iran, in 2013.
The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital symptoms (dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function, but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections). The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used until recently, had a limitation because they did not cover the full spectrum of symptoms and did not imply that the symptoms are related to a decreased estrogen level in menopause. Since the GSM may have a profound negative impact on the quality of life of postmenopausal women, women should be made aware of these problems and treated with an appropriate effective therapy. Thus, in this review we introduce new terminology and discuss the importance of comprehension of GSM and the necessity of active treatment of this syndrome in postmenopausal women.
In multi-target drug design (MTD) medicinal chemistry aims to integrate multiple pharmacophores into a single drug molecule in order to make it active on several molecular biological mechanisms simultaneously. Given the fact that most diseases are multifactorial in nature, MTD is being pursued with increasing intensity, which has resulted in improved outcomes in disease models and several compounds have entered clinical trials. In a wide range of examples we illustrate how various functionalities have been combined within single structures and how this has affected their (pre)clinical outcome. This review describes the successful application of MTD for disorders such as neurodegenerative, cardiovascular, diabetes, metabolic and inflammatory diseases, especially focusing on the field of atherosclerosis where multi-target strategies are a promising alternative to the classical “one target-one drug” design approach.
Ginseng is a popular herb for alleviating menopausal symptoms; however, no conclusive scientific data has shown ginseng as being efficient in such therapies. The present study was designed to evaluate the estrogenic efficacy of ginseng on reproductive target tissues of ovariectomized (OVX) mice. The OVX mice were treated with ginseng at doses of 12.0, 18.0 and 24.0 g/kg per day for four weeks. Ginseng treatments restored the estrus cycle and demonstrated significant estrogenic activity, as indicated by the reversal of the atrophy of the uterus and vagina, upregulation of estrogen receptor (ER) α and ER β expression at the protein and mRNA level in the reproductive tissues, where ER α upregulation was stronger than that of ER β. Meanwhile, treatment with ginseng significantly increased adrenal gland weight and serum estradiol and clearly decreased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in circulation. Notably, the largest changes in these parameters were found at the highest dose of 24.0 g/kg. Moreover, ginseng at 18.0 g/kg resulted in the greatest decrease in weight gain caused by ovariectomy. The data suggest that ginseng estrogenic responses show tissue variation that reflects different affinities of ERs for ginseng components. This study demonstrates that ginseng activity is mediated through estrogenic components and provides further evidence for ginseng treatment of postmenopausal symptoms.
Introduction:
Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years.
Areas covered:
We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy.
Expert opinion:
International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.
The aim of this review was to assess the effectiveness of ginseng as a treatment option for managing menopause symptoms. We searched the literature using 11 databases from their inception to 26 September 2012 and included all randomized clinical trials (RCTs) that compared any type of ginseng to a placebo controls in postmenopausal women. The methodological quality of all studies was assessed using a Cochrane risk of bias tool. Four RCTs met our inclusion criteria. Most RCTs had high risk of bias. One RCT showed that Korean red ginseng (KRG) significantly improved sexual arousal and global health compared with placebo. Another RCT reported the superiority of KRG over placebo for treating menopause symptoms on Kupperman's index and menopausal rating score. The third RCT failed to show a significant effect of KRG on hot flash frequency compared to placebo. The fourth RCT found beneficial effects of ginseng compared to placebo on depression and well-being. In conclusion, the evidence on ginseng as an effective treatment for managing menopause symptoms is limited. Most of the RCTs are burdened with a high risk of bias. Thus firm conclusions cannot be drawn. Rigorous studies seem warranted.
Ginseng is one of the most widely used herbal medicines and is reported to have a wide range of therapeutic and pharmacological applications. Ginseng may also be potentially valuable in treating cardiovascular diseases. Research concerning cardiovascular disease is focusing on purified individual ginsenoside constituents of ginseng to reveal specific mechanisms instead of using whole ginseng extracts. The most commonly studied ginsenosides are Rb1, Rg1, Rg3, Rh1, Re, and Rd. The molecular mechanisms and medical applications of ginsenosides in the treatment of cardiovascular disease have attracted much attention and been the subject of numerous publications. Here, we review the current literature on the myriad pharmacological functions and the potential benefits of ginseng in this area. In vitro investigations using cell cultures and in vivo animal models have indicated ginseng's potential cardiovascular benefits through diverse mechanisms that include antioxidation, modifying vasomotor function, reducing platelet adhesion, influencing ion channels, altering autonomic neurotransmitters release, and improving lipid profiles. Some 40 ginsenosides have been identified. Each may have different effects in pharmacology and mechanisms due to their different chemical structures. This review also summarizes results of relevant clinical trials regarding the cardiovascular effects of ginseng, particularly in the management of hypertension and improving cardiovascular function.
Panax ginseng C.A. Meyer is a common herb with many purported health benefits. However, there is no conclusive evidence supporting its use in the treatment of any particular disease. We conducted a systematic review to evaluate randomised controlled trials. Four English databases were searched with no publication date restriction. Included studies evaluated P. ginseng in patients with any type of disease or in healthy individuals. We assessed the quality of studies using the Cochrane risk of bias tool. Of the 475 potentially relevant studies, 65 met the inclusion criteria. These studies examined P. ginseng's effects on psychomotor performance (17 studies), physical performance (ten), circulatory system (eight), glucose metabolism (six), the respiratory system (five), erectile dysfunction (four), immunomodulation (four), quality of life/mood (four), antioxidant function (two), cancer (two), menopausal symptoms (two) and dry mouth (one). The risk of bias was unclear in most studies. Authors evaluated adverse events in 40 studies, with 135 minor events and no serious adverse events reported. P. ginseng shows promising results for improving glucose metabolism and moderating the immune response. This may have implications for several diseases including type 2 diabetes and chronic respiratory conditions. Further studies are needed to explore P. ginseng's potential as an effective treatment for these and other health conditions. Copyright © 2012 John Wiley & Sons, Ltd.
Objective:
The aim of this study was to evaluate the efficacy and safety of a new low-concentration estriol formulation (0.005% estriol vaginal gel), providing an ultra low dose of estriol per application (50 μg), for the local treatment of postmenopausal vaginal atrophy.
Methods:
Postmenopausal women with symptoms and signs of vaginal atrophy were enrolled in a prospective, double-blind, placebo-controlled study. Women received either 1 g of vaginal gel containing 50 μg of estriol or placebo gel, daily for 3 weeks and then twice weekly up to 12 weeks. A cytological vaginal study, evaluation of vaginal pH, and assessment of symptoms and signs of vaginal atrophy were performed, and changes between baseline and weeks 3 and 12 were assessed. Adverse events were recorded.
Results:
A total of 167 women were included (114 received estriol and 53 received placebo). After 12 weeks of therapy, a superiority of estriol compared with placebo gel was shown in the change in maturation value and vaginal pH (P < 0.001 and P < 0.001, respectively). The superiority of estriol was well demonstrated in improvement of vaginal dryness (P = 0.001) and the Global Symptom Score (P = 0.018). Estriol gel proved also superior in the improvement of several of the most outstanding vaginal signs of vaginal atrophy evaluated. After 3 weeks, estriol gel also showed a superiority over the placebo gel in most symptoms and signs evaluated. Treatment-related adverse events were similar among groups.
Conclusions:
0.005% Estriol vaginal gel, a new formulation providing an ultra low dose of estriol per application, was shown to be safe and effective in the treatment of postmenopausal vaginal atrophy.
The extracts of Korean red ginseng (EKG) is a complex mixture containing ginsenosides, polysaccharides, and several other products. Animal experiments have shown that the intravenous administration of extract of ginseng reduces blood pressure. Recently, it has been reported that ginseng has a relaxing effect on vascular smooth muscle and that the relaxation is associated with nitric oxide (NO) released from the vascular endothelium. The present study was undertaken to investigate the effects of EKG on isolated rabbit corpus cavernosal smooth muscle for evaluation of the possibility of developing EKG as an pharmacoerecting agent. Strips of rabbit corpus cavernosum were mounted in organ chambers to measure isometric tension. On the precontracted muscle strip with phenylephrine (PHE; 5 x 10(-6) M), EKG began to exert a relaxing effect at the concentration of 1 mg/ml and the maximal relaxation effect was reached at 40 mg/ml in a dose-dependent manner. EKG was inhibited significantly by endothelial disruption and by pretreatment with methylene blue, pyrogallol, L-NNA or atropine. EKG partially inhibited the PHE (5 x 10(-6) M) induced contraction up to 45.67% of the control in a dose-dependent fashion. EKG decreased basal tension as well as inhibited the contraction induced by addition of CaCl2 (10(-3) M) dose-dependently in muscle strips at basal equilibrated state in Ca2+ free, high K+ depolarizing solution. EKG also inhibited the contraction induced by depolarization with 20, 40 and 60 mM of KCl. However, this inhibitory effect did not occur with high concentrations of KCl (80 and 120 mM). EKG has a relaxing effect on the rabbit corpus cavernosal tissue in a dose dependent manner. The relaxation action of EKG is mediated by multiple action mechanisms that include increasing the release of NO from the corporal sinusoids, increasing intracellular calcium sequestration, and a hyperpolarizing action.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
The prevalence of polypharmacy in the elderly has risen during the last 20 years. At present, Thailand is coming aged
society which the number of older adults aged 60 or over increase to 16% of total population. Older patients usually present
with multiple comorbidities related to advanced age, resulting in increased demand for medications. Furthermore, other
risk factors of polypharmacy are age, education, the frequency of health care services and easily approachable medication.
The prevalence of polypharmacy in Thailand has varied, ranging from 29% to 75%. Polypharmacy has negative impact
on the elderly such as drug-drug interactions, drug-disease interactions, adverse drug reactions and events, duplicated
drugs, nonadherence, morbidity as well as mortality. Moreover, polypharmacy has profoundly negative effect on health
care systems including expenditure of human resources and medical resources. Prevention of polypharmacy should get
cooperation by multidisciplinary team including physicians, nurses, pharmacists, the elderly and caregivers. In terms of
health care personnel, comprehensive geriatric assessment and taking history of comorbidities and medications should
be concerned before making decision for treatment. However, physicians should start treatment by non-pharmacological
treatment. The strategies of pharmacological treatment in the elderly are consideration of risks and benefits of regimens,
adjustment of doses for renal and hepatic impairment as well as start with a low dose and slow titration. Furthermore,
physicians and pharmacists should be aware of drug-drug interactions, drug-disease interactions as well as adverse drug
reactions and events during treatment. Finally, development of electronic prescription and medical reconciliation can help
physicians and pharmacists monitor efficacy of drug usages and detect prescription problems.
Keywords: Polypharmacy, Elderly, Drug-related problems, Drug administration
Objectives: An increase in life expectancy results in the aging population growth. This study was designed to evaluate the efficacy and adverse events of ginseng that could be used as a herbal medicine in women with sexual dysfunction.
Materials and Methods: The authors of this study searched Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases without a time limitation until May 2018 and examined all the randomized clinical trials (RCTs) that compared the effect of different types of ginseng on sexual function of menopausal women as compared to the placebo controls. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. The heterogeneity was determined using the I2 index. In addition, standardized mean difference (SMD) was used instead of mean differences (MD) and a random effect was reported instead of fixed effect in meta-analysis.
Results: The eligibility criteria were found in five RCTs. All the included studies were placebo-controlled. Two trials had a parallel design while three studies used a crossover design. Although four trials indicated that ginseng significantly improved sexual function, they didn’t report any treatment effect compared to the placebo group. Based on the results of meta-analysis obtained from five studies including 531 women, there was no statistically significant effect of ginseng on female sexual dysfunction (FSD) compared to the placebo control group (SMD: 0.26; 95% CI: -0.26 to 0.76). Nonetheless, there was a considerable heterogeneity among the studies (I2 = 81%; P < 0.0001). Moreover, all the included studies assessed adverse events, but in three of the RCTs, there was no significant difference between the placebo and ginseng groups.
Conclusions: The evidence regarding ginseng as a therapeutic agent for sexual dysfunction is unjustifiable. Rigorous studies seem warranted in this respect.
Aims and objectives
To analyse the prevalence, risk factors and evolution over time of polypharmacy and self‐medication in the older people in Spain from 2006‐2014.
Background
Polypharmacy is a public health problem for older people worldwide that cause different negative effects on their health, increasing health costs and pharmaceutical spending. However, previous studies do not include nationally representative samples and none of them provide updated data.
Design
Cross‐sectional study with community‐dwelling older adults (N=26,277) who participated in the National Health Survey in Spain in 2006 and 2011/12 and the European Health Survey in Spain in 2009 and 2014.
Methods
Polypharmacy (defined as use of five or more medications in the last two weeks), excessive polypharmacy (defined as use of ten or more medications in the last two weeks) and self‐medication (defined as use of medications without a prescription) were evaluated. A logistic regression was used for to know the association between polypharmacy and self‐medication with the sociodemographic characteristic.
Results
The participants were 62% female and 38% male. The mean medication consumption was 2.96 (SD±2.11). Prevalence of polypharmacy was present in 21.9%, prevalence of excessive polypharmacy was 0.6% and prevalence of self‐medication was 10.7%. The most commonly used medications were for blood pressure (51.6%), pain (42.8%) and cholesterol (28.2%). Polypharmacy is associated with sex (females), age, being separated/divorced/widowed, lack of education, higher body mass index, being bedridden during the last two weeks and self‐medication.
Conclusions
The prevalence of polypharmacy and self‐medication are considerable and they increased significantly from 2006 to 2014.
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This study aimed to identify and then synthesize all available data regarding the efficacy of laser therapy for postmenopausal women with genitourinary syndrome of menopause (GSM) with/without urinary incontinence (UI). PubMed, Scopus, Web of Science, Cochrane Library and ClinicalTrials.gov were searched in October 2016. The keywords were “laser genitourinary syndrome of menopause”, “laser vulvovaginal atrophy”, “laser vaginal atrophy” and “laser women incontinence”. Quality of reporting and risk of bias of the included studies were assessed according to STROBE and MINORs checklists, respectively. Quality of the body of evidence was evaluated with the GRADE approach. Fourteen studies involving 542 participants were included in this systematic review and meta-analysis. All GSM symptoms (dryness/dyspareunia/itching/burning/dysuria/urgency/frequency) and UI decreased significantly and consistently in all available publications. The pooled mean differences for the various symptoms were: dryness −5.5(95%CI:-6.7,-4.4;7studies;I²:0%), dyspareunia −5.6(95%CI:-6.8,-4.5;7 studies;I²:0%), itching −4(95%CI:-5.7,-2.2;6 studies;I²:79%), burning −3.9(95%CI:-5.9,-2;6 studies;I²:87%), dysuria −2.9(95%CI:-5.1,-0.7;4 studies;I²:90%) and UI −4.9(95%CI:-6.4,-3.4;2 studies;I²:0%). Because urgency/frequency was assessed by different methodologies the data could not be meta-analyzed. Furthermore, KHQ, UDI-6, MCS12/PCS12, FSFI, overall sexual satisfaction and measurements of the effect of laser therapy on the local pathophysiology improved significantly. In conclusion, laser therapy for postmenopausal women with GSM appears promising. It may reduce symptom severity, improve quality of life of postmenopausal women and restore the vaginal mucosa to premenopausal status. However, the quality of the body of evidence is “low” or “very low” and, thus, evidence-based modification of current clinical practice cannot be suggested.
To evaluate the efficacy and safety of red ginseng on women's health-related quality of life (QOL) and sexual function. A randomized, double-blind, placebo-controlled, crossover clinical study was performed. The main efficacy was measured using the Female Sexual Function Index (FSFl) and the 36-Item Short-Form Health Survey (SF-36). Twenty-four healthy, married women aged 30-45 years with FSFl scores below 25 were randomly divided into two groups: the red-ginseng group (N=12) and the placebo group (N=12). During the first six-week period (Study 1), each group was given red ginseng or placebo twice a day. Before the start of the second six-week period (Study 2), a crossover design was chosen with a two-week break (washout period). Interchanging the two groups after the washout period, red ginseng and placebo were given to each group. The outcomes were measured before and after each six-week period. Overall, 23 participants completed the study. In Study 1, the changes relative to the baseline in the FSFl total score were 22.50% and 22.99% for red ginseng and placebo, respectively. In Study 2, the relative changes were 8.14% for red ginseng and 6.29% for placebo. The results showed a greater improving trend in Study 1 with respect to all of the participants' sexual functions, but no significant difference was found between the groups (P=0.9567). After taking red ginseng, all the participants exhibited an improving trend in the desire domain of FSFl, but no significant difference was shown. In the measurement of SF-36, no significant difference was likewise shown. After taking red ginseng, though, all the participants exhibited an improving trend in the physical functioning (PF) domain of SF-36, with no significant difference. Moreover, there was no significant adverse event related to red ginseng. The QOL and sexual function of the study participants in the red-ginseng group were mostly improved, but no statistically significant effect of red ginseng was shown. It is supposed that this result was partly due to the affirmative impression of red ginseng in Korea. Thus, it is anticipated that a long-term clinical trial will show a significant effect of red ginseng on the QOL and sexual function.
Background and purpose: Quality of life (QOL) is believed to be influenced by sexual function during menopause. The aim of this study was to investigate the relationship between sexual function and QOL among post-menopausal women. Materials and methods: We performed a community-based, descriptive-analytical study of 405 post-menopausal women, aged 40 to 65 years. A multi-stage, randomized sampling was conducted. Data was obtained through interviews using the Female Sexual Function Index (FSFI), World Health Organization Quality of Life-BRIEF)WHOQOL-BREF(, and a researcher-made questionnaire. Data was then analyzed using t-test and multiple linear regression. Results: The mean age and mean duration of menopause were 52.84±3.7 years and 19.8±14.4 months, respectively. Among the subjects 324 (80%) were housewives and 369 (91.2%) had diploma or lower levels of education. The mean total score of QOL was 54.53±7.18. The highest and lowest scores were associated with physical health and psychological health domains, respectively. Overall, 61% had female sexual dysfunction (FSD). The total scores for FSFI were in a positive correlation with the total scores for WHOQOL-BREF (r=0.285, P<0.001) and the scores for all domains of QOL. The scores in all domains of FSFI, except in the domain of pain, had a positive correlation with the total score of QOL (P<0.001). Satisfaction with marital relationship in post-menopausal women was associated with an increase in QOL (P<0.001, r=0.258). Conclusion: Sexual dysfunction could have a negative impact on the quality of life in post-menopausal women. Therefore, to enhance the quality of life in this population sexual dysfunction requires more attention when implementing women’s health initiatives. © 2016, Mazandaran University of Medical Sciences. All Rights reserved.
Ginseng, an herbaceous plant, belonging to the family Araliaceae is a traditional medicinal herb. Also, it is emerging as a functional food and potent adjunct medicine. Saponin ginsenosides (protopanaxadiol and protopanaxatriol) are the signature phytochemicals of this plant. With the surfacing of scientific validations, ginseng is gaining unprecedented attention from consumers as well as researchers. As a number of drug-herb interaction-caused health issues have emerged, the medicinal relevance of this plant has been critically assessed here. In this regard, the recent publications on health benefits of ginseng have been extracted from NCBI and ScienceDirect database. The claimed antioxidant, anti-inflammation, anti-fatigue, antidiabetic, antitumor, immunomodulation, anti-obesity, cardioprotective, antimicrobial, neuroprotective and aphrodisiac properties have been analyzed. This review presents a fair assessment and insights on complementary and alternative medicine (CAM) potential of this herb.
Objective:
To develop a condition-specific quality of life questionnaire for the menopause with documented psychometric properties, based on women's experience.
Methods:
Subjects:
Women 2-7 years post-menopause with a uterus and not currently on hormone replacement therapy. Questionnaire development: A list of 106 menopause symptoms was reduced using the importance score method. Replies to the item-reduction questionnaire from 88 women resulted in a 30-item questionnaire with four domains, vasomotor, physical, psychosocial and sexual, and a global quality of life question. Psychometric properties: A separate sample of 20 women was used to determine face validity, and a panel of experts was used to confirm content validity. Reliability, responsiveness and construct validity were determined within the context of a randomized controlled trial. Construct validation involved comparison with the Neugarten and Kraines'Somatic, Psychosomatic and Psychologic subscales, the reported intensity of hot flushes, the General Well-Being Schedule, Channon and Ballinger's Vaginal Symptoms Score and Libido Index, and the Life Satisfaction Index.
Results:
The face validity score was 4.7 out of a possible 5. Content validity was confirmed. Test-retest reliability measures, using intraclass correlation coefficients were 0.81, 0.79, 0.70 and 0.55 for the physical, psychosocial, sexual domains and the quality of life question. The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change. Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain, 0.66 and 0.40 for the vasomotor domain, 0.65 and -0.71 for the psychosocial domain, 0.48 and 0.38 for the sexual domain, and 0.57 for the quality of life question. Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain, 0.28 for the vasomotor domain, 0.55 and -0.54 for the psychosocial domain, 0.54 and 0.32 for the sexual domain, and 0.12 for the quality of life question. Responsiveness scores ranged from 0.78 to 1.34.
Conclusions:
The MENQOL (Menopause-Specific Quality of Life) questionnaire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life.
The major cause of urogenital atrophy in menopausal women is estrogen loss. The symptoms are usually progressive in nature and deteriorate with time from the menopausal transition. The most prevalent urogenital symptoms are vaginal dryness, vaginal irritation and itching. The genitourinary syndrome of menopause includes vulvovaginal atrophy and the postmenopausal modifications of the lower urinary tract. Dyspareunia and vaginal bleeding from fragile atrophic skin are common problems. Other urogenital complaints include frequency, nocturia, urgency, stress urinary incontinence and urinary tract infections. Atrophic changes of the vulva, vagina and lower urinary tract can have a large impact on the quality of life of the menopausal woman. However, hormonal and non-hormonal treatments can provide patients with the solution to regain the previous level of function. Therefore, clinicians should sensitively question and examine menopausal women, in order to correctly identify the pattern of changes in urogenital atrophy and manage them appropriately.
Genitourinary syndrome of menopause is a common condition that left untreated can progress and negatively affect quality of life and sexual function. Laser therapy has a therapeutic role for several gynecologic conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM). The laser is well tolerated and may increase thickness of the squamous epithelium and improve vascularity of the vagina. These morphological changes presumably alleviate symptoms of dryness, dyspareunia, and irritation. However, the duration of therapeutic effects and safety of repeated applications at this point is not clear. Further research is needed in the form of controlled studies of the laser and other non-hormonal GSM therapies. The objective of this paper is to review the existing literature describing laser therapy for GSM.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Background
In 2012, the Board of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause.
Methods
The 2 societies cosponsored a terminology consensus conference, which was held in May 2013.
Results and conclusion
Members of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis. The term was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology—genitourinary syndrome of menopause (GSM)—in 2014.
Ethnopharmacological relevance: Red ginseng (RG) has been widely used to treat various diseases in East Asian countries. Previous studies have shown the anti-oxidative and anti-diabetic effects of RG. This study aimed to investigate the effects of RG on oxidative stress and insulin resistance in postmenopausal women.
We performed a randomized, double-blind, placebo-controlled trial in 82 postmenopausal women aged 45-60 years. Participants were randomized to receive 3g red ginseng daily or placebo for 12 weeks. Antioxidant enzymes activity (superoxide dismutase, glutathione peroxidase) and oxidative stress markers (malondialdehyde, 8-hydroxydeoxyguanosine) were assessed, and the homeostatic model assessment of insulin resistance index was calculated at the baseline and at the end of the trial.
A total of 71 postmenopausal women completed the study. Serum superoxide dismutase activity was significantly increased after the 12-week RG supplementation (P<0.001), and these changes were statistically significant compared with the placebo group (P=0.004). Serum malondialdehyde levels showed a tendency to decrease after the 12-week RG supplementation (P=0.001), but these changes were not statistically significant compared with the placebo group (P=0.064). No statistically significant changes in serum glutathione peroxidase and 8-hydroxydeoxyguanosine were noted. Further, RG supplementation showed no effects on fasting glucose, fasting insulin, and insulin resistance.
The results suggest that RG may reduce oxidative stress by increasing antioxidant enzyme activity in postmenopausal women.
The diagnostic criteria of sexual dysfunctions (SDs) are paramount for the development of sexual medicine as reliable diagnoses are essential to guide treatment plans. Prior Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications based definitions of SD mostly on expert opinions and included imprecise terms. The validity of diagnoses of SD has only recently been challanged, and efforts are made to make more operational definitions.
This paper aims to compare and contrast the recently released Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of SD with that of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) and explains the rationale for making changes in the new DSM-5. It also aims to address some issues to be considered further for the future.
Online proposed American Psychiatric Association website DSM-5, the new released DSM-5, and DSM-IV-TR diagnostic criteria for SD were throughly inspected, and an extensive literature search was performed for comparative reasons.
Changes in diagnostic criteria of DSM-5 were detected, and DSM-IV-TR and DSM-5 diagnostic criteria for SD were compared and contrasted.
Diagostic criteria were more operationalized, and explicit duration and frequency criteria were set up in DSM-5 for purposes of good clinical research. Classifications based on simple linear sexual response were abondoned, and diagnostic classifications were separetely made for males and females. Desire and arousal disorders in women were merged.
Drifting apart from linear sexual response cycle may be an advancement in establishing specific diagnostic criteria for different genders. However, it is still a question of debate whether there is enough evidence to lump sexual interest and arousal disorders in females. Making more precise definitions is important to differentiate disorders from other transient conditions. However, there is still room to improve our definitions and find a way to include gay and lesbian individuals. Further discussions and debates are expected to be continued in the future. Sungur MZ and Gündüz A. A comparison of DSM-IV-TR and DSM-5 definitions for sexual dysfunctions: Critiques and challenges. J Sex Med **;**:**-**.
Increasing evidence that several drug compounds exert their effects through interactions with multiple targets is boosting the development of research fields that challenge the data reductionism approach. In this article, we review and discuss the concepts of drug repurposing, polypharmacology, chemogenomics, phenotypic screening and high-throughput in vivo testing of mixture-based libraries in an integrated manner. These research fields offer alternatives to the current paradigm of drug discovery, from a one target-one drug model to a multiple-target approach. Furthermore, the goals of lead identification are being expanded accordingly to identify not only 'key' compounds that fit with a single-target 'lock', but also 'master key' compounds that favorably interact with multiple targets (i.e. operate a set of desired locks to gain access to the expected clinical effects).
Female sexual dysfunction (FSD) is a prevalent problem in the female population in Iran. A subjective assessment instrument that allows cross-cultural comparison of FSD is urgently needed.
The aims of the study were to translate, validate, and enhance cross-cultural comparability of an Iranian version (IV) of the Female Sexual Function Index (FSFI)-the IV-FSFI.
A total of 448 women (19-54 years, mean 29.7, standard deviation 7.3) from five different Iranian outpatient obstetrics and gynecology clinics were eligible for this study. The IV-FSFI was developed through forward and backward translation, revision by a research team, and a subsequent pilot study. After an interview for clinical diagnosis of FSD based on the Diagnostic and Statistical Manual of Mental Disorders, all participants completed the IV-FSFI for the validation study. Three hundred sixty-two women completed the IV-FSFI again, 4 weeks after the first visit.
Test-retest reliability was determined by Pearson's product-moment correlations. Reliability was tested using Cronbach's alpha coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and by subsequent confirmatory factor analysis (CFA). Discriminant validity was assessed with between-groups analysis of variance.
The overall test-retest reliability coefficients were high for each domain of the IV-FSFI (r ranging from 0.73 to 0.86) and the internal consistencies within the acceptable range (α from 0.72 to 0.90). Principal component analysis with varimax rotation revealed a best fitting five-factor structure similar to the original FSFI (χ(2) = 2.1, degree of freedom = 17, P < 0.001). CFA confirmed the underlying domain structure, supporting the factorial validity of the IV-FSFI.
In conclusion, the newly developed IV-FSFI has demonstrated to be a reliable and valid instrument with good psychometric properties that allows a quick and accurate preliminary screening of women with unknown sexual health status in clinics and other medical settings.
The aim of this study was to evaluate the effects of red ginseng (RG) on menopausal symptoms and cardiovascular risk factors in postmenopausal women.
A randomized, placebo-controlled, double-blind clinical trial was conducted with postmenopausal women between the ages of 45 and 60 years. A total of 72 women were randomly assigned to either an RG group (supplemented with 3 g of RG, including 60 mg of ginsenosides, per day) or a placebo group for 12 weeks. We analyzed changes in menopausal symptoms (the Kupperman index and the menopause rating scale), cardiovascular risk factors (lipid profiles, high-sensitivity C-reactive protein, and carotid intima-media thickness), and serum estradiol levels from baseline to 12 weeks.
Significant improvements in the Kupperman index (P = 0.032) and in the menopause rating scale (P = 0.035) scores were observed in the RG group compared with the placebo group. Total cholesterol (P = 0.009) and low-density lipoprotein cholesterol (P = 0.015) significantly decreased in the group receiving RG. The RG group also showed a significant decrease in carotid intima-media thickness (P = 0.049). Serum estradiol levels were not influenced by RG supplementation.
RG could be an attractive herbal dietary supplement for relieving menopausal symptoms and conferring favorable effects on markers of cardiovascular disease in postmenopausal women.
We investigated the antioxidant effects of Panax ginseng C.A. Meyer on healthy volunteers. In a double-blind randomized controlled design, 82 participants (21 men and 61 women) who were considered healthy by both objective and subjective health standard were divided into three groups, the control group and the groups received P. ginseng extract (1 or 2g/day) for 4 weeks. Serum level of reactive oxygen species (ROS), malondialdehyde (MDA), total antioxidant capacity (TAC), the activities of catalase, superoxide dismutase (SOD), glutathione reductase (GSH-Rd), and peroxidase (GSH-Px), and total glutathione content were determined before and after the trial. Administration of P. ginseng led to significant decreases in the levels of serum ROS and MDA. Notably, the total glutathione content and GSH-Rd activity considerably improved in the groups that received 2g of P. ginseng. No significant alterations were observed in TAC, catalase, SOD, and GSH-Px activities. In conclusion, our findings indicate that P. ginseng was shown to have antioxidant property. It enhanced the antioxidant defense mechanism in healthy populations and the results may reinforce the use of P. ginseng as a potential antioxidant supplement.
Ginseng is the most popular herb. Ginseng is often referred as the ultimate tonic; the herb boosts general well-being, immune function, libido, and athletic performance. Ginseng is popularly used for its adaptogenic, antineoplastic, immunomodulatory, cardiovascular, CNS, endocrine, and ergogenic effects, but these uses have not been confirmed by clinical trials. A number of ginseng species used in herbal products grow around the world. Some of these plants include American ginseng, Korean ginseng, Sanchi ginseng, Chikusetsu ginseng. Ginseng is also known as Siberian ginseng, devil's shrub, eleuthero, touch-me-not, and wild pepper. Ginseng has been used to improve the body's resistance to stress and to increase vitality. However, the mechanisms underlying ginseng's effects remain to be investigated. Biological effects of ginseng are due to its anti-inflammatory effects, antineurological effect, hypoglycemia effect. Research has shown that drinking a cup of hot ginseng tea has an anti-inflammatory effect.
Many menopausal women experience climacteric symptoms including impairment of sexual function. Recent reports have suggested that Korean red ginseng (KRG) has a relaxing effect on the clitoral cavernosal muscle and vaginal smooth muscle in rats.
We assessed whether KRG extracts would improve sexual function in menopausal women.
Thirty-two menopausal women participated in a placebo-controlled, double-blind, crossover clinical study with administration of either three capsules of ginseng (1 g per capsule) or placebo daily. After completing the KRG or placebo arm, the participants were crossed over to the other arm after a 2-week washout period. The efficacy and safety of the KRG extracts were measured by using questionnaires.
Female Sexual Function Index (FSFI) and Global Assessment Questionnaire (GAQ).
Twenty-eight women completed the study. They were, on average, 51.2 + or - 4.1 years old, and their mean menopausal state was for a duration of 37.4 + or - 2.9 months. Few carryover effects were noted in either study arm. The ginseng extract significantly improved scores on the FSFI from 3.10 + or - 0.87 to 3.50 + or - 0.72 in the sexual arousal domain (P = 0.006). The GAQ was more significantly affected by ginseng extracts than by placebo (P = 0.046). There were no severe adverse events in the KRG group, although two cases of vaginal bleeding occurred during KRG treatment.
Oral administration of KRG extracts improved sexual arousal in menopausal women. Red ginseng extracts might be used as an alternative medicine in menopausal women to improve their sexual life.
The objective of this review is to assess the clinical evidence for or against ginseng as a treatment for Alzheimer's disease (AD). We searched 20 databases from their inception to January 2009 and included all randomized clinical trials (RCTs) of any type of Panax ginseng to treat human patients suffering from AD. Methodological quality was assessed using the Jadad score. Two RCTs met all inclusion criteria. They assessed the effectiveness of ginseng as an adjunct to drug therapy on cognitive function compared with conventional drug therapy. Their results suggested significant effect in favor of ginseng on the Mini-Mental Status Examination (n = 174, weight mean difference (WMD), 1.85; 95% confidence intervals, CIs 0.88 to 2.82, P = 0.0002) and on the Alzheimer's Disease Assessment Scale (ADAS)-cognitive (n = 174, WMD, 3.09; 95% CIs 1.08 to 5.09, P = 0.003). Both of these studies are burdened with serious methodological limitations. In conclusion, the evidence for ginseng as a treatment of AD is scarce and inconclusive. Further rigorous trials seem warranted.
Ginseng has been used by man for thousands of years, and Oriental folk medicine describes it as both a tonic for restoration of strength and a panacea (hence, the genus Panax, meaning all healing). The term 'ginseng' can refer to any of 22 related plants, but it is generally associated with P ginseng. Ginseng is classified pharmacologically as an adaptogen, because experimental studies suggest that it helps the body adapt to stress and corrects adrenal and thyroid dysfunction. The active principles are a mixture of glycosides, consisting of steroidal saponins, bound to various sugars. The most common route of administration is ingestion of the root, which has a sweet and slightly aromatic taste. Recently I have seen a number of intoxications requiring clinical attention. Patients whom I have seen at the Neuropsychiatric Institute of the University of California at Los Angeles suffered from chronic insomnia, nervousness, and loose stools, among other problems. These cases prompted an investigation of long-term ginseng users.
Women are increasingly turning to herbal therapies in an effort to manage their menopausal symptoms. In this study, we investigate the estrogenic activity of four selected herbs commonly used in menopause, namely dong quai, ginseng, black cohosh, and licorice root.
We investigated the effect of these selected herbs on cell proliferation of MCF-7 cells, a human breast cancer cell line. We also assessed their estrogenic activity in a transient gene expression assay system using HeLa cells co-transfected with an estrogen-dependent reporter plasmid in the presence of human estrogen receptor ER alpha or ER beta cDNA. Finally, we investigated the estrogenic activity of these herbs using a bioassay in mice.
Dong quai and ginseng both significantly induced the growth of MCF-7 cells by 16- and 27-fold, respectively, over that of untreated control cells, while black cohosh and licorice root did not. The herbs tested failed to show transactivation of either hER alpha or hER beta and had no effect on uterine weight in vivo when administered orally to mice for a period of 4 days.
Our studies show that dong quai and ginseng stimulate the growth of MCF-7 cells independent of estrogenic activity. Because of the lack of efficacy and the potential for adverse effects, use of these herbs in humans warrants caution pending further study.
To assess the time-dependent effects of Panax ginseng on health-related quality of life (HRQOL) by use of a general health status questionnaire.
Subjects were randomized in a double-blind manner to P. ginseng 200 mg/d (n = 15) or placebo (n = 15) for 8 weeks. The Short Form-36 Health Survey version 2 (SF-36v2), a validated general health status questionnaire, was used to assess HRQOL at baseline and at 4 and 8 weeks. HRQOL between the groups was compared by use of repeated-measures analysis of covariance. A p value <0.05 was considered statistically significant.
There were no significant differences in baseline demographics and SF-36v2 scores between the groups. After 4 weeks of therapy, higher scores in social functioning (P. ginseng 54.9+/-4.6 vs. placebo 49.2+/-6.5; p = 0.014), mental health (P. ginseng 52.2+/-7.7 vs. placebo 47.2+/-7.3; p = 0.075), and the mental component summary (P. ginseng 51.3+/-7.4 vs. placebo 44.3+/-8.3; p = 0.019) scales were observed in patients randomized to P. ginseng; these differences did not persist to the 8-week time point. The incidence of adverse effects was 33% in the P. ginseng group compared with 17% in the placebo group (p = 0.40). Subjects given P. ginseng (58%) were more likely to state that they received active therapy than subjects given placebo (17%; p < 0.05).
P. ginseng improves aspects of mental health and social functioning after 4 weeks of therapy, although these differences attenuate with continued use.
Panax ginseng is marketed and used to maintain natural energy, increase mental and physical abilities, improve mood and promote general health and well-being. Panax ginseng has been studied in a number of randomized clinical trials investigating its effect on physical and psychomotor performance, cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections. Equivocal results have been demonstrated for many of these indications. P. ginseng is also commonly used to promote quality of life (QoL). As a result, ginseng's effect on QoL has become an increasingly important endpoint in clinical trials. We reviewed all studies (n = 9) that determined the effect of P. ginseng on QoL. P. ginseng's has been evaluated at dosages of 80-400 mg. Study duration has spanned from 2 to 9 months. Several QoL measures have been used, ranging from widely accepted core instruments to unpublished investigator-derived questionnaires. In addition, many of the investigators utilized ginseng extracts that were supplemented with vitamins and minerals while others used only standardized ginseng extract. Populations evaluated also differed in terms of underlying morbidity. Nearly every study evaluated (n = 8) demonstrated some degree of QoL improvement. Beneficial effects were evident within instrument summary component scores but improvement in overall composite scores of QoL was rarely seen. However, findings were equivocal. While populations evaluated varied in terms of underlying morbidity, there did not appear to be a substantial difference in their response to ginseng with respect to QoL. Despite some positive results, improvement in overall health-related quality of life cannot, given the current research, be attributed to P. ginseng. However, the possibility that various facets of QoL may have improved and the potential of early transient effects cannot be discounted.