A Novel Extract of Fenugreek Husk (FenuSMART™) Alleviates Postmenopausal Symptoms and Helps to Establish the Hormonal Balance: A Randomized, Double-Blind, Placebo-Controlled Study

A Meta-Analysis: Anti-Inflammatory Medicinal Plants for Age-Related Menopause-Like Symptoms and Psychological Problems in Breast Cancer and Healthy Perimenopausal Women

BACKGROUND

Medicinal plant supplements (MPS) have benefits in improving menopause-like symptoms (MLS).

OBJECTIVES

To investigate the effectiveness of MPS in reducing MLS in healthy women and those with breast cancer (BC).

SEARCH STRATEGY

PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang database and Chinese Scientific Journals Database were searched from the date of library construction until 30 January 2024.

SELECTION CRITERIA

Randomised controlled trials were selected that involved healthy perimenopausal women, BC patients treated with herbal medicines, and the effects of plant-based compounds on MLS.

DATA COLLECTION AND ANALYSIS

The review included 12 studies with 917 patients with BC and 15 studies with 2104 healthy perimenopausal women. The data were analysed using the Meta-mar tool.

MAIN RESULTS

MPS improved Kupperman's Index (KMI) and menopause rating scale (MRS) scores compared with the comparator. Patients with BC experienced a greater reduction in KMI and MRS because of treatment than healthy perimenopausal women. Patients with BC had a more significant reduction in KMI than women who received hormone therapy. In both healthy perimenopausal women and women with BC, MPS treatment resulted in significantly higher response rates and fewer psychological problems. Women with BC experienced a decrease in anxiety and insomnia by MPS. Network analysis showed that the response rate was the factor most associated with MPS use.

CONCLUSIONS

Anti-inflammatory MPS may assist women with BC or healthy perimenopausal women experience less MLS.

Effects of Integrated Extracts of Trigonella foenum-graecum and Asparagus racemosus on Hot Flash-like Symptoms in Ovariectomized Rats

Vasomotor symptoms, such as hot flashes (HFs), commonly affect women during menopause, leading to a reduced quality of life. The current study evaluates the combined effect of active components Asparagus racemosus (AR) and Trigonella foenum-graecum (TFG) in a single oral formulation (IAT) for alleviating menopausal symptoms in ovariectomized rats. Following bilateral ovariectomy, the animals were randomly assigned to nine groups: (1) Control, (2) Ovariectomy (OVX), (3) OVX+TA1 (TA: Combination of Trigonella and Asparagus; TFG 30 mg/kg + AR 30 mg/kg), (4) OVX+TA2 (TFG 30 mg/kg + AR 15 mg/kg), (5) OVX+TA3 (TFG 15 mg/kg + AR 30 mg/kg), (6) OVX+TA4 (TFG 40 mg/kg + AR 30 mg/kg), (7) OVX+TA5 (TFG 30 mg/kg + AR 40 mg/kg), (8) OVX+IAT1 (IAT: Integrated Asparagus and Trigonella; TFG+AR integrated extract, 30 mg/kg), and (9) OVX+IAT2 (TFG+AR integrated extract, 60 mg/kg). On the 8th day of treatment, tail and skin temperatures were recorded every 30 min for 24 h. Ovariectomized rats exhibited menopausal symptoms, such as hormonal imbalances and elevated skin temperature. Administration of AR, TFG, and IAT significantly decreased serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and cortisol while increasing estradiol, progesterone, and dopamine (p < 0.0001), effectively alleviating hot flash-like symptoms. Additionally, they mitigated ovariectomy-induced oxidative stress by lowering malondialdehyde (MDA) levels and restoring antioxidant enzyme activity. Ovariectomized rats exhibited increased expression of a proto-oncogene (c-FOS), gonadotropin-releasing hormone (GnRH), Kisspeptin, Neurokinin B (NKB), and Transient receptor potential vanilloid 1 (TRPV1), along with reduced expressing brain-derived neurotrophic factor (BDNF) levels, which were reversed by treatment, especially with the IAT2 combination. The AR and TFG combination, particularly in IAT formulations, showed strong potential in alleviating menopausal symptoms in ovariectomized rats. These findings suggest that the combination of AR and TFG extracts could be a natural alternative for managing postmenopausal symptoms by restoring reproductive hormone levels, regulating lipid profiles, and enhancing antioxidant defense systems.

Effect of Furocyst on Lipid Profile and Insulin Resistance Across Different Categories of Body Mass Index in Women With Polycystic Ovarian Syndrome (PCOS)

Introduction Insulin resistance is a fundamental factor in the pathogenesis of polycystic ovarian syndrome (PCOS) and has been found to mediate a close association with obesity and dyslipidemia. While the anti-diabetic and anti-inflammatory properties of fenugreek seed extracts have been demonstrated, research on its anti-hyperlipidemic properties is still in its novice stage, with inconclusive evidence. The present study assessed the impact of fenugreek seed extracts rich in furostanolic saponins (Furocyst) on lipid profiles across different categories of body mass index (BMI) in women with PCOS. Methodology The study was a single-blinded, randomized clinical study conducted among 230 patients between 18 and 45 years of age, presenting to the Gynecology and Obstetrics OPD for treatment of PCOS. After screening for eligibility, patients were enrolled and randomized into the experimental group (receiving Furocyst BD for three months) and the placebo group. Blood samples collected before treatment and after the completion of treatment were investigated for insulin resistance and lipid profile. The final analysis was conducted on 188 patients (104 in the Furocyst group and 84 in the placebo group) and stratified for different categories of BMI (based on WHO classification). Results A significant reduction in the mean BMI in all patients overall and in patient subgroups according to BMI was noted after 12 weeks of treatment with Furocyst, which was statistically significant in the obese (p<0.001). The HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index was also reduced in the Furocyst group across all BMI categories, including sub-classes of obese (p<0.001). The lipid-lowering effects of Furocyst were observed on total cholesterol, triglyceride, and VLDL (very-low-density lipoprotein) in all patients, irrespective of the initial BMI category (p<0.05). The drug did not affect the mean serum HDL (high-density lipoprotein) levels. In obese patients, Furocyst also exhibited a statistically significant reduction in LDL-HDL ratio and cholesterol-HDL ratio. Conclusion The present study demonstrates the insulin-sensitizing, glucose-regulating, anti-obesity, and anti-hyperlipidemic properties of Furocyst in women with PCOS. The overweight and obese seem to benefit most from the drug. The use of Furocyst may be considered a pragmatic approach to treating PCOS-related symptoms and improving metabolic disturbances, specifically by optimizing the lipid profile in the affected women and lowering cardiovascular risk factors in the long term.

The effect of Fenugreek seed dry extract supplement on glycemic indices, lipid profile, and prooxidant-antioxidant balance in patients with type 2 diabetes: A double-blind randomized clinical trial

Introduction

This study aims to determine the effects of fenugreek seed dry extract (FDE) on the glycemic indices, lipid profile, and prooxidant-antioxidant balance (PAB) in patients with type 2 diabetes (T2D).

Methods

A double-blind randomized clinical trial was carried out on 54 individuals with T2D. Participants were randomly assigned to a FDE group (received 3 tablets containing 335 mg of FDE daily for 8 weeks) or a placebo group (received tablets containing microcrystalline cellulose). Anthropometric indices, physical activity, diet, fasting blood sugar (FBS), serum insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein (HDL-C), and PAB were assessed.

Results

An eight-week intake of 3 tablets containing 335 mg of FDE decreased serum insulin (P=0.016, P<0.001), HOMA-IR (P=0.009, P<0.001), TG (P<0.001, P=0.001), and PAB (P<0.001, P<0.001) compared to the baseline, in both placebo and intervention groups respectively. TC decreased significantly compared to the baseline in the placebo group (P=0.028), while HDL-C increased in the FDE group compared to the baseline (P<0.001) and placebo group (P=0.014).

Conclusion

In the present study even though changes of parameters were more in intervention group compared to the control group, we did not observe any significant differences between studied groups except for HDL-C. However, the effects might become apparent with a higher dosage, longer study duration, or a larger sample size compared to the placebo group. Further clinical trials are needed in this regard.

Phytotherapeutic approach for conquering menopausal syndrome and osteoporosis

Women face a significant change in their reproductive health as menopause sets in. It is marred with numerous physiological changes that negatively impact their quality of life. This universal, transition phase is associated with menopausal and postmenopausal syndrome, which may spread over 2-10 years. This creates a depletion of female hormones causing physical, mental, sexual and social problems and may, later on, manifest as postmenopausal osteoporosis leading to weak bones, causing fractures and ultimately morbidity and mortality. Menopausal hormone therapy generally encompasses the correction of hormone balance through various pharmacological agents, but the associated side effects often lead to cessation of therapy with poor clinical outcomes. However, it has been noticed that phytotherapeutics is trusted by women for the amelioration of symptoms related to menopause and for improving bone health. This could primarily be due to their reduced side effects and lesser costs. This review attempts to bring forth the suitability of phytotherapeutics/herbals for the management of menopausal, postmenopausal syndrome, and menopausal osteoporosis through several published research. It tries to enlist the available botanicals with their key constituents and mechanism of action for mitigating symptoms associated with menopause as well as osteoporosis. It also includes a list of a few herbal commercial products available for these complications. The article also intends to collate the findings of various clinical trials and patents available in this field and provide a window for newer research avenues in this highly important yet ignored health segment.

Current perspectives on fenugreek bioactive compounds and their potential impact on human health: A review of recent insights into functional foods and other high value applications

Despite long-standing uses in several food and medicine traditions, the full potential of the leguminous crop fenugreek (Trigonella foenum-graecum L.) remains to be realized in the modern diet. Not only its seeds, which are highly prized for their culinary and medicinal properties, but also its leaves and stems abound in phytochemicals with high nutritional and health promoting attributes. Fenugreek dual food-medicine applications and reported metabolic activities include hypoglycemic, antihyperlipidemic, antioxidative, anti-inflammatory, antiatherogenic, antihypertensive, anticarcinogenic, immunomodulatory, and antinociceptive effects, with potential organ-protective effects at the cardiovascular, digestive, hepatic, endocrine, and central nervous system levels. Effectiveness in alleviating certain inflammatory skin conditions and dysfunctions of the reproductive system was also suggested. As a food ingredient, fenugreek can enhance the sensory, nutritional, and nutraceutical qualities of a wide variety of foods. Its high nutritive density can assist with the design of dietary items that meet the demand for novelty, variety, and healthier foods. Its seeds provide essential protective nutrients and other bioactive compounds, notably galactomannans, flavonoids, coumarins, saponins, alkaloids, and essential oils, whose health benefits, alone or in conjunction with other bioactives, are only beginning to be tapped into in the food industries. This review summarizes the current state of evidence on fenugreek potential for functional food development, focusing on the nutrients and non-nutrient bioactive components of interest from a dietary perspective, and their applications for enhancing the functional and nutraceutical value of foods and beverages. New developments, safety, clinical evidence, presumed mechanisms of action, and future perspectives are discussed. HIGHLIGHTS: Fenugreek seeds and leaves have long-standing uses in the food-medicine continuum. Fenugreek phytochemicals exert broad-spectrum biological and pharmacological activities. They show high preventive and nutraceutical potential against common chronic diseases. Current evidence supports multiple mechanisms of action mediated by distinct bioactives. Opportunities for fenugreek-based functional foods and nutraceuticals are expanding.

Efficacy of plant-derived dietary supplements in improving overall menopausal symptoms in women: An updated systematic review and meta-analysis

This updated systematic review and meta-analysis aims to confirm the effectiveness of plant-based supplements in improving overall menopausal symptoms and vasomotor symptoms. A systematic review of the literature was conducted by searching the PubMed/MEDLINE, Web of Science, EMBASE, and CENTRAL databases up to June 2022. Randomized placebo-controlled clinical trials that evaluated the effects of dietary supplements on menopausal symptoms were included. Outcome measures included daily hot flash frequency, Kupperman's index, Menopause Rating Scale, and Greene Climacteric Scale. Pooled data were analyzed using a fixed-effects model and expressed as a weighted mean difference with a 95% confidence interval for continuous outcomes. For qualitative assessment, 67 studies were selected. For quantitative assessment, 54 reports were obtained from 61 studies. The study participants were peri- or postmenopausal women aged 38-85, most of whom experienced hot flashes as a menopausal symptom. The investigational products included 28 soy-derived, 6 red clover-derived, and 28 other plant-derived supplements. Qualitative assessment revealed that approximately 76% of the studies were generally of fair or good quality, whereas 24% were of low quality. Meta-analysis results indicated significant improvements in all questionnaire scores, including hot flash frequency, in the dietary supplement group compared with the placebo group. Comprehensive evaluation using different questionnaire tools showed that the various plant-derived dietary supplements can significantly alleviate menopausal symptoms. However, further rigorous studies are needed to determine the association of plant-derived dietary supplements with menopausal health because of the general suboptimal quality and heterogeneous nature of current evidence.

The Anabolic Effect of Fenugreek: A Systematic Review with Meta-analysis

The use of plant steroids to improve physical health and performance is becoming increasingly popular. One of these plant steroids is diosgenin, which is mainly available in fenugreek. As a result, some studies have been conducted to improve physical health. Fenugreek extracts are also becoming increasingly popular in the context of athletic performance. Based on these assumptions, a systematic review with meta-analysis was conducted to evaluate the promoting effects of fenugreek on strength performance, body composition, and hormone concentration. Four databases were screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The current version of ReviewManager (RevMan) was used for the statistical evaluation. Seven studies with 449 participants (378 male, 71 female) met the inclusion criteria. A small effect of fenugreek was detected for total testosterone (standard mean difference (SMD): 0.32; 95% confidence interval (CI): 0.09 0.55), free testosterone (SMD: 0.24; 95% CI: -0.04, 0.52), lean body mass (SMD: 0.19; 95% CI: -0.10, 0.49), fat mass (SMD: -0.19; 95% CI: -0.44, 0.05), and leg press performance (SMD: 0.22; 95% CI: -0.02, 0.47), in male athletes. The meta-analysis shows that chronic application of fenugreek has performance-enhancing and anabolic effects in male athletes, but no statements can be made for female athletes.

The role of diet in managing menopausal symptoms: A narrative review

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

The Effects of Fenugreek Seed Consumption on Blood Pressure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

INTRODUCTION

Cardiovascular diseases (CVDs) are growing health issues worldwide. Hypertension (HTN) is one of the most common among CVDs in all populations. Fenugreek has recently been the center of multiple investigations.

AIM

In this systematic review and meta-analysis, we aimed at gathering and summing up the existing literature regarding the impact of fenugreek seed on systolic blood pressure (SBP) and diastolic blood pressure (DBP).

METHODS

All major databases (MEDLINE, Cochrane library, EMBASE, and Web of Science) were searched from inception up to 28 June 2022. Relevant randomized controlled trials (RCTs) meeting the inclusion criteria were included and the required data was extracted. The pooled effects were reported as weighted mean differences (WMDs). I-squared test was used to detect between-study heterogeneities. Subgroup analyses were conducted to find sources of heterogeneities. P-values < 0.05 were considered as statistically significant.

RESULTS

Six RCTs including a total of 373 participants were included in the final meta-analysis. Fenugreek seed supplementation significantly reduced SBP (WMD: 3.46 mmHg, 95% CI - 6.33, - 0.59, P=0.018), but not DBP (WMD: 3.19 mmHg; 95% CI, - 5.82 to 12.21, P=0.488). Subgroup analyses showed that fenugreek seed administered in dosages ≥ 15 g/day and durations ≤ 12 weeks significantly reduced SBP and DBP.

CONCLUSION

Supplementation with fenugreek seed, especially in dosages ≥ 15 g/day and durations ≤ 12 weeks, might play a role in reducing SBP, but not DBP. However, further investigations are warranted to ensure the clinical relevance of these findings.

Effects of fenugreek supplementation on the components of metabolic syndrome: A systematic review and dose-response meta-analysis of randomized clinical trials

Metabolic syndrome (MetS) is a cluster of metabolic disorders with a heavy disease burden. Fenugreek was reported to be effective in some components of MetS. Therefore, a comprehensive review and meta-analysis of randomized controlled trials was conducted to study the effects of fenugreek on MetS indices. From the beginning until August 2022, PubMed, Embase, Scopus, and Web of science were searched. Data were analyzed using the random-effect model, and presented as weighted mean difference (WMD) and associated 95 % confidence interval (CI). This meta-analysis comprised from a total of 29 eligible RCTs with 31 arms measuring fasting plasma glucose (FPG), Triglyceride (TG), high-density lipoprotein (HDL), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The results indicated significant improving effects of fenugreek on FPG (WMD: -16.75 mg/dL; 95 % CI: -23.36, -10.15; P < 0.001), TG (-20.12 mg/dL; 95 % CI: -34.238, -5.994; P < 0.001), HDL (WMD: 3.55 mg/dL; 95 % CI: 1.98, 5.12; P < 0.001), WC (WMD: -2.51; 95 % CI: -3.78, -1.24; P < 0.001) and SBP (WMD: -3.45 mmHg; 95 % CI: -6.38, -0.52; P = 0.021); However the effect on DBP (WMD: 3.17; 95 % CI: -5.40, 11.73; P = 0.469) and BMI (WMD: -0.40 kg/m2; 95 % CI: -1.114, 0.324; P = 0.281) was not significant. Administration of fenugreek can meaningfully reduce FPG, TG, WC, and SBP and increase HDL. The overall results support possible protective and therapeutic effects of fenugreek on MetS parameters.

Diosgenin and Its Analogs: Potential Protective Agents Against Atherosclerosis

Atherosclerosis is a chronic inflammatory disease of the artery wall associated with lipid metabolism imbalance and maladaptive immune response, which mediates most cardiovascular events. First-line drugs such as statins and antiplatelet drug aspirin have shown good effects against atherosclerosis but may lead to certain side effects. Thus, the development of new, safer, and less toxic agents for atherosclerosis is urgently needed. Diosgenin and its analogs have gained importance for their efficacy against life-threatening diseases, including cardiovascular, endocrine, nervous system diseases, and cancer. Diosgenin and its analogs are widely found in the rhizomes of Dioscore, Solanum, and other species and share similar chemical structures and pharmacological effects. Recent data suggested diosgenin plays an anti-atherosclerosis role through its anti-inflammatory, antioxidant, plasma cholesterol-lowering, anti-proliferation, and anti-thrombotic effects. However, a review of the effects of diosgenin and its natural structure analogs on AS is still lacking. This review summarizes the effects of diosgenin and its analogs on vascular endothelial dysfunction, vascular smooth muscle cell (VSMC) proliferation, migration and calcification, lipid metabolism, and inflammation, and provides a new overview of its anti-atherosclerosis mechanism. Besides, the structures, sources, safety, pharmacokinetic characteristics, and biological availability are introduced to reveal the limitations and challenges of current studies, hoping to provide a theoretical basis for the clinical application of diosgenin and its analogs and provide a new idea for developing new agents for atherosclerosis.

Efficacy and safety of phytoestrogens in the treatment of perimenopausal and postmenopausal depressive disorders: A systematic review and meta-analysis

BACKGROUND

Depression is one of the most common and specific symptoms among menopausal women, leading to significant personal, family, and economic burdens. Some studies have shown that phytoestrogens can help relieve symptoms of depression.

OBJECTIVES

This systematic review and meta-analysis aim to assess the efficacy and safety of phytoestrogens in treating depression among menopausal women.

METHODS

A comprehensive search for relevant studies published until November 25, 2020, was conducted in PubMed, the Cochrane Library, Chinese Biomedical Literature Database, Web of Science, and EMBASE. Statistical analyses were performed with R 4.0.3.and Review Manager 5.4.

RESULTS

2183 studies were identified and 10 studies with 15 independent reports were included, involving 1248 participants. The quality of the four studies was assessed as high risk, six studies were assessed as unclear. The analyses conducted according random effects model indicated the significant positive effect on depressive symptoms for postmenopausal women compared with the placebo (SMD = -0.62; 95% CI = -1.13 to -0.12; Q = 45.62, df = 14, P < .01; I²  = 79%). The low dose phytoestrogens (25 mg/d ≤ dose ≤ 100 mg/d) have better effectiveness (SMD = -0.52; 95% CI = -0.85 to -0.20; I²  = 79%, P< .01) than high dose (dose > 100 mg/d) and ultralow dose (0 < dose < 25 mg/d), but showed no statistical significance (Q = 0.81 df = 2, P = .67). Isoflavones had better effectiveness (SMD = -0.48; 95% CI = -0.75 to 0.21; I²  = 75%, P < .01) than lignans of phytoestrogens (SMD = -0.22; 95% CI = -0.37 to 0.08; I²  = 0%, P = .96). The duration of intervention affects the efficacy of phytoestrogens (β = -0.03; 95% CI: [-0.05, 0.00]; P = .045). The effectiveness varies in regions. The adverse reactions frequently reported were gastrointestinal symptoms and cold or upper respiratory tract infection.

CONCLUSIONS

Phytoestrogen can relieve depression symptoms among menopausal, especially for postmenopausal women who take low doses(25 mg/d ≤ dose ≤ 100 mg/d) of phytoestrogens for a long-term duration. Although mild adverse reactions have been reported, phytoestrogen could be considered as a complementary treatment for postmenopausal depression.

Safety and influence of a novel extract of fenugreek on healthy young women: a randomized, double-blinded, placebo-controlled study

Background

Fenugreek (Trigonella foenum-graecum) seed is a popular kitchen spice and medicinal herb with wide applications in Indian folklore. Earlier studies have shown that the hydro-ethanolic extracts of fenugreek are efficient in the management of a number of hormone related disorders in women, including post and peri-menopausal discomforts, sexual dysfunctions, lactation and even in amenorrhea. However, systematic informations on their safety and influence on hormonal balance are limited.

Results

Forty-eight healthy menstruating women aged 20 to 48 were randomized either to FHE (n = 24) or placebo (n = 24) and supplemented with 250 mg × 2/day for 42 days. FHE did not produce any side effects or adverse events. It offered significant (P < 0.05) beneficial effects to sexual problems (41.6%) and irritability (40%) among the participants who had higher sexual dysfunctions scores (> 1) when monitored by the validated Menopausal Rating Scale (MRS) scale. Further, hormone analysis indicated an enhancement in estradiol (P = 0.040), free testosterone (P = 0.025), and total testosterone (P = 0.012) in FHE group in comparison to placebo. There were no significant changes in progesterone (P = 0.174) and FSH (P = 0.879) upon FHE supplementation. The hematological and biochemical safety parameters were also at par with the safety of the extract.

Conclusion

Thus, the supplementation of FHE may be considered as a natural alternative for sexual issues in women.

Trial registration

CTRI/2018/09/015614 dated 05/09/2018.

[Genitourinary menopause syndrome. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]

INTRODUCTION

Genitourinary menopause syndrome (SGUM) is defined as a set of symptoms associated with a decrease of estrogen and other sexual steroids during menopause. The main symptoms are vulvovaginal (dryness, burning, itching), sexual (dyspareunia), and urinary (urinary infections, pollakiuria, nycturia, pain, urinary incontinence by urgenturia). SGUM leads to an alteration of the quality of life, and affects especially women's sexuality.

OBJECTIVE

The objective of this review was to elaborate guidelines for clinical practice regarding the management of SGUM in postmenopausal women, and in particular, in women with a history of breast cancer, treated or not with hormone therapy.

MATERIALS AND METHODS

A systematic review of the literature on SGUM management was conducted on Pubmed, Medline and Cochrane Library. Recommendations from international scholarly societies were also taken into account: International Menopause Society (IMS) https://www.imsociety.org, The North American Menopause Society (NAMS) https://www.menopause.org, Canadian Menopause Society https://www.sigmamenopause.com, European Menopause and Andropause Society (EMAS) https://www.emas-online.org, International Society for the Study of Women's Sexual Health (ISSWSH) https://www.isswsh.org.

RESULTS

Vaginal use of lubricants, moisturizers and hyaluronic acid improves the symptoms of SGUM and may be offered to all patients. For postmenopausal women, local estrogen will be preferred to the oral route because of their safety and efficacy on all symptoms of SGUM during low-dose use. Prasterone is a local treatment that can be proposed as an effective alternative for the management of dyspareunia and sexual function disorder. Current data on oral testosterone, tibolone, oral or transdermal DHEA and herbal medicine are currently limited. Ospemifène, which has shown a significant improvement in sexual symptoms, is not currently marketed in France. In the particular case of women with a history of breast cancer, non-hormonal regimens are a first-line therapy. Current data on the risk of breast cancer recurrence when administering low-dose local estrogen are reassuring but do not support a conclusion that this treatment is safe.

CONCLUSION

SGUM is a common symptom that can affect the quality of life of postmenopausal women. A treatment should be systematically proposed. Local non-hormonal treatment may be offered in all women. Local low-dose estrogen therapy and Prasterone has shown an interest in the management of symptoms. In women before a history of breast cancer, local non-hormonal treatment should be offered first-line. The safety of low-dose local estrogen therapy and Prasterone cannot be established at this time. Other alternatives exist but are not currently recommended in France due to lack of data.

Modulation of inflammatory markers by petroleum ether fraction of Trigonella foenum-graecum L. seed extract in ovariectomized rats

This study evaluates the modulation of inflammatory markers by petroleum ether fraction of Trigonella foenum-graecum L. (PE-TFG) seed extract in ovariectomized rats. The HPTLC method was used for standardization and to quantify the diosgenin in PE-TFG. For testing PE-TFG in rats, the total duration of treatment was 12-weeks, and the rats were sacrificed on week 12. The tissue samples such as blood, liver, heart, and aorta were isolated for testing inflammatory markers such as adiponectin, leptin, PPAR-γ, TNF-α, lipid profile, hepatic markers, antioxidants, and oxidative stress markers. The PE-TFG treatment decreased the elevation of total cholesterol, triglyceride, AST, and ALT. Upon PE-TFG treatment, there was a significant increase in adiponectin and PPAR-γ mRNA expression. Leptin and TNF-α were normal after treatment with PE-TFG seed extract. Further, micro-steatosis of hepatocytes marked glomerular hypertrophy in the kidney and increased thickness of tunica intima and media of common carotid artery was reversed after treatment with PE-TFG. PRACTICAL APPLICATIONS: Trigonella foenum-graecum L. is a curative plant used to treat inflammatory conditions like diabetes, obesity, dyslipidemia, arthritis, cancer, and digestive disorders. In our study, PE-TFG supplementation has a protective effect on OVX-induced inflammation, oxidative stress, mRNA expression of adiponectin and PPAR-γ, hepatic steatosis, and decreased thickness of tunica intima and media of common carotid artery.

Herbal foodstuffs in Avicenna's recommended diet to improve sperm quality and increase male fertility; an evidence-based approach

Attention to diet was considered important issues in improvement of men infertility in Persian Medicine (PM). The purpose of this study was to extract herbal foodstuffs introduced by Avicenna, one of the greatest PM physicians to improve the semen production and to provide evidence of their impact on the basis of current studies."Canon of Medicine", the most important Avecinna's book, was searched with keywords equivalent to semen, fertility and infertility, main herbal foodstuffs were extracted and was searched with keywords sperm, semen, infertility, and fertility in Google scholar, PubMed and Scopus databases. Manuscripts from 1950 up to December 2019 were selected and reviewed. Almond, Onion, Chickpea, Garlic, Coconut, Palm date, Sesame, Fenugreek, Carrot, Fig, Grapes, Pistachio, Hazelnut and Walnut are among main foodstuffs which recommended by Avicenna and there is also evidence that they have positive effects on testosterone production and improvement of various sperm parameters, including count, motility and morphology. Containing large amount of different macro and micronutrients such as vitamins including vit B, C, A and E, minerals such as Mg, Se, Zn, Cu and Fe, important unsaturated fatty acids such as linoleic and oleic acids, amino acids such as lysine and arginine and phytochemicals such as polyphenols, flavonoids, triterpenes and steroids can be considered as a main factor in the effectiveness of these foodstuffs. Designing a diet based on the fruits, vegetables, nuts and seeds that Avicenna has recommended, may be effective in treating male infertility but further studies are needed to clarify this issue. Research on the effectiveness of his other recommended foodsuffs may also offer new treatments and supplements for this purpose.

Efficacy of a novel extract of fenugreek seeds in alleviating vasomotor symptoms and depression in perimenopausal women: A randomized, double-blinded, placebo-controlled study

The present randomized, double-blinded, placebo-controlled study investigated the effect of a standardized fenugreek extract (FHE) on perimenopausal discomforts and its influence on hormonal balance and safety. Healthy women characterized with perimenopausal symptoms (n = 48), as assessed by MRS questionnaire, were randomized either to FHE (n = 24) or placebo (n = 24) and supplemented with 250 mg × 2/day for 42 days. Both inter and intra-group comparison revealed a significant improvement in somatic, psychological, and urogenital scores in FHE group, especially for hot flashes (25.9%), night sweats (26.5%), depression (31.8%), and insomnia (21.6%). Further hormone analysis revealed an enhancement in serum estradiol (18.9%), free testosterone (38.2%), and progesterone (19.9%) concentrations and a significant decrease in FSH (38.2%) and SHBG (21.1%) concentrations toward establishing a hormonal balance among FHE-group; without significant changes in other clinical safety parameters. Thus, FHE supplementation offered a significant reduction in vasomotor effects and depression in perimenopausal women, without any adverse effects PRACTICAL APPLICATIONS: Fenugreek is a popular kitchen spice and Ayurvedic medicine for a variety of health conditions including diabetes, hypercholesterolemia, hepatotoxicity, gastritis, and also for a variety of hormone-related health conditions such as sexual functions, lactation, osteoporosis, PCOS, and post/perimenopausal discomforts. Fenugreek is rich in alkaloids, steroidal saponins, flavonoids and 4-hydroxyisoleucine. The present randomized-controlled study investigated the plausible application of a standardized hydro-ethanolic extract of fenugreek seeds (FHE) having a unique 3:1 ratio for protodioscin to trigonelline in the management of perimenopausal discomforts. It was observed that FHE at a dosage of 250 mg × 2/day for 42 days significantly reduced the discomforts, especially vasomotor symptoms and depression, and helped to attain a hormonal balance without any adverse effects or deviations in clinical safety parameters. Thus, FHE could be a potential natural agent for the management of post and perimenopausal discomforts and has to be explored in future studies.

Variation in menopausal vasomotor symptoms outcomes in clinical trials: a systematic review

BACKGROUND

There is substantial variation in how menopausal vasomotor symptoms are reported and measured among intervention studies. This has prevented meaningful comparisons between treatments and limited data synthesis.

OBJECTIVES

To review systematically the outcome reporting and measures used to assess menopausal vasomotor symptoms from randomised controlled trials of treatments.

SEARCH STRATEGY

We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to May 2018.

SELECTION CRITERIA

Randomised controlled trials with a primary outcome of menopausal vasomotor symptoms in women and a sample size of at least 20 women per study arm.

DATA COLLECTION AND ANALYSIS

Data about study characteristics, primary vasomotor-related outcomes and methods of measuring them.

MAIN RESULTS

The search identified 5591 studies, 214 of which were included. Forty-nine different primary reported outcomes were identified for vasomotor symptoms and 16 different tools had been used to measure these outcomes. The most commonly reported outcomes were frequency (97/214), severity (116/214), and intensity (28/114) of vasomotor symptoms or a composite of these outcomes (68/214). There was little consistency in how the frequency and severity/intensity of vasomotor symptoms were defined.

CONCLUSIONS

There is substantial variation in how menopausal vasomotor symptoms have been reported and measured in treatment trials. Future studies should include standardised outcome measures which reflect the priorities of patients, clinicians, and researchers. This is most effectively achieved through the development of a Core Outcome Set. This systematic review is the first step towards development of a Core Outcome Set for menopausal vasomotor symptoms.

TWEETABLE SUMMARY

Menopausal hot flushes and night sweats have been reported in 49 different ways in clinical research. A core outcome set is urgently required.

Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire

Background

Studies have demonstrated that women with low desire and low excitement have negative feelings regarding their physical and emotional satisfaction, as well as their happiness. In this study, we evaluate the efficacy of Libicare® - a multi-ingredient food supplement - to improve sexual function in postmenopausal women.

Methods

This was an exploratory, prospective, non-controlled, observational study. Postmenopausal women aged 45–65 with a risk of sexual dysfunction (Female Sexual Function Index (FSFI) < 25.83) were included during routine clinical visits and treated with 2 tablets of Libicare® daily for 2 months. Libicare® is an oral food supplement containing Trigonella foenum graecum, Turnera diffusa, Tribulus terrestris, and Ginkgo biloba dry extracts. Primary endpoint: change vs. baseline in FSFI score. Secondary endpoints: 1) changes in testosterone and serum steroid levels of free testosterone and sex hormone-binding globulin (SHBG) levels and 2) tolerability.

Results

A total of 29 patients (mean age: 54.69 years) were included. FSFI mean (SD) score showed a significant increase: 20.15 (4.48) vs 25.03 (6.94), baseline vs final; p = 0.0011, paired t-test. Most patients (86.2%) increased their FSFI score. All FSFI domains, except dyspareunia, showed significant increases. The highest increase was observed in the desire domain (p = 0.0004). Testosterone and SHBG levels were assessed in 21 patients. A significant increase in testosterone level was observed: 0.41 (0.26) vs. 0.50 (0.34) pg/mL, baseline vs. final; p = 0.038, Wilcoxon test. 52.4% of patients increased their testosterone levels. Finally, a significant decrease was observed in SHBG level: 85 (32.9) vs. 73 (26.8) nmol/L, baseline vs. final; p = 0.0001; paired t-test. 95.2% of patients decreased their SHBG levels.

Conclusion

In this pilot study, a significant improvement in sexual function and related hormone levels was observed with Libicare®. Further studies must be conducted to confirm these exciting results.

Trial registration

Current Controlled Trial ISRCTN12928573. Date of registration: 28/March/2019. Retrospectively registered.

An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women

OBJECTIVE

The aim of this overview was to evaluate the effectiveness of phytoestrogens on vaginal health and dyspareunia in peri- and post-menopausal women.

MATERIAL AND METHODS

Three databases including MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials were from inception to August 2017.

RESULT

Two systematic reviews and 11 RCTs were included in the overview. According to the findings, isoflavones increased the maturation value and attenuated the vaginal atrophy in the post-menopausal women. Topical isoflavones had beneficial effects on the vaginal atrophy. Similar efficacy was found in Pueraria mirifica and conjugated estrogen cream on dryness ( p = 0.277), soreness ( p = 0.124) and irritation ( p = 0.469), as well as discharge ( p = 0.225) and dyspareunia ( p = 0.089). However, the conjugated estrogen cream was more effective compared to Pueraria mirifica ( p > 0.005) regarding maturation index improvement. Comparison of fennel 5% vaginal cream and placebo gel showed significant difference in superficial cells ( p < 0.01), parabasal cells ( p < 0.01) and intermediate cells ( p < 0.01), whereas no difference was found between the oral fennel and placebo in terms of superficial, parabasal and intermediate cells as well as Maturation value. Administration of 80 mg red clover oil had a significant effect on superficial ( p < 0.005), intermediate ( p < 0.005) and parabasal and vaginal dryness ( p < 0.005) compared to the placebo. Flaxseed had also a trivial effect on maturation value. Genistein had a more prominent effect on the genital score. The severity of dyspareunia decreased by 27%.

CONCLUSION

Phytoestrogens have various effects based on administration route and type on the vaginal atrophy.

Toxicological evaluation of a saponin-rich standardized extract of fenugreek seeds (FenuSMART®): Acute, sub-chronic and genotoxicity studies

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Safety evaluation of a standardized extract of fenugreek seeds (FenuSMART).

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Acute and subchronic oral toxicity studies of FenuSMART on Wistar rats.

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Mutagenicity study of FenuSMART.

The present study investigated the safety of a saponin-rich standardized extract of fenugreek seeds (FenuSMART^®; FHE), that has been clinically shown to be effective in ameliorating the postmenopausal discomforts and establishing hormonal balance. The safety was assessed by oral acute (2500 mg/kg b. wt. for 14 days) and subchronic (250, 500 and 1000 mg/kg b. wt. for 90 days) toxicity studies on Wistar rats and mutagenicity studies employing Salmonella typhimurium strains. Administration of FHE did not produce any toxicologically significant changes in clinical/behavioral observations, ophthalmic examinations, body weight, organ weight, feed consumption, urinalysis, hematology and clinical biochemistry parameters when compared to the untreated control group of animals. Highest dose recovery group (1000 mg/kg b. wt.) of animals also showed no mortality or adverse events; with hematological and biochemical parameters at par with those of controls. Terminal autopsy revealed no alterations in relative organ weight or any treatment-related histopathology changes. FHE also showed no mutagenicity upon Ames test employing TA-98, TA-100 and TA-102 Salmonella typhimurium strains with or without metabolic activation. Based on the results of the study, the no observed-adverse-effect level (NOAEL) of FHE was determined as 1000 mg/kg b. wt./day, the highest dose tested.

A Systematic Review and Meta-analysis on the Effect of Herbal Medicine to Manage Sleep Dysfunction in Peri- and Postmenopause

OBJECTIVES

Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there is a growing interest in the use of herbal medicine. The aim of this systematic review is to assess the effects herbal medicines have on sleep disorders of peri- and postmenopausal women.

METHODS

Three databases were searched including MEDLINE, Scopus, and the Cochrane Library from inception to March 2018.

RESULTS

Six trials assessed the effect of soy on sleep disorders. Forrest plot for 2 studies showed that the standardized mean difference (SMD) of the sleep problems was lower in the soy group than the placebo group (SMD = -0.996; P < 0.001; 95% confidence interval, -1.42 to -0.563). Three trials showed soy had no significant effect on sleep disorders and one study showed a positive effect on sleep disorders. Accordingly, it is difficult to reach a definite conclusion regarding the effects of soy on sleep disorders based on these findings. According to a trial, significant beneficial effect associated with taking Schisandra chinensis. Findings suggested that some herbal medicines like red clover, lavender combined with bitter orange and pin bark extract had attenuating effects on sleep disorders. After intake of 530 mg of valerian twice a day for one month, statistically significant effects were observed regarding the quality of sleep of postmenopausal women.

CONCLUSIONS

The present systematic review and meta-analysis found inadequate evidence to draw conclusions regarding the effectiveness of herbal medications, especially soy.

Effectiveness of fenugreek as a galactagogue: A network meta-analysis

A systematic review and network-meta analysis (NMA) were performed to test significance of the galactagogue effect of fenugreek administrated to lactating women versus other comparators (i.e., placebo/control/other galactagogues). A pairwise comparison for the treatment effect was carried out to generate the forest plot for the NMA. League tables were generated using treatment effect, weighted mean difference (WMD; 95% confidence interval, CI) for all pairwise comparisons, where WMD > 0 favors the column-defining treatment. Five studies were identified with 122 participants receiving treatment with fenugreek. The NMA results of 4 studies indicated that consumption of fenugreek significantly increased amount of the produced breast milk [11.11, CI 95% 6.77, 15.46] versus placebo. The pairwise comparison revealed that fenugreek was effective as a galactagogue compared to placebo, control, and reference groups WMD 17.79 [CI 11.71, 23.88]. However, the effect of fenugreek was substantially inferior to Coleus amboinicus Lour and palm date. The NMA using pairwise comparison demonstrated the effect of C. amboinicus and palm date in the stimulation of the breast milk production was comparable and superior to all comparators.

Comprehensive evaluation of the role of soy and isoflavone supplementation in humans and animals over the past two decades

Soy and soy-based foods are considered healthy, particularly in many Asia-Pacific countries, where soy products have long been consumed. Soy and soy-related products have been found to help prevent the occurrence of cardiovascular diseases and certain types of cancer, such as breast and prostate cancer. These products can also have antioxidative effects that alleviate hot flashes during menopause and bone loss. These biological and therapeutic functions are primarily due to the isoflavones derived from soy, whose structure is similar to the structure of 17-β-oestradiol. Despite the many health benefits for humans and animals, the application of isoflavones remains controversial because of their anti-oestrogenic properties. We focused on general information regarding isoflavones, as well as their structure, function, and application. We summarized evidence showing that dietary or supplemental isoflavones exert protective effects on the health of humans and animals. Based on the literature, we conclude that soy foods and isoflavones may be effective and safe; however, more high-quality trials are needed to fully substantiate their potential use.