Advancing Women's Health in the 21st Century: Applying the Tools of Clinical Pharmacology

Erxian decoction, a Chinese herbal formula, for menopausal syndrome: An updated systematic review

ETHNOPHARMACOLOGICAL RELEVANCE

Erxian decoction (EXD), a famous Chinese herbal prescription, consists of Rhizoma Curculiginis, Herba Epimedii, Radix Morindae Officinalis, Radix Angelicae Sinensis, Cortex Phellodendri, Rhizoma Anemarrhenae, all of which are recorded in the Chinese Pharmacopoeia.

OBJECTIVE

To conduct an updated systematic and meta-analysis investigating efficacy and safety of EXD for menopausal syndrome.

METHODS

An electronic search was conducted in eight databases from inception until July 2018. Randomized controlled trials with risk-of-bias score ≥ 7 according to the Cochrane Back Review Group were included for analyses. All participants with a diagnosis of menopausal syndrome met the established criteria. The treatment group was EXD monotherapy or adjunct therapy. Comparators were placebo, hormone replace therapy, hormone plus nonhormonal agents, nonhormonal agents and no treatment. The primary outcome measurements were the Kupperman index, total hot flush scores, total menopause rating scale (MRS) scores and total menopause-specific quality of life (MENQOL) scores. The secondary outcomes were total clinical effective rate, traditional Chinese medicine (TCM) syndrome scores, Hamilton depression (HAMD) scale scores, self-rating depression scale (SDS) scores, self-Rating Anxiety Scale (SAS) scores, athens insomnia scale (AIS) scores, serological indicators, blood pressure, and adverse events. RevMan 5.3 Software was used for data analyses. GRADE system was used to assess the level of evidence.

RESULTS

Sixteen eligible studies with 1594 subjects were identified. Five studies showed EXD was contradictory results according to Kupperman index of menopausal syndrome compared with hormone. One study showed EXD significantly improved total hot flush scores, total MRS scores and total MENQOL scores compared with placebo (P < 0.05). Meta-analysis of 10 EXD monotherapy or 2 paratherapy studies showed that both can significantly improve total effective rate compared with hormone (P < 0.05); 3 studies showed that EXD plus hormone significantly reduces the TCM syndrome scores, HAMD scale scores, SDS scores and SAS scores compared with hormone (P < 0.05). One study showed a significant effect of EXD for reducing AIS scores compared with hormone (P < 0.05); 7 studies showed contradictory effects for improving serological indicators compared with hormone. Two studies reported adverse effects, whereas the other studies did not mention. The quality of the evidence of primary outcomes was moderate to high according to the GRADE profiler.

CONCLUSIONS

The present findings do not allow an assessment of the evidence because the low-quality studies included cannot be reproduced. However, we identified an area, which is worthy of further research. Rigorous RCTs are still needed in the future.

Antioxidant effect of garlic (Allium sativum) and black seeds (Nigella sativa) in healthy postmenopausal women

Objectives:

The objective of this study is to investigate the antioxidant effects of garlic extract and crude black seeds’ consumption on blood oxidant/antioxidant levels in healthy postmenopausal women.

Methods:

In total, 30 healthy postmenopausal women (mean age = 50.31 ± 4.23 years) participated. They ingested two garlic soft gels per day (each is equivalent to 1000 mg of fresh garlic bulb) and crude black seed grounded to powder in a dose of 3 g/day for 8 weeks. Oxidant (malondialdehyde) activity in plasma and antioxidants superoxide dismutase and glutathione peroxidase activities in erythrocytes were studied.

Results:

Significant low levels of plasma malondialdehyde with increased erythrocyte glutathione peroxidase and superoxide dismutase activities.

Discussion:

Menopause is associated with an increase in oxidative stress and a decrease in some antioxidant parameters. Consumption of garlic extracts and crude black seeds may have a beneficial effect on improved balance between blood oxidants and antioxidants in healthy postmenopausal women.

Is drug utilization in Greece sex dependent? A population-based study

Despite scarce data pertaining to prescription drug sales in Greece, the lack of large-scale epidemiological studies has made it difficult to elaborate on putative differences regarding drug consumption patterns between the two sexes. Herein, we sought to investigate whether sex may have an impact on medication trends of the Greek population. The data reported are part of a survey conducted under the auspices of the National Center for Social Research. Information was collected from 2499 Athenian citizens. Probability of drug use was assessed through Pearson chi-square (χ(2) ) test and logistic regression was implemented to clarify whether sex or other socio-economic and morbidity factors may influence drug utilization. Women consumed more drugs as compared to men. Sex proved to be a differentiating factor influencing the use of analgesic/non-steroidal anti-inflammatory drugs, cardiovascular, anxiolytic and antidepressant drugs, as well as drugs for the treatment of thyroid diseases and osteoporosis. Present results further implicate other socio-economic factors (e.g. education, employment and financial status) in the harnessing of drug use in Greece. To the best of our knowledge, this is the largest pharmacoepidemiological study to report that Greek women consume more drugs and present different medication patterns, as compared to men. Further research is considered imperative in order for the awareness of prescribers, policy-makers and the general public on this sensitive matter to be increased.

''What are you?'' A recurring question in a cross-cultural psychiatrist's life and career

This article contributes to the Transcultural Psychiatry special issue of autobiographical articles on: ''The Personal and the Professional: Lives and Careers of Cultural Psychiatrists.'' The author describes influences and themes in her professional development as a cross-cultural psychiatrist and academic. Growing up as a part-Chinese, part-white child in rural Midwestern America resulted in frequently being asked: ''What are you?'' This abrupt, bald, but essential question eventually became a useful tool in the productive, repeated re-working of identity, values, and goals throughout her personal and professional life. Experiences of being an outsider, family histories, and early observations of racism are linked to later interests in cross-cultural psychiatry, ethics, and the protection of vulnerable populations. She describes her research on cross-cultural measurement, depression, suicidality, domestic violence and violence in war. Issues of career advancement and internal conflict are described for women academics who occupy three simultaneous, primary roles: academic, doctor and mother. The theme of ''crossing,'' as in ''cross-cultural,'' indicates the effort and intention required to move between races, cultures, classes, intellectual disciplines, personal and professional identities, clinical and academic roles, and social roles allocated to men and women.

A novel mechanism: Erxian Decoction, a Chinese medicine formula, for relieving menopausal syndrome

ETHNOPHARMACOLOGICAL RELEVANCE

Many clinical and experimental reports demonstrated that Erxian Decoction (EXD) was effective in relieving menopausal syndrome.

AIM OF THE STUDY

The mechanisms of action of EXD were explored on the endocrine and antioxidant regimen.

MATERIALS AND METHODS

Menopause causes a decline in both endocrine function and activities of antioxidant enzymes. In this study, 12-month-old female Sprague-Dawley-rats (SD-rats) with a low serum estradiol level were employed. Their endocrine functions after treatment with EXD were assessed by the determination of their serum estradiol level and ovarian mRNA levels of aromatase, which is a key enzyme for biosynthesis of estradiol. Meanwhile, superoxide dismutase-1 (SOD), catalase (CAT) and glutathione peroxidase (GPx-1) in the liver were also determined to assess the effect of EXD on the antioxidant regimen.

RESULTS

Results revealed a significant elevation in serum estradiol level and the mRNA level of ovarian aromatase and liver CAT in the EXD-treated menopausal rat model.

CONCLUSIONS

The results obtained from mRNA and estradiol level of the present investigation revealed that the EXD relieves the menopausal syndrome involved an increase of endocrine and antioxidant function through, at least, the activation of aromatase and CAT detoxifying pathways.