Effect of Foeniculum vulgare (fennel) on vaginal atrophy in postmenopausal women: A double-blind, randomized, placebo-controlled trial

Effect of concept mapping model on critical thinking skills of family medicine residents: A randomized controlled trial

BACKGROUND

The cognitive process of critical thinking (CT) involves the examination of the existing reasons and an analysis of the information to draw conclusions and make decisions. The goal of the study was to determine how concept mapping (CM) technique affects family medicine residents' capacity for critical thought.

MATERIALS AND METHODS

We conducted a randomized controlled trial among family medicine residents aged between 26 and 28 years. A total of 100 residents were involved; over the course of 3 months, 50 residents were exposed to the conventional teaching model and 50 residents to the CM model. Data was collected using California CT skills test (CCTST) modified Arabic version and a self-administered questionnaire. The primary intervention was teaching method, experimental group received CM lessons while control group had conventional lessons. First session was carried out at baseline and second session one week after baseline, whereas 3rd, 4th, and 5th sessions conducted at end of 1st, 2nd, 3rd months, respectively. Both groups were assessed at baseline and at end of 3rd month. Both groups were reassessed at end of three months. Quantitative data was presented as mean and SD, whereas frequencies and percentages used for qualitative data. Pre- and post-intervention CT scores for study groups were compared using t-test or Mann-Whitney U test, as appropriate. Groups were compared on pre- and post-intervention CT grades using Chi-square test.

RESULTS

Vast majority (98%) of participants were females, nearly half were 27 year old, and belonged primarily to urban areas (76%). There was no difference in the CT scores between the groups at baseline. The post-intervention CT scores for study group were statistically significantly higher (18.36±2.68) compared to control group (15.94±1.94) (P = 0.001).

CONCLUSION

The CM approach was superior to the conventional teaching approach in terms of improving CT.

Phytotherapic approach in menopause: light and darkness

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 approaches 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 approaches, considering the state of health of patient and the real efficacy of the drugs. We aim to outline the main phytotherapy treatments to choose in menopause.

EVIDENCE ACQUISITION

This review is based on focused research of the current literature on PubMed and Scopus such as research databases. We selected 4120 papers through these keywords: "MENOPAUSE" AND "phytotherapy," "natural therapy," "phytoterapy drugs." Then, the literature was scanned selecting English papers of last 10 years (last research on October 1, 2021), excluding reviews. Separately, two researchers MGT and CP examined and read 212 full selected papers. We included clinical trials and randomized clinical trials written in English and excluded duplicates, animal studies and studies with lack of group of interest, non-relevant outcomes, inappropriate methodology. Retrospective studies, case reports, case series, original articles, brief communications, and letter to the editor were included in our research. We furthermore completed our research by the examination of every study's bibliography.

EVIDENCE SYNTHESIS

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 antiestrogenic 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 must be considered an interesting tool in the treatment of signs and symptoms in selected menopause woman.

Efficacy of the herbal formula of Foeniculum vulgare and Rosa damascena on elderly patients with functional constipation: A double-blind randomized controlled trial

BACKGROUND

Constipation is a common chronic bowel disorder with an incidence of more than 50% in the elderly population. Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipation used widely by the elderly.

OBJECTIVE

This study evaluates the efficacy of an herbal formula made from Foeniculum vulgare Mill. and Rosa damascena for the treatment of constipation in an elderly population and consequent changes to their quality of life.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

This double-blind randomized active controlled clinical trial, with parallel group allocation ratio of 1:1, was conducted in a referral clinic in Afzalipour Hospital, affiliated to Kerman University of Medical Sciences in Kerman, Southeastern Iran. Individuals over 60 years of age, diagnosed with functional constipation (based on the Rome IV criteria), were included in this study. Participants received a sachet of 10 g F. vulgare and R. damascena (herbal formula group) or polyethylene glycol 4000 (PEG 4000 group) with a glass of warm water two times a day for 4 weeks and were followed up for 4 additional weeks.

MAIN OUTCOME MEASURES

Constipation severity, stool consistency, and the quality of life were used as the primary outcomes. Drug side effects were used as a secondary outcome. The outcomes were assessed using the Constipation Assessment Scale, the Bristol Stool Form Scale, and the Patient Assessment of Constipation Quality of Life questionnaire.

RESULTS

A total of 25 participants in each group completed the four-week treatment cycle and the eight-week follow-up. At the end of the four-week treatment cycle, all clinical outcomes had significant improvements in both groups (P < 0.05). The analysis of constipation severity (P < 0.001), stool consistency (P < 0.001), and the quality of life (P < 0.001) showed significant improvements with fewer side effects (mild diarrhea) and a longer duration of symptom relief in the herbal formula group compared to the PEG 4000 group.

CONCLUSION

Although both interventions significantly improved the treatment outcomes, constipation severity, stool consistency and the quality of life were improved more effectively by the herbal formula than by PEG 4000; however, the mechanism of action is not yet understood.

TRIAL REGISTRATION

This trial was registered in the Iranian Registry of Clinical Trials (IRCTID: IRCT20200108046056N1).

[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.

Variation in outcome reporting and measurement tools in clinical trials of treatments for genitourinary symptoms in peri- and postmenopausal women: a systematic review

IMPORTANCE

Genitourinary symptoms affect 40% to 60% of postmenopausal women. Evidence-based approaches to diagnosing and managing these symptoms are limited by inconsistencies in outcomes and measures used in clinical trials.

OBJECTIVE

The aim of the study was to systematically review all outcomes and measurement tools reported in randomized clinical trials of interventions for genitourinary symptoms associated with menopause.

EVIDENCE REVIEW

We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to December 2018. Randomized controlled trials with a primary or secondary outcome of genitourinary symptoms associated with menopause, English language, and sample size of 20 or more women per study arm were included. Study characteristics, outcomes, and measurement methods were collected.

FINDINGS

The search yielded 3,478 articles of which 109 met inclusion criteria. Forty-eight different outcomes were reported with "atrophy" as the most common (56/109, 51%) followed by measures of sexual function (19/109, 17%). Almost all (108/109, 99%) trials included patient-reported measures, with 21 different measures and 39 symptom combinations. Clinician-reported scales of vulvovaginal appearance were used in 36 of 109 (33%) trials, with extensive variation in what was measured and reported. Cytological measures from the vaginal epithelium were the most commonly used objective tools (76/109, 70%).

CONCLUSIONS AND RELEVANCE

There is heterogeneity in reported outcomes and measures used in clinical trials of treatments for genitourinary symptoms at menopause and uncertainty as to which outcomes best reflect patient priorities and symptoms. The findings from this systematic review have informed an international survey of stakeholders to determine priorities for outcome selection and reporting. This survey will then inform the development of a Core Outcome Set for use in future clinical trials by the COMMA (Core OutcoMes in MenopAuse) consortium. : Video Summary:http://links.lww.com/MENO/A599.

Fennel (Foeniculum vulgare Miller) for the management of menopausal women's health: A systematic review and meta-analysis

This review aimed to evaluate the current evidence on the effectiveness and safety of fennel (Foeniculum vulgare Miller) for managing menopausal women's health. Fourteen databases were searched. We included randomized controlled trials (RCTs) that evaluated any type of fennel treatment in menopausal women. Seven RCTs that met our inclusion criteria were identified and analyzed. The included RCTs had concerning risks of bias in general. Two RCTs compared the effects of fennel with placebo, and the meta-analysis results favored fennel for improving menopausal symptoms (n = 145, standard mean difference -1.32 [-1.76, -0.87], p < 0.00001). Other studies failed to show beneficial effects of fennel in terms of sexual function, quality of life (QoL), and psychological health. No serious adverse events were reported. Our review presented evidence for fennel improving menopausal symptoms. However, the effectiveness and safety of fennel in improving QoL, and psychological health remains unclear.

Effect of fennel on primary dysmenorrhea: a systematic review and meta-analysis

BACKGROUND

One of the most common complaints for women is dysmenorrhea. Several studies investigated the treatment effects of medicinal plants on primary dysmenorrhea.

OBJECTIVES

This systematic review and meta-analysis investigates the effect of Foeniculum vulgare (Fennel) on pain in primary dysmenorrhea in comparison to non-steroidal anti-inflammatory drugs such as mefenamic acid.

METHODS

PubMed, EMBASE, EBSCO Web of Science, Scopus, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, ProQuest, ISI Web of Science, Google Scholar, Magiran, SID, Iran Medex, and Irandoc were searched up to January 2019. Quality assessment of clinical trials was conducted using Jadad scoring system. Totally, 12 studies were entered in the meta-analysis. I ² was calculated to determine heterogeneity. Fixed effects and/or random effects models were applied.

RESULTS

Meta-analysis of these trials showed that F. vulgare intake decreased significantly the intensity of dysmenorrhea compared to the placebo (SMD -0.632; CI: -0.827 to -0.436; p<0.001; heterogeneity p=0.807; I ²=0%; fixed effect model; seven articles). However, the effect of Mefenamic acid with F. vulgare was not different from each other (SMD=-0.214; CI: -0.446 to 0.017; p=0.07; heterogeneity p=0.58; I ²=0%; fixed effect model; six trials).

CONCLUSION

The F. vulgare alleviates dysmenorrhea. Regarding the same effect of F. vulgare with NSAIDs, it is highly recommend to the women suffered from dysmenorrhea specifically the ones who have high tendency toward herbal medicine.

Effects of a Combination of Foeniculum vulgare, Melissa officinalis Extract, and Nigella saliva Powder on Healthy Menopausal Women with Sexual Dysfunction: A Randomized Clinical Trial

Background: Menopause is a critical period with frequent sexual disorders. Objectives: The current study assessed the therapeutic effect of a combination of the aerial part of Melissa officinalis, fennel fruit extract, and Nigella sativa seed powder on the sexual dysfunction of postmenopausal women. Methods: This randomized clinical trial was performed on 48 menopausal women from April 2015 to October 2017. The participants included the menopausal women referring to the clinic of Gorgan health centers aged between 41 and 54 years with natural menopause (amenorrhea for at least 12 months) and discomfort in sexual activity. They were randomized into two treatment groups. Group 1 (n = 27) received 1000 mg capsules (Melissa officinalis, fennel extract, and Nigella sativa powder), and group 2 (n = 21) received a placebo (1000 mg starch capsules (in an eight-week course of treatment (one capsule per day for each group). The variables in the female sexual function index (FSFI) questionnaire were compared in the two groups before and after the intervention. Results: The results showed that the mean scores of sexual dysfunction in the domains of arousal, lubrication, orgasm, satisfaction, and pain were not significantly different between the two groups (P > 0.05). Conclusions: Despite many studies on the effectiveness of Melissa, Foenculum, and Nigella, this study showed that a combination of Foeniculum vulgare, Melissa officinalis extract, and Nigella sativa seed powder does not improve the sexual function of postmenopausal women with sexual dysfunction, and it might be the synergism effect of this combination.

A Review of Pharmacological Treatments for Vaginal Atrophy in Postmenopausal Women in Iran

Vaginal atrophy is one of the most common menopausal complications and is often overlooked. There are various pharmacological and non-pharmacological treatment approaches to reduce vaginal atrophy; however, no comprehensive study on a convenient, affordable, inexpensive, and noninvasive treatment with fewer complications has been conducted so far. Thus, the current study aimed to provide a systematic review of pharmacological treatment for vaginal atrophy in postmenopausal women in Iran. In this systematic review, all Iranian articles published in Persian or English during 2009 to 2019 were collected and analyzed by searching the Scopus, PubMed, Web of Science, Magiran, Iranian Registry of Clinical Trials (IRCT), and Cochrane Library databases. The inclusion criteria were clinical trials for vaginal atrophy and menopause. Based on the selection criteria, articles with a Jadad scale score of 3 and above were included in the study and qualitatively analyzed. Overall, 15 clinical trials met the inclusion criteria. In total, 12 articles examined the efficacy of pharmacological treatments (including three herbal medicines, three vitamins and dietary supplements, and two chemical drugs) in treating vaginal atrophy in postmenopausal women. Various types of medication have been used to improve vaginal atrophy, and effective treatments include licorice, chamomile, royal jelly, vitamin E, vitamin D, hyaluronic acid, and Vagifem; however, the results of studies on fennel have been inconsistent. However, considering the small number of studies reviewed, further studies with a stronger methodology are needed to confirm the efficacy of these medications.

Foeniculum vulgare as Valuable Plant in Management of Women's Health

This review paper evaluates use of Foeniculum vulgare extracts as a popular female plant in management of different ailments of women. Information in this paper was gathered from accessible sources (PubMed, Science Direct, Springer, Wiley, and Google), and traditional books (Persian or English modern traditional books), unpublished data (R&D reports, thesis and dissertation) by keywords based on the words F. vulgare or fennel and women. Efficacy of oral fennel oil in management of dysmenorrhea, premenstrual syndrome, amenorrhea, menopause, lactation, and polycystic ovary syndrome were confirmed according to results of clinical studies. Results of clinical efficacy of fennel oil on menstrual bleeding is complicated, but results of one meta-analysis study revealed that fennel oil significantly increased means of bleeding in the first menstrual periodic cycle (P = 0.001), while fennel oil had no significant effect on bleeding in the second menstrual cycle (P = 0.67). Topical and vaginal fennel extract (5%) exhibited good efficacy in treatment of sexual function, vaginal atrophy, and hirsutism. Fennel had no effect on bone density, or body mass index of menopause women. Results of clinical studies introduce fennel as a valuable medicinal plant in management of women's ailments, but understanding the mechanism of action could be the subject of future studies.

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.

Psychometric properties of the Persian language version of the Female Sexual Function index among postmenopausal women

Objective

The present research aimed to evaluate the psychometric properties of the Persian language version of the Female Sexual Function Index (FSFI) among postmenopausal women.

Material and Methods

This secondary analysis examined 402 healthy postmenopausal Iranian women presenting to healthcare centers across Iran. The sampling method was convenience sampling. The translation of the FSFI and its cross-cultural adaptation were conducted under the guidelines proposed by Beaton. The reliability (Cronbach’s alpha coefficient and test-rest reliability) and construct validity confirmatory factor analysis) were assessed. Model fitting index [such as the root mean square error of approximation (RMSEA), the Goodness of Fit Index (GFI) and the Comparative Fit Index (CFI)] was calculated.

Results

The mean age of the study participants was 53.63±7.8 years. Test-retest reliability was high for both the entire scale (r=0.964; p<0.001) and its six dimensions (0.76-0.94; p<0.001). The Cronbach’s alpha of the entire scale and its dimensions was greater than 0.80. The original six-factor was used, which showed a relatively poor fit (χ²=667.054; p<0.001; χ²/df=4.86; GFI=0.92; RMSEA=0.098; GFI=0.85). After adding three correlated error terms to the six-factor model, an acceptable fit was obtained (χ²=470.542; p<0.001; χ²/df=3.51; CFI=0.95; RMSEA=0.079; GFI=0.89).

Conclusion

According to our results, the FSFI tool indicated a satisfactory fit for a six-factor model, as similar to the original English version, for use in clinical practice and research regarding healthy postmenopausal Iranian women. More research needs to be conducted on this scale to assess all of its psychometric properties.

Effect of Fennel on the Health Status of Menopausal Women: A Systematic and Meta-analysis

OBJECTIVES

The aim of the present study is the systematic and critical investigation of the effectiveness of fennel on the climacteric symptoms among menopausal females.

METHODS

A search of the trials studying the effect of fennel on menopausal females was conducted in 2017 using the MEDLINE and Scopus databases and the Cochrane Library with the following keywords: fennel, Foeniculum vulgare, and menopause.

RESULTS

Fennel combined with officinalis is more effective in the attenuating of sleep disorders compared to Citalopram. The comparison of these two groups regarding the mean bone mineral density and bone mineral content (P = 0.14, P = 0.504); the total hip femoral (P = 0.42, P = 0.66); the trochanter (P = 0.075, P = 0.07); the intertrochanter (P = 0.84, P = 0.93); and the femoral neck (P = 0.43, P = 0.64) did not show any significant statistical differences; however, a statistically significant difference regarding the vasomotor symptoms (P < 0.01) was found. The other significant differences are related to the values of the total cholesterol (P = 0.103); low-density lipoprotein cholesterol, or LDL-C (P = 0.104); high-density lipoprotein cholesterol, or HDL-C (P = 0.266); triglyceride (P = 0.679); body weight (P = 0.212); body mass index (P = 0.041); waist and hip circumferences (P = 0.365); and fat distribution (P = 0.337) between the two groups. The standardized mean difference (SMD) values of sexual activity (SMD = 0.638; P < 0.001), and maturation value (SMD = 0.601; P = 0.003) are highly significant among the fennel-treated women compared with the placebo group.

CONCLUSIONS

According to the findings of the present study, fennel is important in the relieving of vasomotor symptoms, vaginal itching, dryness, dyspareunia, sexual function, sexual satisfaction, and sleep distribution.