Lec 4- Gynaecological Herbs PDF

Phytotherapy (PG-906 clinical, PG-907 General) Herbal therapy for Gynecological disorders. root Pharm D ninth semester students By: Dr/Shimaa Abdelgawad Lecturer of Pharmacognosy,...

Phytotherapy (PG-906 clinical, PG-907 General) Herbal therapy for Gynecological disorders. root Pharm D ninth semester students By: Dr/Shimaa Abdelgawad Lecturer of Pharmacognosy, Faculty of Pharmacy, Fayoum University  Gynecology Definition: Gynecology is the medical practice dealing with the health of the female reproductive system (uterus, vagina and ovaries). Gynecological disorders such as: ❑ Abortion. ❑ Morning sickness ❑ Leucorrhea. ❑ Fertility problems. ❑ Delivery problem. ❑ Menstrual disorders (PMS & Dysmenorrhea). ❑ Menopause syndrome.  I. Premenstrual syndrome (PMS) DEFINITION OF PMS: PMS is a condition, which is associated with somatic, emotional and behavioral symptoms during the women menstruation. 85 % of women have PMS. SYMPTOMS OF PMS: PMS is characterized by over 150 clinical symptoms (behavioral, psychological, and physical). Emotional and behavioral signs and symptoms ❑ Tension or anxiety ❑ Depressed mood ❑ Crying spells ❑ Mood swings and irritability or anger ❑ Appetite changes and food cravings ❑ Trouble falling asleep (insomnia) ❑ Social withdrawal ❑ Poor concentration ❑ Change in libido SYMPTOMS OF PMS: PMS is characterized by over 150 clinical symptoms (behavioral, psychological, and physical). Physical signs and symptoms ❑ Joint or muscle pain ❑ Headache ❑ Fatigue ❑ Weight gain related to fluid retention ❑ Abdominal bloating ❑ Breast tenderness ❑ Acne flare-ups ❑ Constipation or diarrhea ❑ Alcohol intolerance CAUSES OF PMS: The etiology of the syndrome is multifactorial and not fully defined. 1- Cyclic changes in hormones: estrogen surplus ↑↑and progesterone deficiency↓↓ → disturbed function of aldosterone activity → sodium and water retention, imbalance of the hypophyseal–pituitary–adrenal axis → : ❑ Inadequate secretion of adrenal hormones ❑ Disturbed secretion of neurotransmitters (↓ serotonin) → depression ❑ Hyperprolactinemia → breast tenderness ❑ Dietary deficits of calcium, magnesium, and pyridoxine (Vit B6). Signs of PMS change with hormonal fluctuations and disappear with pregnancy and menopause. CAUSES OF PMS: 2- Chemical changes in the brain: Fluctuations of serotonin, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to → ✓ Premenstrual depression ✓ Fatigue ✓ Food cravings ✓ Sleep problems The disruption in estrogen → causes the hypothalamus to release norepinephrine → which triggers a decline in acetylcholine, dopamine, and serotonin → that leads to insomnia, fatigue, depression. TREATMENT OF PMS: 1- Healthy daily habits: low carbohydrate diet, exercise, enough sleep, and relaxation. 2- Acupuncture. 3- Vitamin supplements: Calcium, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking. TREATMENT OF PMS: 4- Commonly prescribed medications for premenstrual syndrome include: Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms when used in the two weeks before menstruation begins. Nonsteroidal anti-inflammatory drugs (NSAIDs): such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort. Diuretics: to reduce the weight gain, swelling and bloating of PMS. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS. Hormonal contraceptives: These prescription medications stop ovulation, which may bring relief from PMS symptoms. 5-Herbal medicine: the use of herbs, such as, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John's wort. II. Dysmenorrhea DEFINITION OF DYSMENORRHEA: Pain associated with menstruation is called dysmenorrhea. More than 1/2 of women who menstruate have some pain for 1 to 2 days each month. Usually, the pain is mild. But for some women, the pain is so severe that it keeps them from doing their normal activities for several days a month.  SYMPTOMS OF DYSMENORRHEA: ✓ Most women have some pain (abdominal, hips, lower back, inner thighs) with their menstrual periods. ✓ For some women, severe pain comes with other symptoms, including diarrhea, nausea, vomiting, fever, headache, and dizziness. TYPES OF DYSMENORRHEA: 1- Primary dysmenorrhea: Is the cramping pain that comes before or during a period. This pain is caused by natural chemicals called prostaglandins that are made in the lining of the uterus. Prostaglandins cause the muscles and blood vessels of the uterus to contract. On the first day of a period, the level of prostaglandins is high. As bleeding continues and the lining of the uterus is shed, the level goes down. This is why pain tends to lessen after the first few days of a period. Primary dysmenorrhea begins soon after a girl starts having menstrual periods. In many women with primary dysmenorrhea, periods become less painful as they get older. This type of period pain also may improve after giving birth. TYPES OF DYSMENORRHEA: 2- Secondary dysmenorrhea: Is caused by a disorder or diseases in the reproductive organs (Endometriosis, Fibroids, pelvic inflammation, bowel or bladder disease). The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. For example, the pain may begin a few days before a period starts. The pain may get worse as the period continues and may not go away after it ends. TREATMENT OF DYSMENORRHEA 1- Exercise: Exercising most days of the week can make you feel better. Aerobic workouts, such as walking, jogging, biking, or swimming, help produce chemicals that block pain. 2- Apply heat: Taking a warm bath or placing a heating pad or hot water bottle on your abdomen can be soothing. 3- Sleep: Getting enough sleep before and during your period is important. Being well rested can help you cope with discomfort. 4- Relax: Meditating or practicing yoga also can help you cope with pain. TREATMENT OF DYSMENORRHEA 5- Medications: Analgesics: that target prostaglandins. These medications, called nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen (OTC medications), (specially in primary dysmenorrhea). Antispasmodics: to relive uterine spasm and colic (specially in primary dysmenorrhea). Birth control methods that contain estrogen and progestin, such as the pill, the patch, and the vaginal ring, can be used to treat painful periods (specially in secondary dysmenorrhea). 6- Hormonal intrauterine device (IUD): (specially in secondary dysmenorrhea). 7-Treatments for secondary dysmenorrhea or even surgery TREATMENT OF DYSMENORRHEA 8- Herbal treatments: (for primary dysmenorrhea). Herbal phytotherapy including the use of: 1- Analgesic & Anti inflammatory herbs: such as evening primrose oil. 2- Hormone modulator herbs: such as Chaste tree berries. 3- Antispasmodic herbs: such as Fennel, Anise, Cinnamon, etc… Natural herbal remedies for PMS & dysmenorrhea: 1. Evening primrose 2. Chaste tree 3. Chinese Angelica 4. Fennel 5. Chamomile ❑ Botanical origin 6. Fenugreek ❑ Active constituent 7. Ginger ❑ Mechanism of action 8. Cinnamon ❑ Dosage 9. Common yarrow ❑ Side effects 10. Guava ❑ Contraindications 11.Valerian ❑ Drug interactions 1-Evening primrose seed oil ‫زيت زهرة الربيع المسائية‬  1-Evening primrose oil Botanical origin Oil obtained from seeds of Oenothera biennis family: Onagraceae Active constituents Omega-6 essential fatty acid: Linoleic acid (60%–80%) GLA (8%–14%) is all-cis- 6,9,12 octadecatrienoic acid → metabolized to dihomo- gamma linolenic acid  1-Evening primrose oil Mechanism of action ❑ Increases the production of prostaglandin E1, which has analgesic & anti-inflammatory effects. ❑ Interaction with prolactin. ❑ Increase cervical mucus.  1-Evening primrose oil Dosage: 3 to 6 g daily for 4-10 months Indications: 1- For PMS and dysmenorrhea a- alleviates PMS symptoms (breast swelling, Adverse drowsiness, avidity, and facial eruption). reaction: b- Reduce severity and duration of PMS Upset stomach (physical, mental, and social). c- Antidepressant in PMS Nausea 2- Polycystic ovarian syndrome (PCOS) Diarrhea 3-Increased cervical mucus to improve the Headache. chances of pregnancy.  1-Evening primrose oil Contraindications: Pregnancy and breast-feeding. Drug interactions: Bleeding disorders. ✓Anticoagulants Epilepsy: EPO ↑ the seizures. Surgery. 2- Chaste tree berries or Vitex (Cloister pepper, Hemp tree, and Monk's pepper) ‫ ثمار‬، ‫ثمار نبات كف مريم‬ ‫ أو فلفل الراهب‬،‫العفة‬ Fruits  2- Chaste tree berries Botanical origin Fruits of Vitex agnus-castus Family: Lamiaceae Active constituents 1-Essential oil: (Cineole, and sabinene). Iso vitexin 2-Iridoid glycosides: (aucubin and agnuside). Extract standardized to its agnuside content 3-Flavonoids: (castican, orientin and iso vitexin). 4-Essential fatty acids: (oleic acid, linolenic acid, palmitic acid, stearic acid). Agnuside  2- Chaste tree berries Mechanism of action Inhibits prolactin secretion from pituitary gland (through binding to dopamine-2 receptors). Restore estrogen progesterone balance (through weak estrogenic activity). Decreases premenstrual symptoms (Through binding to opioid receptors → analgesic effect).  2- Chaste tree berries Indications: In treatment of: Hyper-prolactinaemia (infertility) PMS. Menstrual irregularities (dysmenorrhea). Cyclic breast pain (mastalgia). Acne due to hormone imbalance. Treatment of menopause.  2- Chaste tree berries Dosage: Adverse reaction: Extract: 160-400 mg daily & up to ❑ Bleeding between menstrual 1800 mg. periods ❑ Dry mouth ❑ Hair loss ❑ Headache ❑ Itching ❑ Mild digestive upset ❑ Nausea (so mixed with ginger) ❑ Rapid heartbeat ❑ Skin rash.  2- Chaste tree berries Contraindications: Drug interactions: Hormone-sensitive conditions (such as endometriosis, uterine Contraceptives: fibroids, and cancers of the breast, Vitex ↓ its efficacy. ovaries, or prostate). Medications used for Parkinson's disease, mental disorders or schizophrenia: as it affects Parkinson's disease. dopamine levels.  3- Dang gui (Chinese Angelica Female ginseng) ‫حشيشة المالك الصينية‬ Roots  3- Dang gui Botanical origin Roots of Angelica sinensis Family: Apiaceae Z-Ligustilide Active constituents 1- Volatile oil (Dihydro-phthalides lactones): Z-Ligustilide Angelicide 2- Ferulic acid. Angelicide 3- Polysaccharides.  3- Dang gui Mechanism of action 1- Uterine antispasmodic: relax the uterus muscles. Ligustilide may also inhibit prostaglandin F-2α, oxytocin, acetylcholine chloride and potassium depolarization-induced uterine contraction. 2- Improve micro-circulation: ferulic acid and Ligustilide increase the number of opened capillaries and promote blood flow and circulation.  3- Dang gui Indications: dong quai used for several conditions, including: 1-Menstrual disorders: painful periods, heavy bleeding, and irregular cycles. 2- Menopausal symptoms: to manage menopausal symptoms such as hot flashes and mood changes. 3- Premenstrual syndrome (PMS): help to alleviate PMS symptoms, such as breast tenderness and mood changes. 4- Fertility: dong quai used to boost fertility.  3- Dang gui Dosage: Root: 3-15 g/day. Extract: 75-500 mg. Adverse reaction: Fever Gynecomastia Bleeding Photosensitization  3- Dang gui Contraindications: Drug interactions: Pregnancy/Lactation→ Anticoagulant: ↑ bleeding abortifacient. risk. Bleeding disorders. Hormone-sensitive conditions such Aminolevulinic acid: as breast cancer, uterine cancer, Photosensitizing agents ovarian cancer, endometriosis, or may enhance the uterine fibroids. photosensitizing effect of Surgery. aminolevulinic acid. 4-Fennel ‫الشمر‬ Fruits  4-Fennel Botanical origin Fruits of Foeniculum vulgare Family: Apiaceae. Active constituents Essential oil (3-6%): ❑ Trans-anethole (90%) ❑ Fenchone (20%) ❑ Small amounts of limonene, camphor, alpha-pinene Trans-anethole Fenchone  4-Fennel Mechanism of action Analgesic: Alleviate menstrual pain by lowering the prostaglandin levels in blood. Analgesic effect equal to Mefenamic acid and ibuprofen. Antispasmodic: Reduced the intensity of oxytocin and PGE2 induced contractions significantly  4-Fennel Adverse reaction: Dosage: Fennel may cause stomach Dried fruit: 5 to 7 g upset, photodermatitis, contact daily. dermatitis, and cross reactions. Fennel oil: 200 mg/day The oil may induce reactions, Indications: such as hallucinations and ❑ Promote lactation & seizures. Four case reports of menstruation. premature thelarche (breast ❑ Reducing pain in primary development) in girls have dysmenorrhea been reported with the use of fennel.  4-Fennel Contraindications: Drug interactions: ❑ Allergy to celery, carrot or mugwort. ❑ Medications ❑ Bleeding disorders. metabolized by ❑ Hormone-sensitive condition cytochrome P450 such as breast cancer, uterine enzymes. cancer, ovarian cancer, ❑ Contraceptive drugs endometriosis, or uterine ❑ Anticoagulant. fibroids: 5-Chamomile ‫شيح البابونج‬ Flower heads  5-Chamomile Botanical origin Flowers of Matricaria chamomilla Family: Asteraceae Chamazulene Active constituents Essential oil: chamazulene (blue color), α-bisabolol. Flavonoids: Apigenin and related flavonoid glycosides. Apigenin  5-Chamomile Mechanism of action 1- Analgesic: inhibit COX enzyme, reduce prostaglandin synthesis in the endometrium. 2- Antispasmodic: and relaxing uterine crambs associated with PMS 3- Antidepressant: apigenin modulate the actions of dopamine and serotonin. 4- Anxiolytic: Apigenin act as agonist for central benzodiazepine (GABA)receptors.  5-Chamomile Dosage: Dried flower: 1.1 - 15 g/day. Adverse reaction: Extract: 500–1,500 mg Nausea daily. Dizziness Allergic reactions Indications: Inflammation if For reducing abdominal and applied directly to pelvic pain, fatigue, lethargy and depression during the eye. menstrual cycle Anaphylaxis.  5-Chamomile Drug interactions: Contraindications: Anticoagulants Allergic reactions to Cyclosporine. Ragweed, Marigold, Medications metabolized Chrysanthemum, and Daisy. by cytochrome P450 liver enzymes. 6-Fenugreek ‫الحلبة‬ Seed  6-Fenugreek Botanical origin Seeds of Trigonella foenum-graecum Family: Leguminosae. Active constituents Trigonelline Steroidal sapogenins: Diosgenin. Proteins: rich in lysine and tryptophan. Flavonoids: Quercetin, Rutin, vitexin, Isovitexin Alkaloids: Trigonelline & Choline. Diosgenin  6-Fenugreek Mechanism of action 1- Analgesic: → alkaloids → interact with serotonergic and opioid receptors. 2- Anti inflammatory, anxiolytic & phytoestrogen: → Diosgenin (steroidal sapogenin) → corticosteroid like effect → & phytoestrogen (has estrogenic activity). 3-The antihistaminic effect → reduce premenstrual symptoms. 4- Antispasmodic: relief uterine crams.  6-Fenugreek Dosage: Dried seed: 5-10 g/day. Extract: 0.6-1.2 g/day. Indications: 1- For PMS &dysmenorrhea pains: don’t affect pain severity but Adverse reaction: reduce duration of pain. Diarrhea 2- Decrease symptoms of Stomach upset dysmenorrhea (fatigue, headache, Bloating, and gas nausea, vomiting, lack of energy). 3- Control PMS food cravings. Allergic reactions in 4- Control PMS anxiety. some people.  6-Fenugreek Contraindications: Pregnancy: malformations in the baby, as well as early contractions. Drug interactions: Allergies: People who are allergic to Antidiabetics. other plants in the Fabaceae family, Anticoagulants. including soybeans, peanuts, green Theophylline: Using peas, and other. fenugreek while taking Surgery: Fenugreek might slow blood theophylline might reduce the clotting. effects of theophylline. Diabetics: Fenugreek can affect blood sugar levels in people with diabetes. 7- Cinnamon ‫القرفة‬ Bark  7- Cinnamon Botanical origin Barks of Cinnamon Zeylanicum Family: Lauraceae Active constituents Essential oil: contain Cinnamaldehyde (55-57%). Eugenol (5-18%).  7- Cinnamon Mechanism of action Analgesic & Anti-inflammatory: (Eugenol) → Prevent the biosynthesis of prostaglandins Antispasmodic: (Cinnamaldehyde) Clinical studies revealed that Cinnamon reduced the severity and duration of pain during menstruation, but this effect was lower compared with Ibuprofen.  7- Cinnamon Dosage: Adverse reaction: Dried bark: 1 to 3 g/day Headache Extract: 420 mg 3 times daily Heartburn Bloating Indications: Abdominal discomfort 1- Reduce pain, menstrual Nausea bleeding, nausea and vomiting Diarrhea with PMS and primary Allergic reactions:(Tongue dysmenorrhea. or gum swelling, a burning 2- Cinnamon acts as a or itching sensation and vasodilator → regulate PMS and white patches in the mouth). a missed cycle. 3- Helps in treatment of poly Liver toxicity (in very high cystic ovary disease. doses).  7- Cinnamon Contraindications: Pregnancy: due to its Drug interactions: emmenagogue effect. Diabetic patients. Antidiabetics. Liver disease. Anticoagulants. Heart disease. Renal disease. 8- Ginger ‫الزنجبيل‬ rhizome  8- Ginger Botanical origin Rhizomes of Zingiber officinale family: Zingiberaceae. Active constituents Oleoresin: (volatile oil+resin) Including Gingerols (6-gingerol). Shagols.  8- Ginger Mechanism of action Analgesic & anti inflammatory: Ginger inhibits the activities of cyclooxygenase and lipoxygenase, decrease in the formation of prostaglandins and leukotrienes. Antiemetic: Peripherally in GIT → ↑↑ gastric tone and motility. ↑↑ gastric emptying. Centrally → ↓↓ serotonin receptors. Antispasmodic A clinical trial indicated that ginger (250-mg capsules) was as effective as the nonsteroidal anti-inflammatory drugs mefenamic acid (250 mg) and ibuprofen (400 mg) in relieving pain in women with primary dysmenorrhea.  8- Ginger Dosage: Dried plant: 0.5 - 3 g daily up to 12 weeks. Dried extract: 250-500 mg 3 times daily. Adverse Indications: reaction: 1- Analgesic for backache and Heartburn. abdominal pain in PMS & Diarrhea. dysmenorrhea. Burping. 2- Reduction of severity of mood and physical and behavioral symptoms of Stomach discomfort PMS  8- Ginger Drug interactions: Contraindications: Anticoagulant: bleeding. Bleeding disorders. Antidiabetics: hypoglycemia. Gallstones. Anti-hypertensives: hypotension. Pregnancy: ginger Cyclosporine, Metronidazole shouldn’t exceed 2g (Flagyl): Ginger increases the absorption and side effects of these drugs. ‫‪9- Common yarrow‬‬ ‫األخليا أو ذات األلف ورقة‬ ‫‪Herb‬‬  9- Common yarrow Botanical origin Herb of Achillea Millefolium Family: Asteraceae Active constituents 1. Sesquiterpene lactones: Cynaroside I (proazulene) named achillicin. 2. Flavonoids (anti-spasmodic): cynaroside I and cosmosiin II. 3. Alkamides: p-hydroxy-phenethyl amide IV. Achillicin p-hydroxy-phenethyl amide IV.  9- Common yarrow Mechanism of action Spasmolytic: (flavonoids) Inhibition of CaCl2 induced contractions. Anti-inflammatory: (sesquiterpene lactones & alkamides) Reduce prostaglandin synthesis → pain and bleeding duration of menstruation.  9- Common yarrow Dosage: Adverse reaction: Dried herb: 4-5 g /day. Contact dermatitis or skin irritation. Extract: 250-500 mg Blurry vision, dry daily mouth, fatigue, Indications: and heart Reduce the symptoms palpitations of PMS and pain (anticholinergic severity toxicity).  9- Common yarrow Drug interactions: Contraindications: Anticoagulants. Pregnancy and lactation. Lithium: Yarrow may Allergy to ragweed and related decrease your body's ability to plants. get rid of lithium, increasing Bleeding disorders. the risk of lithium build-up and severe side effects. 10. Guava ‫ورق الجوافة‬ Leaves  10. Guava leaves Botanical origin Leaves of Psidium guajava Family: Myrtaceae Active constituents Quercetin Flavonoids: Quercetin and its glycosides, morin and its glycosides, kæmpferol, luteolin-7-O-glucoside and apigenin-7-O-glucoside. Morin  10. Guava leaves Mechanism of action 1-Antispasmodic → calcium antagonists. 2-Analgesic & anti-inflammatory → inhibits prostaglandin-synthesis → reduce pain in dysmenorrhea. Efficacy equivalent to ibuprofen. Guava leaves Anti-dysmenorrhea (for menstruation pain): a clinical study performed on 197 women using pills contain guava leaf extract (6 mg extract/day) over five days during three consecutive cycles. The pills alleviated menstrual pain and could replace the use of medicaments like ibuprofen.  10. Guava leaves Dosage: Extract: 6 mg/day Adverse (clinical trial showed that 3 reaction: mg/day) was not Orally, might active). cause temporary Indications: nausea or For Pain and cramps stomach pain in in PMS & some people. dysmenorrhea Skin irritation.  10. Guava leaves Contraindications: Pregnancy and breast-feeding Eczema: Guava leaf extract contains chemicals that can Drug cause skin irritation, especially in people with skin interactions: conditions like eczema. Antidiabetic Diabetes: Guava might lower blood sugar. drugs: risk of Surgery: Guava might lower blood sugar and also has hypoglycemia. anticoagulant effect, so guava might increase the risk for bleeding or interfere with blood sugar control during and after surgical procedures. Stop using guava as a medicine at least 2 weeks before a scheduled surgery. 11. Rhizoma Valeriana ‫ حشيشة الهر‬-‫ ناردين‬-‫واليريانا‬ Valerian Rhizome & roots  11. Valerian Botanical origin The dried rhizome (stolon) and roots of Valeriana officinalis Family: Valerianaceae. Active constituents Volatile oil 0.5-2 % (Bornyl isovalerianate). Epoxy iridoid esters = Secoiridoid (valepotriates). Glutamine amino acid. Valtrate Valerenic acid  11. Valerian Mechanism of action 1-Musculo tropic agent (antispasmodic): valerenic acid which inhibits contraction of smooth muscles resulting from cellular depolarization (Calcium channel blocker) → intracellular calcium concentration decreases, which in turn relaxes uterine muscle → reduce Pain and cramps in Dysmenorrhea. 2- Anxiolytic: (GABA agonist, Stimulate synthesis and release of GABA & decrease GABA catabolism) → reduce anxiety and stress in PMS.  11. Valerian Dosage: Extract: 200-300 mg daily for up to 6 Adverse reaction: weeks. Dizziness. Indications: Drowsiness. Headache. Antispasmodic: reduce Stomach upset. severity of pain in Mental dullness. dysmenorrhea. Vivid dreams. Reduces emotional, Withdrawal physical, and behavioral symptoms. symptoms of PMS.  11. Valerian Contraindications: Drug interactions: Surgery ✓CNS depressants: might Pregnancy and breast-feeding cause too much sleepiness. Thank you