Herbs of special interest to women

Phytochemical screening and galactagogic attributes of Pergularia daemia (Forssk.) Chiov. leaf extract in lactating mice (Mus musculus)

Introduction

Pergularia daemia (Forssk.) Chiov. [PD] is used as a galactagogue by various tribes in Purulia district, India, lacks a scientific basis.

Objectives

The purpose of the study was to determine whether administration of aqueous leaf extract of P. daemia can increase milk production in lactating mice and encourages development in suckling pups.

Methods

30 lactating mice (n=6 per group) with a minimum of 5 pups each were treated with the aqueous PD extract at 50, 100, 150 and 200 mg/kg body weight while the control group was administered with only distilled water. The mice were daily fed with aqueous leaf extract via gavage, which started at day 3 and continued to day 15 post-partum and milk secretion was assessed by the weight-suckle-weight method. The qualitative estimation, UV-vis analysis and GC-MS study of the leaf extract was also done for the presence of phytoconstituents.

Results

Administration of aqueous leaf extract led to a considerable increase in milk production (28.1%) and the pups gained weight substantially (p<0.05) when compared to control. Milk production was enhanced in mice treated with 150 mg/kg b.wt. of leaf extract compared to other doses (p<0.05). The GC-MS analysis of the aqueous leaf extract of P. daemia revealed 20 major peaks, some with small retention time and also revealing presence of several phyto-estrogenic compounds.

Conclusion

The present study effectively demonstrated that aqueous leaf extract of PD enhanced milk production in mice and might be used as an alternative strategy for increasing milk production and can be extrapolated to farm animals and human beings.

The Use of Complementary Medicine During Childbearing Years: A Multi-Country Study of Women From the Middle East اس نه الطب التكميلي خلال سنوات الإنجاب: دراسة متعددة البلدان لنساء من الشرق الأوسط

The prevalence of self-prescribed complementary medicine (CM) use is an area of concern across the Middle East. We conducted a descriptive qualitative study to describe women’s use of CM during their childbearing years in Egypt, Jordan, Saudi Arabia and Iran. The study conducted using face to face audio-recorded interviews with 70 participants. Our findings showed that women used several herbal plants to ease pain and discomfort during menstruation and/or during pregnancy and in postpartum care. Acupuncture, meditation, and massage were less likely to be used by women. The impact of CM was often described in relation to perceived usefulness and safety of herbs. Cultural beliefs and roles of women contributed to the use of herbs among women. Given the high use of herbal medicine, there is a need for discussion about the potential of adverse effects of some plants or their metabolites following self-medication during the childbearing years.

Community Pharmacists' Knowledge, Attitude, and Practice in Providing Self-Care Recommendations for the Management of Premenstrual Syndrome

Background and objectives: Premenstrual syndrome (PMS) comprises a variety of physical and emotional symptoms that affect women of reproductive age. The distress caused by PMS often leads to self-medication, and many over-the-counter or non-prescription products are available for relieving PMS symptoms. The choice of a suitable product should be based on advice from a health professional, such as a community pharmacist. Hence, we assessed the knowledge, attitude, and practice of Malaysian community pharmacists in providing self-care recommendations for the management of PMS. Materials and Methods: A cross-sectional survey was carried out in Kuala Lumpur, Malaysia from September to November 2018 using a self-administered questionnaire. The respondents were community pharmacists working in Kuala Lumpur and were chosen from a list of Type A license holders in the city. Results: We achieved a response rate of 79% and included 181 questionnaires in the final analysis. Of the 181 respondents, most of them (76.8%; n = 139) had medium to good levels of knowledge of PMS. Likewise, most of the respondents (78.5%; n = 142) had positive attitudes toward their role in PMS management. Having taken courses on managing minor illnesses in women substantially enhanced their levels of knowledge of (p = 0.002), but not their attitude towards, PMS management. Among the PMS-relieving products, the most commonly recommended products were ibuprofen (79%; n = 143), mefenamic acid (74.5%; n = 135), and naproxen (66.9%; n = 121), which are well known for their anti-inflammatory effect. This suggests that the respondents based their product choice on sound evidence. Conclusions: Community pharmacists can play an important role in the management of PMS. In future work, a larger sample can be assembled to obtain more insight into the readiness of community pharmacists to help women in self-managing PMS and establish a specialized service to this end.

Structure-Guided Identification of Black Cohosh (Actaea racemosa) Triterpenoids with In Vitro Activity against Multiple Myeloma

Black cohosh is a well-established medicinal plant and preparations of its rootstock are used for the treatment of mild climacteric complaints. The compounds considered responsible for the therapeutic effect are triterpene glycosides, characterized by a cycloartane scaffold and a pentose moiety. Because some of these triterpenoids were found to exhibit relevant cytotoxic effects against human breast cancer cells, we decided to investigate their activity on multiple myeloma cell lines NCI-H929, OPM-2, and U266. In a systematic approach, we initially tested three known cytotoxic compounds of three different triterpenoid types, revealing the cimigenol-type triterpenoid as the most active constituent. In a second round, seven naturally occurring cimigenol derivatives were compared with respect to their sugar moiety and their substitution pattern at position C-25, leading to 25-O-methylcimigenol-3-O-α-L-arabinopyranoside as the most potent candidate. Interestingly, not only the methyl group at position C-25 increased the cytotoxic effect but also the arabinose moiety at position C-3 had an impact on the activity. The variety of cimigenol derivatives, moreover, allowed a detailed discussion of their structure–activity relationships, not only for their effect on multiple myeloma cells but also with regard to previous studies on the cytotoxicity of black cohosh triterpenoids.

Investigating Chemical Composition and Indications of Hydrosol Soft Drinks (Aromatic Waters) Used in Persian Folk Medicine for Women's Hormonal and Reproductive Health Conditions

Hydrosol soft drinks in Persian nutrition culture are produced as side products of the essential oil industry to be used as safe remedies for treatment of some ailments. This study investigated hydrosols for women's hormonal health conditions. Detailed information was gathered by questionnaires. Chemical constituents of these mono- or poly-herbal hydrosols were identified after liquid/liquid extraction and gas chromatography-mass spectrometry. Hierarchical cluster and K-means analysis (SPSS software) were used to find their relevance. A literature survey was also performed. In most cases, thymol, carvacrol, and carvone were the major constituents except for dill, white horehound, willow, Moderr, and yarrow hydrosols, whose their major components were dill ether, menthol, phenethyl alcohol, linalool, or camphor. Based on clustering methods, some similarities could be found in their constituents with some exceptions. None of them have been studied scientifically before. These investigations may lead to the development of some functional drinks or even new lead components.

Wild food plants and minor crops in the Ripollès district (Catalonia, Iberian Peninsula): potentialities for developing a local production, consumption and exchange program

BACKGROUND

Wild food plants (WFP) have always been consumed by humans, first as the main basis of their food and, since the origins of agriculture, as ingredients of normal diets or as an alternative during situations of scarcity. In contemporary industrialized societies their use is for the most part being abandoned, but they may still play an important role. With the purpose of advancing in the ethnobotanical knowledge of one region of the Catalan Pyrenees, the present study reports the findings of a research project conducted in the Ripollès district (Catalonia, Iberian Peninsula), concerning ethnobotanical knowledge and use of wild and semi-wild vascular plants as foods, along with minor crops.

METHODS

From August 2004 to July 2014, we performed 104 interviews (93 of which yielded data on food plants) with 163 informants, using the method of semi-structured ethnobotanical interview. We identified the plants quoted and kept herbarium vouchers.

RESULTS

We detected 967 use reports for 80 wild or naturalized taxa, which are or have been consumed in the Ripollès district, the most cited being Taraxacum dissectum, Cynara cardunculus and Origanum vulgare. Certain frequently reported species such as Molopospermum peloponnesiacum and Taraxacum dissectum have only been rarely cited previously or indicated as food plant in very restricted geographical areas. Most cited families included Asteraceae and Lamiaceae, followed by Rosaceae and Apiaceae. Preferred consumed plant parts included leaves, followed by aerial parts, along with fruits and infructescences, while most wild food plants are eaten raw or used as condiments. Demographic factors such as age and locality of informants seem to be more relevant to wild food plant knowledge than gender. Middle-aged people and inhabitants from the Higher Freser River Valley seem to have a greater knowledge of WFP, both in relation to the number of species elicited, as well as the diversity of uses and preparations. To a lesser degree, women seem to have a slightly higher WFP knowledge than men. The consumption of these resources is still fairly alive amongst the populace, yet changes affecting younger generations-in most cases abandonment-have been reported by various participants.

CONCLUSION

The information provided by this kind of research permits the detection of those traditional species that could constitute the basis for the future development and management of wild edible plant resources along with minor crops. It also helps to determine the factors affecting their use, as well as the distinct target groups that such programmes could be addressed to.

Ethnopharmacological survey on medicinal plants used in herbal drinks among the traditional communities of Pakistan

ETHNOPHARMACOLOGICAL RELEVANCE

There is very limited information regarding medicinal plants used by traditional healers in Pakistan, for treating wide-ranging diseases. Current study provides significant ethnopharmacological information, both qualitative and quantitative on medical plants in Pakistan and the pharmacological importance of herbal drinks, especially in the discovery of new drugs.

MATERIALS AND METHODS

The current ethnomedicinal field study was conducted from various traditional communities of Pakistan to document usage of medicinal plants as herbal drinks. Data was collected through field interviews from local people and using semi-structured questionnaires. Data was analyzed using quantitative indices such as UV (use value), RFC (Relative frequency of citation), and FL (Fidelity level).

RESULTS

The present study recorded 217 plant species belonging to 174 genera and 69 families used in herbal drinks preparations. Major herbal preparations include decoctions, infusions and juice. According to use reports, significant species were Aloe vera, Artemisia fragrans, Allium cepa, Senegalia catechu, Alternanthera sessilis, Malva ludwigii, Arnebia benthamii, Cichorium intybus, Coccinia grandis, Dalbergia sissoo. Major ailment treated with herbal drinks include heartburn, fever, diarrhea, hypertension, and others. Use value (UV) varies from 0.23 to 0.02, with Mentha arvensis (0.23) having the highest value of UV followed by Mentha longifolia (0.22), Plantago lanceolate (0.19), Achillea millefolium (0.18), Coriandrum sativum (0.18), Justicia adhatoda and Malva sylvestris (0.17). Values of RFC varies from 0.28 to 0.09 while Fidelity level (FL) among plants varies from 37.5 to 100. Alternanthera sessilis, Oxytropis lapponica, Millettia pinnata and Salvia bucharica had the highest FL value (100).

CONCLUSION

The use of medicinal plants is prevalent in traditional communities of Pakistan. Different herbal preparations are in common practice including various herbal drinks a common tradition and much favoured herbal preparation in terms of its results and regarded as reciprocal to modern drugs. Therefore, suggesting further pharmacological, phytochemical evaluation for essential metabolites and chemical constituents.

Traditional Therapies Used to Manage Diabetes and Related Complications in Mauritius: A Comparative Ethnoreligious Study

Religious communities from Mauritius still rely on traditional therapies (TT) for primary healthcare. Nonetheless, there is still a dearth of scientific information on TT used by the different religious groups to manage diabetes and related complications (DRC). This study aimed to gather ethnomedicinal knowledge on TT used by the different religious groups against DRC. Diabetic patients (n = 95) and traditional healers (n = 5) were interviewed. Fifty-two plant species belonging to 33 families and 26 polyherbal formulations were documented to manage DRC. The most reported DRC was hypertension (n = 36). Leaves (45.2%) and juice (36%) were the most cited mode of preparation of herbal recipes. Plants which scored high relative frequency of citation were Citrus aurantifolia (0.55) and Morinda citrifolia (0.54). The cultural importance index showed that Ocimum tenuiflorum, Cardiospermum halicacabum, Camellia sinensis, and Ophiopogon japonicas were the most culturally important plants among Hindu, Muslim, Christian, and Buddhist community, respectively. Hindu and Muslim community showed the highest similarity of medicinal plants usage (Jaccard index = 95.8). Seven animal species distributed over 4 classes were recorded for the management of DRC. Plants and animals recorded as TT should be submitted to scientific studies to confirm safety and efficacy in clinical practice and to identify pharmacologically active metabolites.

Traditional preference of Wild Edible Fruits (WEFs) for digestive disorders (DDs) among the indigenous communities of Swat Valley-Pakistan

ETHNOPHARMACOLOGICAL RELEVANCE

Digestive disorders (DDs) causes indisposition and lead to death, especially in the underdeveloped world where hygienic conditions are scarce. A major proportion of the human populace depends on the use of traditional knowledge about the consumption of medicinal plants for many diseases, including DDs. The contemporary study summarizes the indigenous uses of Wild Edible Fruits (WEFs) of Swat Valley used for DDs and to evaluate the bio-efficacy of these pharmacologically essential fruit species from the available literature.

MATERIAL AND METHODS

An ethnomedicinal study was conducted in Swat valley, Northern Pakistan. Data was collected through field assessment as well as from traditional healers and local people by means of personal interviews and semi-structured questionnaires, giving value to both rural and urban communities. The ethnomedicinal knowledge was quantitatively analysed using various indices like Familiarity Index (FI), Consensus index (CI), Informant consensus factor (ICF) and the present data was compared with previous studies in the neighbouring areas using Jaccard similarity coefficient (JI).

RESULTS

The present study recorded use reports on 53 WEFs of ethnomedicinal prominence in the treatment of DDs, belonging to 23 families. The recurrent growth forms were trees (51%) shrubs (38%) and herbs (11%). High consumption of fruits (50%), leaves (27%) and flowers (12%) was recorded. The traditional preparations were mostly in the form of unprocessed dried/fresh, powder, Juice and decoction and were usually taken orally. Almost 20-30% of the plants occurred in synanthropic vegetation while more than 75% were found in natural woodland and grassland vegetation. Family Berberidaceae dominated with highest FIV (41) followed by Punicaceae (38), Oxalidaceae (36) and Moraceae (35). ICF values for carminative (0.6) showed high consensus factor followed by anthelmintic, gastroenteritis and intestinal disorders (0.5). FI value is high for Berberis lycium (0.5), Morus alba (0.5), Morus nigra (0.5) followed by Olea ferruginea (0.45). B. lycium had the high consensus index, whereas, a study conducted on Lesser Himalayas Pakistan showed high value of Jaccard similarity coefficient.

CONCLUSION

WEFs are predominantly used in the treatment of various diseases in the valley and traditional knowledge about the use of these species against DDs is still prevailing. Multiple uses of these WEFs suggest further investigation into its phytochemical, toxicological and pharmaceutical potential. This study will serve as a baseline data for future pharmacological studies.

Safety of Popular Herbal Supplements in Lactating Women

The increasing popularity and use of dietary supplements has required health care professionals to become more knowledgeable of their properties, interactions, and adverse effects. The objectives of this review were to evaluate the safety of popular dietary supplements in breastfeeding mothers and the effects on the infants. Nine of the most popular herbal dietary supplements were identified based on the 2011 US market report of the top 10 selling botanicals and the most frequently received inquiries by the Ruth A. Lawrence Lactation Study Center at the University of Rochester Medical Center. Relevant publications were identified through June 2014 using PubMed and EMBASE; tertiary references, including the Drugs and Lactation Database and Natural Medicine Comprehensive Database, were also reviewed. These herbals include black cohosh, cranberry, echinacea, evening primrose, garlic, ginseng, melatonin, milk thistle, and St John's wort. Studies varied greatly with regard to study design, herbal intervention, and outcome measures. Findings suggested that dietary/herbal supplements have not been evaluated in high-quality clinical trials, and there is limited evidence supporting safety of use, particularly among lactating women. Therefore, it is essential for physicians to provide counseling for nursing mothers seeking information on dietary supplements, highlighting reliable safety profiles, inquiring about the potential benefits the patient is seeking, and assessing the patient's perception of this supplement during breastfeeding. More research and clinical trials are required in this area to guide the recommendations and expand our current knowledge of these products.

Plants used during pregnancy, childbirth, postpartum and infant healthcare in Palestine

PURPOSE

This study aims to evaluate the prevalence and the factors related to the use of herbs by women during pregnancy, childbirth, postpartum and for infant healthcare. The study also aims to identify the herbs therapeutic uses and preparation. To date, no previous studies have investigated this prevalence in Palestine.

METHODS

A cross-sectional survey of women of different child-bearing age group inhabiting different locations in Palestine was carried out by means of a semi-structured questionnaire.

RESULTS

A total of 372 women were interviewed. Of the participants 72.3% reported using herbs at different pregnancy stages and for infant healthcare. The most common herbal products used in this study at different stages of pregnancy were Pimpinella anisum, Salvia fruticosa, Matricaria aurea, and Mentha spicata.

CONCLUSION

This study revealed that there is an appreciable prevalence of herbal use among pregnant women at different pregnancy stages and for infant healthcare in Palestine.

An Evidence-Based Systematic Review of Black cohosh (Cimicifuga racemosa, Actaea racemosa) by the Natural Standard Research Collaboration

An evidence-based systematic review of black cohosh (Cimicifuga racemosa, Actaea racemosa) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review

BACKGROUND

During their reproductive years about 10% of women experience some kind of symptoms before menstruation (PMS) in a degree that affects their quality of life (QOL). Acupuncture and herbal medicine has been a recent favorable therapeutic approach. Thus we aimed to review the effects of acupuncture and herbal medicine in the past decade as a preceding research in order to further investigate the most effective Korean Medicine treatment for PMS/PMDD.

METHODS

A systematic literature search was conducted using electronic databases on studies published between 2002 and 2012. Our review included randomized controlled clinical trials (RCTs) of acupuncture and herbal medicine for PMS/PMDD. Interventions include acupuncture or herbal medicine. Clinical information including statistical tests was extracted from the articles and summarized in tabular form or in the text. Study outcomes were presented as the rate of improvement (%) and/or end-of-treatment scores.

RESULTS

The search yielded 19 studies. In screening the RCTs, 8 studies in acupuncture and 11 studies in herbal medicine that matched the criteria were identified. Different acupuncture techniques including traditional acupuncture, hand acupuncture and moxibustion, and traditional acupuncture technique with auricular points, have been selected for analysis. In herbal medicine, studies on Vitex Agnus castus, Hypericum perforatum, Xiao yao san, Elsholtzia splendens, Cirsium japonicum, and Gingko biloba L. were identified. Experimental groups with Acupuncture and herbal medicine treatment (all herbal medicine except Cirsium japonicum) had significantly improved results regarding PMS/PMDD.

CONCLUSIONS

Limited evidence supports the efficacy of alternative medicinal interventions such as acupuncture and herbal medicine in controlling premenstrual syndrome and premenstrual dysphoric disorder. Acupuncture and herbal medicine treatments for premenstrual syndrome and premenstrual dysphoric disorder showed a 50% or better reduction of symptoms compared to the initial state. In both acupuncture and herbal medical interventions, there have been no serious adverse events reported, proving the safety of the interventions while most of the interventions provided over 50% relief of symptoms associated with PMS/PMDD. Stricter diagnostic criteria may have excluded many participants from some studies. Also, depending on the severity of symptoms, the rate of improvement in the outcomes of the studies may have greatly differed.

Effects of a Chinese medical herbs complex on cellular immunity and toxicity-related conditions of breast cancer patients

Rose geranium (Pelargonium graveolens, Geraniaceae) has anti-cancer and anti-inflammatory properties, and promotes wound healing. Similarly, Ganoderma tsugae (Ganodermataceae), Codonopsis pilosula (Campanulaceae) and Angelica sinensis (Apiaceae) are traditional Chinese herbs associated with immunomodulatory functions. In the present study, a randomised, double-blind, placebo-controlled study was conducted to examine whether the Chinese medicinal herb complex, RG-CMH, which represents a mixture of rose geranium and extracts of G. tsugae, C. pilosula and A. sinensis, can improve the immune cell count of cancer patients receiving chemotherapy and/or radiotherapy to prevent leucopenia and immune impairment that usually occurs during cancer therapy. A total of fifty-eight breast cancer patients who received chemotherapy or radiotherapy were enrolled. Immune cell levels in patient serum were determined before, and following, 6 weeks of cancer treatment for patients receiving either an RG-CMH or a placebo. Administration of RG-CMH was associated with a significant reduction in levels of leucocytes from 31·5 % for the placebo group to 13·4 % for the RG-CMH group. Similarly, levels of neutrophils significantly decreased from 35·6 % for the placebo group to 11·0 % for the RG-CMH group. RG-CMH intervention was also associated with a decrease in levels of T cells, helper T cells, cytotoxic T cells and natural killer cells compared with the placebo group. However, these differences between the two groups were not statistically significant. In conclusion, administration of RG-CMH to patients receiving chemotherapy/radiotherapy may have the capacity to delay, or ease, the reduction in levels of leucocytes and neutrophils that are experienced by patients during cancer treatment.

Menstrual cycle-related exacerbation of disease

Exacerbation of common medical and mental health disorders at specific phases of the menstrual cycle is a prevalent phenomenon. Although the precise cause is unclear, studies implicate complex interactions between the immune and neuroendocrine systems. The menstrual cycle also is a trigger for the onset of depressive disorders, including premenstrual dysphoric disorder, a disorder specific to the luteal phase of the menstrual cycle, and depression associated with the transition to menopause. This article discusses common mental health problems exacerbated by the menstrual cycle, with a particular focus on premenstrual dysphoric disorder and perimenopausal depression. Throughout the reproductive lifespan, routine screening and assessment for the presence of common psychiatric disorders are critical for accurate diagnosis and provision of effective treatment. Management options include referral or consultation with a primary care provider or psychiatrist; treatment options for premenstrual dysphoric disorder and perimenopausal depression include pharmacotherapy with antidepressant agents and/or psychotherapy. Hormones may be helpful.

A new potyvirus first isolated and identified from Angelica sinensis

A filamentous virus was isolated in Angelica sinensis (Angelica sinensis (Oliv.) Diels) which shows mosaic symptoms on leaves in Minxian, Gansu province, China. According to morphology and molecular biology properties, this virus, which has a flexuous rod-shaped particle about 750 nm in length and 12 nm in width, was assigned to the genus Potyvirus, family Potyviridae. Its coat protein (CP) shows high similarity with six other potyviruses by analysis of peptide mass fingerprinting (PMF). The 919 bp nucleotides of 3' terminal covering partial CP gene and 3'-untranslated region was amplified by RT-PCR using degenerate primers which were designed according to the result of PMF. In sequence comparisons and phylogenetic analysis, the new isolate was found to be closely related to Japanese hornwort mosaic virus (JHMV), Konjak mosaic virus (KoMV), and Zantedeschia mosaic virus (ZaMV). The most closely related virus is JHMV03 (AB251346), with 96.59% aa and 87.60% nt identity to the isolate. All results suggest the presence of a new member of potyvirus, tentatively named Dang Gui strain of Japanese hornwort mosaic virus (JHMV-DG*). In our research the antiserum against the CP of JHMV-DG had also been prepared. To our knowledge, it is the first time that a potyvirus has been isolated and identified in Angelica sinensis.

Le syndrome prémenstruel: revue générale

Premenstrual syndrome (PMS) is a recurrent disorder that occurs in the luteal phase of the menstrual cycle. It is characterized by intense physical, psychological, and behavioral changes that interrupt interpersonal relationships and disrupt the lives of affected women. Premenstrual syndrome is believed to affect 75% of women of childbearing age. Because no tests can confirm PMS, the diagnosis should be made on the basis of a patient-completed daily symptom calendar and the exclusion of other medical disorders. PMS symptoms occur during the luteal phase of the menstrual cycle and remit with the onset of menstruation or shortly afterward. The aetiology of PMS is still unknown uncertain, but are likely associated with aberrant responses to normal hormonal fluctuations during the menstrual cycle. A wide range of therapeutic interventions has been tested in the treatment of premenstrual symptoms. Most non-pharmacological interventions that have been proven efficacious require a series of interventions. If non-medical approaches are ineffective, drug therapy may be appropriate. Several pharmaceutics agents have been shown to relieve symptoms. Calcium carbonate and selective serotonin reuptake inhibitors have demonstrated excellent efficacy.

Biological Inhibitory Effects of the Chinese Herb Danggui on Brain Astrocytoma

OBJECTIVE

Previous studies have demonstrated the utility of the traditional Chinese herb danggui in the treatment of chronic myelogenous leukemia. Our aim was to examine whether it might similarly be used to treat glioblastoma multiforme.

METHODS

The lipid-soluble active ingredients of danggui were extracted with acetone (AS-AC) or chlorophenol (AS-CH) and their antiproliferative and proapoptotic effects were studiedin vitro on cultured GBM 8401 cells and in vivoon tumors in nude mice.

RESULTS

After a 24-hour treatment, either AS-AC or AS-CH at a lower (50 micro g/ml) and a higher concentration (100 micro g/ml) significantly inhibited the proliferative activity of GBM 8401 cultured cells by 30-50%, as well as the expression of cathepsin B and vascular endothelial growth factor (VEGF). In nude mice, the growth of the tumor was inhibited by 30% by AS-CH or AS-AC (20 mg/kg; p < 0.05) and by 60% by AS-CH or AS-AC (60 mg/kg; p < 0.05). AS-AC and AS-CH also significantly inhibited microvessel formation in the tumors of nude mice.

CONCLUSIONS

Danggui may inhibit tumor growth by reducing the level of VEGF and the proapoptotic protein, cathepsin B. Thus, danggui may be useful in the treatment of high-grade astrocytomas.

Immunomodulatory activity of polysaccharide isolated from Angelica sinensis

The immunomodulatory activities of an Angelica sinensis polysaccharide (AP), purified from the fresh root of A. sinensis Diels, were investigated in vitro in relation to the specificity to immune cells. AP consisted of rhamnose, arabinose, mannose, glucose, galactose with the molar ratio of 1.00:4.54:2.98:11.09:7.45. Cell proliferation results showed that proliferation of total spleen cells, macrophages and T cells were promoted by the action of AP. The treatment of AP increased the production of IL-2 and IFN-gamma, while that of IL-4 was decreased. RT-PCR analysis displayed that the IL-2 and IFN-gamma gene expression were enhanced but the IL-4 gene expression was decreased. Some differences in cytokines secretion pattern were also detected, the expression of IFN-gamma was rapidly augmented while that of IL-2 responded later. The flow cytometry results showed that the percentage of CD4(+)T cell in total spleen cells was remarkably increased by AP, while that of CD8(+)T cell was slightly decreased. In conclusion, AP has immunomodulatory activity by regulating expression of Th1 and Th2 related cytokines. The time-effect relation of cytokines response also suggests that macrophages and natural killer cells involved in nonspecific immunity were primary activated, and helper T cell were secondarily affected by AP.

Polysaccharides from the root of Angelica sinensis protect bone marrow and gastrointestinal tissues against the cytotoxicity of cyclophosphamide in mice

Cyclophosphamide (CY) is a cytostatic agent that produces systemic toxicity especially on cells with high proliferative capacity, while polysaccharides from Angelica sinensis (AP) have been shown to increase the turnover of gastrointestinal mucosal and hemopoietic stem cells. It is not known whether AP has an effect on CY-induced cytotoxicity on bone marrow and gastrointestinal tract. In this study, we assessed the protective actions of AP on CY-induced leukopenia and proliferative arrest in the gastroduodenal mucosa in mice. Subcutaneous injection of CY (200 mg/kg) provoked dramatic decrease in white blood cell (WBC) count and number of blood vessels and proliferating cells in both the gastric and duodenal mucosae. Subcutaneous injection of AP significantly promoted the recovery from leukopenia and increased number of blood vessels and proliferating cells in both the gastric and duodenal tissues. Western blotting revealed that CY significantly down-regulated the protein expression of vascular endothelial growth factor (VEGF), c-Myc and ornithine decarboxylase (ODC) in gastric mucosae but had no effect on epidermal growth factor (EGF) expression. AP also reversed the dampening effect of CY on VEGF expression in the gastric mucosa. These data suggest that AP is a cytoprotective agent which can protect against the cytotoxicity of CY on hematopoietic and gastrointestinal tissues when the polysaccharide is co-administered with CY in cancer patients during treatment regimen.

Estrogenic activity of standardized extract ofAngelica sinensis

Since ancient times, extracts of plants have been used for women's health to prevent menopausal symptoms. The symptoms of menopause have been attributed to a reduction in the amount of estrogen produced by the ovaries. In this study the estrogenic activity of a commercial standardized extract of the roots of Angelica sinensis, used to relieve climacteric symptoms was evaluated using in vivo tests such as the degree of cornification of vaginal epithelium, uterotrophic assays and serum LH concentration in ovariectomized rats. Furthermore, the effects on the estrous cycle in rat were investigated. The results obtained have shown that the administration of a standardized ethanol extract in ovariectomized rats exhibited a stimulation of the uterine histoarchitecture, a significant cornification in the vaginal epithelium and a reduction of serum LH concentration showing the estrogenic nature of the extract. Furthermore, the administration of the extract in intact female rats provoked a significant modification of the vaginal smear in 67% of treated rats. The estrous cycle thus modified was characterized by a prolonged estrus stage with a temporary reduction of the regular cyclicity.

Vitex agnus castus: a systematic review of adverse events

Vitex agnus castus L. (VAC) [Verbenaceae] is a deciduous shrub that is native to Mediterranean Europe and Central Asia. Traditionally, VAC fruit extract has been used in the treatment of many female conditions, including menstrual disorders (amenorrhoea, dysmenorrhoea), premenstrual syndrome (PMS), corpus luteum insufficiency, hyperprolactinaemia, infertility, acne, menopause and disrupted lactation. The German Commission E has approved the use of VAC for irregularities of the menstrual cycle, premenstrual disturbances and mastodynia. Clinical reviews are available for the efficacy of VAC in PMS, cycle disorders, hyperprolactinaemia and mastalgia, but so far no systematic review has been published on adverse events or drug interactions associated with VAC. Therefore, this review was conducted to evaluate all the available human safety data of VAC monopreparations. Literature searches were conducted in six electronic databases, in references lists of all identified papers and in departmental files. Data from spontaneous reporting schemes of the WHO and national drug safety bodies were also included. Twelve manufacturers of VAC-containing preparations and five herbalist organisations were contacted for additional information. No language restrictions were imposed. Combination preparations including VAC or homeopathic preparations of VAC were excluded. Data extraction of key data from all articles reporting adverse events or interactions was performed independently by at least two reviewers, regardless of study design. Data from clinical trials, postmarketing surveillance studies, surveys, spontaneous reporting schemes, manufacturers and herbalist organisations indicate that the adverse events following VAC treatment are mild and reversible. The most frequent adverse events are nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash. No drug interactions were reported. Use of VAC should be avoided during pregnancy or lactation. Theoretically, VAC might also interfere with dopaminergic antagonists. Although further rigorous studies are needed to assess the safety of VAC, the data available seem to indicate that VAC is a safe herbal medicine.

Alternatives to estrogen to manage hot flushes

Hot flushes are probably the most common symptom resulting in medical consultation in relation to the menopause and, when severe, they can affect quite dramatically women's quality of life. Hormone (estrogen) replacement therapy (HRT) is the most effective treatment for this symptom and in the ideal setting of clinical trials, under optimal selection of patients and compliance, it reduces hot flushes by about 70-80%. Recently, however, a series of 'scares' has had large resonance in the lay press about possible adverse effects of HRT. These have undermined both doctors' and women's confidence in the use of these compounds. This has been witnessed by the recent fall in HRT sales. A number of compounds, both pharmacological and herbal in origin, have been used for the treatment of neurovegetative symptoms in menopausal women. The present article critically reviews evidence of the efficacy of some of the most commonly used compounds and assesses their effect in relation to that of HRT.

Reactive oxygen species-independent G1 arrest induced by evening primrose extract in Ehrlich ascites tumor cells

We previously demonstrated that evening primrose extract (EPE) induced apoptosis in Ehrlich ascites tumor cells (EATC), and this effect was specific on tumor cells. Furthermore, our results demonstrated that EPE exposure elicited a rapid increase in the activity of superoxide dismutase and intracellular peroxides levels. These changes caused translocation of Bax to mitochondria and a subsequent release of mitochondrial cytochrome c. However, no activation of caspase-3 was observed in EPE-treated EATC. On the other hand, apoptosis-inducing factor (AIF) was translocated from mitochondria to nuclei. The EPE-induced translocation of AIF was suppressed with the addition of catalase, suggesting that the rapid intracellular peroxide levels after addition of EPE triggers off induction of apoptosis, which is AIF-mediated and caspase-independent. In this study, we have shown that EPE elicited a dose-dependent accumulation of cells in the G1 phase and inhibited DNA synthesis. Our results also demonstrated that cell cycle arrest and inhibition of proliferation in EATC by EPE are associated with decreased Rb phosphorylation. Furthermore, inhibitions of Rb phosphorylation and DNA synthesis by EPE were not suppressed with the addition of catalase. The present study suggests that intracellular peroxides, which trigger off induction of apoptosis, are not the trigger of EPE-induced G1 arrest in cell cycle.

Evaluation and management of breast pain

Pain is one of the most common breast symptoms experienced by women. It can be severe enough to interfere with usual daily activities, but the etiology and optimal treatment remain undefined. Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. After appropriate clinical evaluation, most patients with breast pain respond favorably to a combination of reassurance and nonpharmacological measures. The medications danazol, tamoxifen, and bromocriptine are effective; however, the potentially serious adverse effects of these medications limit their use to selected patients with severe, sustained breast pain. The status of other therapeutic strategies and directions for future research are discussed.

Herbal product use and menopause symptom relief in primary care patients: a MetroNet study

OBJECTIVES

The four study objectives were to determine (1) the prevalence of use of four herbal product types promoted to reduce menopause symptoms (phytoestrogens, St. John's wort, Ginkgo biloba, and ginseng) among primary care patients approaching or in menopause, (2) the extent to which women who use these types of herbal products report menopause-related symptoms compared with herbal product nonusers, (3) the frequency of reported symptom reduction after use, and (4) if use was disclosed to their physicians.

METHODS

A cross-section of ethnically diverse women 40-55 years of age (35.5% African American, 60.2% Caucasian) who were recruited from eight primary care centers in Michigan to complete a self-report survey. The questionnaire included demographic items, health history, recent use of four herbal product types purported to relieve menopause symptoms and perception of symptom improvement, and interest in additional herbal product information.

RESULTS

Of 397 women, 24.9% reported taking, in the previous 6 months, at least one of the four study herbs. Herbal product use did not vary by patient demographics or health characteristics. Herbal product users reported more menopause symptoms than nonusers, and 68% of the users said that the herbs improved their symptoms; 56.4% said that their physician was aware of their herbal product use.

CONCLUSIONS

Primary care patients experiencing common menopausal symptoms are likely to use herbal products that are purported to provide menopause symptom relief, and many believe that these products improve their menopausal symptoms. Healthcare providers should be aware of patient's positive attitude, use patterns, and lack of disclosure of use of herbal medicines. Inquiry of herbal product use is another way for physicians to learn about patient self-medication of bothersome symptoms.

Isolation of linoleic acid as an estrogenic compound from the fruits of Vitex agnus-castus L. (chaste-berry)

A methanol extract of chaste-tree berry (Vitex agnus-castus L.) was tested for its ability to displace radiolabeled estradiol from the binding site of estrogen receptors alpha (ERalpha) and beta (ERbeta). The extract at 46 +/- 3 microg/ml displaced 50% of estradiol from ERalpha and 64 +/- 4 microg/ml from ERbeta. Treatment of the ER+ hormone-dependent T47D:A18 breast cancer cell line with the extract induced up-regulation of ERbeta mRNA. Progesterone receptor (PR) mRNA was upregulated in the Ishikawa endometrial cancer cell line. However, chaste-tree berry extract did not induce estrogen-dependent alkaline phosphatase (AP) activity in Ishikawa cells. Bioassay-guided isolation, utilizing ER binding as a monitor, resulted in the isolation of linoleic acid as one possible estrogenic component of the extract. The use of pulsed ultrafiltration liquid chromatography-mass spectrometry, which is an affinity-based screening technique, also identified linoleic acid as an ER ligand based on its selective affinity, molecular weight, and retention time. Linoleic acid also stimulated mRNA ERbeta expression in T47D:A18 cells, PR expression in Ishikawa cells, but not AP activity in Ishikawa cells. These data suggest that linoleic acid from the fruits of Vitex agnus-castus can bind to estrogen receptors and induce certain estrogen inducible genes.

Phytoestrogens: a review of the present state of research

Phytoestrogens are a diverse group of plant-derived compounds that structurally or functionally mimic mammalian estrogens and show potential benefits for human health. The number of articles published on phytoestrogens has risen dramatically in the past couple decades. Further research continues to demonstrate the biological complexity of phytoestrogens, which belong to several different chemical classes and act through diverse mechanisms. This paper discusses the classification of phytoestrogens, methods of identification, their proposed mechanisms of action and botanical sources for phytoestrogens. The effects of phytoestrogens on breast and prostate cancers, cardiovascular disease, menopausal symptoms and osteoporosis will also be examined including research on benefits and risks.

Caspase-independent apoptosis induced by evening primrose extract in Ehrlich ascites tumor cells

We previously demonstrated that evening primrose extract (EPE) induced apoptosis in Ehrlich ascites tumor cells, while mouse embryo fibroblast cells (NIH3T3) used as a normal cell model, showed no effect of cell viability by treatment of EPE. Furthermore, our results demonstrated the rapid increase in intracellular peroxides levels, loss of mitochondrial membrane potential and the release of cytochrome c to cytosol, suggesting that the rapid increase in intracellular peroxides levels after addition of EPE triggers off induction of apoptosis. In this study, we identified that EPE elicited the translocation of Bax to mitochondria and apoptosis-inducing factor (AIF) to nuclei, but no activation of caspase-3-like protease. We also demonstrated that the rapid EPE-induced increase in hydrogen peroxide levels caused the translocation of Bax to mitochondria, and then mitochondrial cytochrome c was released. One of the main consequences of mitochondrial cytochrome c release is the activation of caspase-3. However, no caspase-3 activation was observed. On the other hand, AIF was translocated from mitochondria to nuclei. The EPE-induced translocation of AIF was suppressed with the addition of catalase, suggesting that the rapid intracellular peroxide levels after addition of EPE triggers off induction of apoptosis, which is AIF-mediated and caspase-independent.

Experimental study of anti-tumor effects of polysaccharides from Angelica sinensis

AIM: To investigate the in vivo anti-tumor effects of total polysaccharide (AP-0) isolated from Angelica sinensis (Oliv.) Diels (Danggui) on mice and the in vitro inhibitory effects of AP-0 and its sub-constituents (AP-1, AP-2 and AP-3) on invasion and metastasis of human hepatocellular carcinoma.

METHODS: Three kinds of murine tumor models in vivo, sarcoma 180 (S180), leukemia L1210 and Ehrlich ascitic cancer (EAC) were employed to investigate the anti-tumor effects of AP-0. For each kind of tumor model, three experimental groups were respectively given AP-0 at doses of 30, 100 and 300 mg/kg by ip once a day for 10 days. Positive control groups were respectively given Cy at a dose of 30 mg/kg for S180 and leukemia L1210, and 5-FU at a dose of 20 mg/kg for EAC. On d 11, mice bearing S180 were sacrificed and the masses of tumors, spleens and thymus were weighed. The average living days of mice bearing EAC and of mice bearing L1210 were observed, and the rates of life prolongation of each treatment were calculated, respectively. The inhibitory effects of APs on hepatoma invasion and metastasis in vitro were investigated by employing human hepatocellular carcinoma cell line (HHCC) with the Matrigel invasion chamber, adhesion to extracelluler matrix and chemotatic migration tests, respectively.

RESULTS: AP-0 had no obviously inhibitory effect on the growth of S180, but it could significantly decrease the thymus weights of the mice bearing S180. AP-0 could significantly reduce the production of ascitic liquids and prolong the life of mice bearing EAC. AP-0 could also increase the survival time of mice bearing L1210. AP-0 and AP-2 had significantly inhibitory effects on the invasion of HHCC into the Matrigel reconstituted basement membrane with the inhibitory rates of 56.4% and 68.3%, respectively. AP-0, AP-1, AP-2 and AP-3 could influence the adhesion of HHCC to extracellular matrix proteins (Matrigel and fibronectin) at different degrees, among them only AP-3 had significant blocking effect on the adhesion of HHCC to fibronectin with an inhibitory rate of 30.3%. AP-0, AP-1 and AP-3 could partially inhibit the chemotactic migration abilities of HHCC.

CONCLUSION: The experimental findings suggest that total polysaccharide of Angelica sinensis (Oliv.) Diels (Chinese Danggui) possesses anti-tumor effects on experimental tumor models in vivo and inhibitory effects on invasion and metastasis of hepatocellular carcinoma cells in vitro.

Herbs commonly used by women: an evidence-based review

OBJECTIVE

To review the evidence of herbs commonly used by women.

DATA SOURCES

Articles were located by searching Medline, Cochrane Database of Systemic Reviews, and the Combined Health Information Database and by hand searching the reference lists of recent systematic reviews. The databases were searched in January 2000 and October 2000 by using the Latin and common name of each herb.

METHODS OF STUDY SELECTION

Preference was given to randomized, placebo-controlled trials. When available, English language studies were reviewed. If not, data are presented from review articles that summarize the foreign study.

RESULTS

Many women use herbal therapies. In the United States, herbs are considered dietary supplements. The Food and Drug Administration (FDA) cannot remove them from the market unless they are proven unsafe. The herb industry plans to improve monitoring. Many prospective randomized controlled trials are being funded. Gingko biloba seems to slow the progression of dementia but increases the risk of bleeding. St John's Wort is efficacious for treating mild to moderate depression but has many drug interactions. Ginseng seems to improve well being in perimenopausal women, but it is often impure and has side effects and drug interactions. Garlic slightly lowers blood pressure and lipids. Echinacea slightly decreases the duration of colds but does not prevent them. Valerian is beneficial for insomnia, but there is no long-term safety data. Black cohosh may help the symptoms of perimenopause, and chasteberry may improve premenstrual syndrome. More study is needed on both herbs.

CONCLUSION

Some herbs are medically useful, but the American public would benefit from increased regulation. Manufacturers should be able to ensure that herbs contain pure ingredients. Side effects and drug interactions should be listed. Well-designed studies are being conducted. The results will be helpful to physicians and patients when the clinical evidence becomes available.

Identification of caffeic acid derivatives in Actea racemosa (Cimicifuga racemosa, black cohosh) by liquid chromatography/tandem mass spectrometry

Caffeic acid derivatives occurring in black cohosh [Cimicifuga racemosa (L.) Nutt., Actaea racemosa (Ranunculaceae)], some of which may have pharmacological activity, were analyzed using high-performance liquid chromatography (HPLC) electrospray ionization tandem mass spectrometry (ESI-MS/MS) with the aim of developing a methodology for their rapid identification in a complex plant matrix. Based on these studies, structurally characteristic product ions and neutral molecule losses were identified, which were then used during LC/MS/MS with product ion scanning, precursor scanning and constant neutral loss scanning to detect caffeic acid derivatives in a crude extract of black cohosh. Several caffeic acid derivatives were detected, and the identification of six of them were confirmed by comparison with authentic standards including caffeic acid, ferulic acid, isoferulic acid, fukinolic acid, cimicifugic acid A, and cimicifugic acid B. Four other compounds were detected that appeared to be caffeic acid derivatives based on LC/MS/MS retention times, molecular weights, and fragmentation patterns during MS/MS. Since standards were unavailable for these four compounds, they were tentatively identified using LC/MS/MS as cimicifugic acid E, cimicifugic acid F, dehydrocimicifugic acid A, and dehydrocimicifugic acid B. Dehydrocimicifugic acid A and dehydrocimicifugic acid B have not been reported previously to be constituents of black cohosh.

Pharmacy-based care for perimenopausal and postmenopausal women

Perimenopause and menopause represent a major physiologic and, often, psychosocial transition in the lives of women. During this time, women often experience disturbing new symptoms and develop an increased awareness of their risks for major chronic illnesses. Women in this stage of life are often highly motivated to improve their health and can benefit greatly from pharmacy-based preventive health care services. Although perimenopausal and menopausal women represent an important target market, some pharmacists may wish to offer more focused services within the broader arena of women's health. For example, a number of community pharmacies have developed niche services for these patients, such as osteoporosis screening, (46) breast cancer risk assessment, (50) or bioidentical HRT consulting and compounding. (59) Other pharmacy care services that may be targeted to women in midlife include smoking cessation, weight management, and dietary supplement consulting. Based on the experiences of the Mar-Main Pharmacy staff, a practical approach is to implement new services gradually, while focusing on providing high-quality, individualized service to a small number of patients. Using this strategy, Mar-Main Pharmacy has experienced tremendous growth in its bioidentical HRT services. This increase in demand for pharmacy services has arisen from word-of-mouth referrals from patients and physicians rather than formal marketing. Perimenopausal and menopausal women represent a growing and increasingly knowledgeable group of patients. Many of these women are seeking care that is individualized, responsive to their health beliefs, and designed to help them maintain a high quality of life. Providing pharmacy-based consulting services for these patients can be extremely rewarding, both professionally and personally.

Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants

OBJECTIVES

We estimated the prevalence and longitudinal correlates of use of complementary and alternative medicine (CAM) at midlife among participants of the Study of Women's Health Across the Nation (SWAN).

METHODS

Multiple logistic regression was used to evaluate the relationship between baseline survey-reported symptoms and use of herbal, spiritual, and physical manipulation therapies 1 year later.

RESULTS

Almost half of all women had used CAM in the past year. Baseline psychological symptoms were associated with subsequent use of spiritual therapies among White and Chinese women. Baseline CAM use was a major predictor of subsequent use in White, Japanese, and Chinese women.

CONCLUSIONS

Baseline CAM use, rather than presence of symptoms, was the major predictor of subsequent CAM use. Premenopausal health behaviors are important determinants of choice of therapy during midlife.

Phytoestrogens: a viable option?

Estrogen replacement therapy is one of the most commonly prescribed medicines in the United States by traditional medical professionals. Over the past decade, the market for complementary/ alternative therapies for hormone replacement has dramatically increased. Women are seeking more "natural" alternatives to treat menopausal symptoms. Well-designed randomized clinical trials are often lacking, as is the information on efficacy and safety. This article will review several popular herbal therapies for menopausal symptoms including phytoestrogens, black cohosh (Cimicifuga racemosa), dong quai (Angelica sinensis), chast tree (Vitex agnus-castus), and wild Mexican yam. Their use, mechanism of action, and adverse effects are outlined.

Evaluation and Management of Premenstrual Syndrome and Premenstrual Dysphoric Disorder

OBJECTIVE

To review premenstrual disorders, their varied symptoms, possible etiology, and treatment options.

DATA SOURCES

Published articles identified through MEDLINE (1966-2001) using the search terms premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) and the additional terms treatment and etiology. Additional references were identified from the bibliographies of the retrieved articles.

DATA SYNTHESIS

PMS refers to a group of menstrually related disorders that are estimated to affect up to 40% of women of childbearing age. The varied symptoms of PMS include mood swings, tension, anger, irritability, headache, bloating, and increased appetite with food cravings. PMS symptoms occur during the luteal phase of the menstrual cycle and remit with the onset of menstruation or shortly afterward. Approximately 5% of women with PMS suffer from PMDD, a more disabling and severe form of PMS in which mood symptoms predominate. Because no tests can confirm PMS or PMDD, the diagnosis should be made on the basis of a patient-completed daily symptom calendar and the exclusion of other medical disorders. The causes of PMS and PMDD are uncertain, but are likely associated with aberrant responses to normal hormonal fluctuations during the menstrual cycle. For most women, symptoms can be relieved or reduced through lifestyle interventions, such as dietary changes and exercise, and drug therapy with hormonal or psychotropic agents. For PMDD, selective serotonin reuptake inhibitors have recently emerged as first-line therapy. Certain dietary supplements, including calcium, also may be an option for some women.

CONCLUSION

PMS and PMDD are complex but highly treatable disorders. Pharmacists can improve the recognition and management of these common conditions by providing patient education on premenstrual symptoms and counseling women on lifestyle interventions and pharmacotherapy to relieve their discomfort.

Women's health care during the perimenopause

OBJECTIVE

To review the perimenopause, its associated symptoms, and current management options.

DATA SOURCES

Published articles identified through MEDLINE (1966-2000) using the search terms perimenopause and treatment. Additional articles and books were identified from the bibliographies of the retrieved articles.

DATA SYNTHESIS

The perimenopause is the transition period from normal ovulatory cycles to menopause. It is associated with erratic fluctuations in reproductive hormone levels, often leading to irregular menstrual cycles, vasomotor symptoms, changes in mood or cognition, and sexual dysfunction. The perimenopause is an ideal time to evaluate a woman's health risks for such common chronic midlife conditions as heart disease, osteoporosis, and some cancers, and to initiate appropriate preventive health measures. Low-dose oral contraceptives and other hormonal therapies are often effective in managing perimenopausal symptoms.

CONCLUSION

The transition to menopause is an important time in the female life span that is associated with varied physical and psychological symptoms. Pharmacists should be prepared to provide education about the perimenopause and counsel women on the benefits and risks of various pharmacologic and nonpharmacologic treatments that can ease their passage through this often difficult transition. Pharmacists also are well-positioned to educate and encourage perimenopausal women to initiate lifestyle changes that can enhance their health for the rest of their lives.