{"paper_id":"98d5b4e2-8fba-4a43-ba8d-5dc13ff84f94","body_text":"Page 1 of 7\nApitherapy and Gynaecology –To What Extent \nCan Methods from This Area Be Alternatives to \nConventional Ones?\nKarsten Münstedt* MD, Ph.D1, Jutta Hübner MD, Ph.D2 and Heidrun Männle MD1\n1Ortenau Klinikum Offenburg-Kehl, Ebertplatz 12, Germany\n2Department Haematology and Internal Oncology, University of Jena, Germany\nAbstract\nBackground: Some holistic apitherapists claim that conventional medicine can be replaced by apitherapy. This claim has never been \nsubstantiated or falsified. \nMethods/Design: Since holistic apitherapy is mainly promoted in books, we analyzed 135 books on apitherapy written in either German, \nEnglish or French. We also compared the recommendations with findings from preclinical and clinical studies on the various bee products. \nResults: A maximum of 6 topics were discussed in apitherapy books in relation to the top 20 gynaecological diagnoses. However, the mean \nwas only 1.6 topics. We also found that the important topics like endometriosis, ovarian cysts, pelvic pain and vulvodynia were not discussed in \nany of books. Furthermore, we found that there was significant variation in the treatment recommendations for most of the top 20 gynaecological \nproblems. \nConclusion: The claim that conventional medicine can be replaced by apitherapy is not supported by our analysis. The comparison between \napitherapists’ recommendations and preclinical and clinical studies reveals that most recommendations are not supported by scientific evidence.\nKeywords: Apitherapy; Gynaecology; Health claim; Bee product; Honey; Propolis; Royal jelly\nThis work is licensed under Creative Commons Attribution 4.0 License   WJGWH.MS.ID.000607. \nISSN: 2641-6247                                                                                                                           DOI: 10.33552/WJGWH.2021.05.000605\nWorld Journal of \nGynecology & Women’s Health\nResearch Article Copyright © All rights are reserved by Karsten Münstedt\nIntroduction\nObstetrics and gynaecology is the medical specialty that \nencompasses the two subspecialties related to pregnancy, \nchildbirth, and the postpartum period (obstetrics) and the health of \nthe female reproductive system – vagina, uterus, ovaries, and breasts \n(gynaecology). Additionally, there are various subspecialties. \nExamples are \n•\t Maternal-fetal medicine – a subspecialty focusing on the \nmedical and surgical management of high-risk pregnancies \nand surgery on the fetus.\n•\t Reproductive endocrinology and infertility - a subspecialty \ndealing with the causes and treatment of infertility\n•\t Gynaecological oncology - a subspecialty centering on the \nmedical and surgical treatment of women with cancer of the \nreproductive organs\n•\t Female pelvic medicine and reconstructive surgery - a \nsubspecialty concentrating on the diagnosis and surgical \ntreatment of women with urinary incontinence and prolapse \nof the pelvic organs\n*Corresponding author:  Karsten Münstedt MD, Ph.D, Ortenau Klinikum Offen -\nburg-Kehl, Ebertplatz 12, 77654 Offenburg, Germany.\nReceived Date: July 20, 2021\nPublished Date: August 06, 2021\n\nCitation: Karsten Münstedt MD, Ph.D, Jutta Hübner MD, Ph.D, Heidrun Männle MD. Apitherapy and Gynaecology –To What Extent Can \nMethods from This Area Be Alternatives to Conventional Ones?. 5(1): 2021. WJGWH.MS.ID.000605. \nDOI: 10.33552/WJGWH.2021.05.000605.\nPage 2 of 7\nWorld Journal of Gynecology & Women’s Health                                                                                                             Volume 5-Issue 1\n•\t Advanced laparoscopic surgery\n•\t Family planning - a subspecialty with the emphasis on \ncontraception and pregnancy termination (abortion) \n•\t Pediatric and adolescent gynaecology\n•\t Menopausal and geriatric gynaecology\nA variety of evidence-based treatment options exist for these \ndifferent diseases which are part of national and international \nstandards and guidelines.\nAn increasing number of patients use complementary and \nalternative medicine (CAM), aside from this field of conventional \nmedicine. The terms “alternative” and “complementary” are often \nused interchangeably. However, they refer to different concepts:\n•\t “Complementary” use means a non-mainstream practice used \ntogether with conventional medicine,\n•\t  “ Alternative” use means the use of a non-mainstream practice \nin place of conventional medicine. (https://www.nccih.\nnih.gov/health/complementary-alternative-or-integrative-\nhealth-whats-in-a-name) \nThere is often no or not sufficient data to support the value of \nmany CAM methods. Often, a placebo effect may improve symptoms \nor the spontaneous course of the disease or regression to mean \nmay explain the effects observed and discussed by patients and \nproponents of these methods. In the field of oncology, it has been \nshown that prognosis is poorer with alternative medicine [1]. \nOne CAM treatment concept is holistic apitherapy. It is defined \nas the use of substances produced by honeybees (such as venom, \npropolis, pollen or honey and others) to treat various medical \nconditions. Today, apitherapy is widely promoted by apitherapeutic \nsocieties all over the world and beekeepers (https://apitherapy.\ncom/addresses/societies/; accessed April 2 nd, 2020). Holistic \napitherapy is largely promoted in apitherapeutic congresses \nand beekeeping congresses but especially in books. As has \nbeen shown in several analyses, the books on apitherapy do not \ncomprise the scientific evidence but rather the personal beliefs of \nholistic apitherapists [2-6]. This is true for cancer, dysmenorrhea, \nmenopausal problems, benign prostate, hyperplasia and allergic \nseasonal rhinitis [2-6]. However, the books on apitherapy are meant \nto be guidelines for apitherapists and other practitioners. \nApitherapists have also claimed that apitherapy can cure all or \nalmost all diseases [7,8]; https://apitherapy.com/en/apitherapy-\ndata-base/apitherapy/diseases-that-can-be-treated-through-\napitherapy/; accessed October 9 th, 2020). These claims have not \nbeen validated yet. Since it is impossible to assess the entire field \nof medicine, we analyzed to what extent apitherapy could replace \nor complement treatments for problems in the field of gynaecology, \nexcluding the surgical and oncological aspects. \nDespite this, even a first glance conveys the impression that the \nrecommendations alone for one specific medical problem are quite \ncontroversial. Thus, an interested reader might become even more \nconfused after having read all the available information, realizing in \nthe end that there is no generally accepted treatment for a certain \ndisease. For example, in an analysis of 129 books on apitherapy, 29 \ndifferent recommendations on what was thought to be best for the \ntreatment of seasonal allergic rhinitis were found. This is all the \nmore remarkable since the topic was only mentioned in 50 books \n[3].\nMaterial and Methods \nBased on data from the Central Institute for Statutory Health \nCare and various publications on the subject, we identified \nthe diseases and symptoms most frequently dealt with in the \ngynaecological field. \nSince the information on apitherapy can be found mainly in \nbooks, we identified 135 books on apitherapy using the search \nterms “apitherapy” , “apitherapie” and “apithérapie” as well as the \nnames of various bee products on bookseller platforms and the \nJUST find system of the Justus-Liebig-University Gie ßen, Germany, \nwhich comprises 337 databases from the EBSCO Discovery Service. \nThere was no pre-selection of the books except the restriction to \nthe English, French and German languages. \nBased on our search regarding the most eminent problems in \nthe field, all the books were analyzed in detail for apitherapeutic \nrecommendations regarding the following diseases (in alphabetical \norder):\n1. Abnormal uterine bleeding, Menorrhagia (heavy periods)\n2. Breast lumps, fibroids & common breast problems\n3. Chlamydia\n4. Condylomas, dysplasia / human-papilloma-virus-infections\n5. Decreased libido (decreased sex drive)\n6. Dysmenorrhea (painful periods)\n7. Dyspareunia (painful intercourse)\n8. Endometriosis\n9. Gonorrhea and vaginitis\n10. Incontinence\n11. Infertility \n12. Lichen sclerosis\n13. Menopausal complaints\n14. Osteoporosis\n15. Ovarian cysts\n16. Pelvic pain\n17. Polycystic Ovarian Syndrome (PCOS)\n18. Premenstrual syndrome (PMS)\n\nCitation: Karsten Münstedt MD, Ph.D, Jutta Hübner MD, Ph.D, Heidrun Männle MD. Apitherapy and Gynaecology –To What Extent Can \nMethods from This Area Be Alternatives to Conventional Ones?. 5(1): 2021. WJGWH.MS.ID.000605. \nDOI: 10.33552/WJGWH.2021.05.000605.\nPage 3 of 7\nWorld Journal of Gynecology & Women’s Health                                                                                                             Volume 5-Issue 1\n19. Urinary tract infection\n20. Vulvodynia\nWe excluded contraception because it cannot be recognized \nas a disease. At the same time, we analyzed the scientific evidence \nregarding the use of bee products for the above-named disease \nconditions using PubMed and JUST find (data search engine of the \nJustus-Liebig-University Gie ßen, Germany, which comprises 337 \ndatabases from the EBSCO Discovery Service). \nThe analyses of the contents of the books were documented \nin PSPP , a free statistical software application, intended as a free \nalternative for IBM SPSS Statistics. We used descriptive statistics. \nResults\nGynaecological \nproblem\nNumber of men-\ntions in books[n \n(%)]N = 135\nNumber of \ndifferent \ntreatment \nconcepts\nMethods suggested                                                                          \n(Numbers of mentions if more than one)\nFindings of the literature analysis                                       \n(Reference number)\n1. Abnormal uterine \nbleedings 10 (7.4) 10\nMonotherapies: royal jelly, pollen, propolis, honey \nmassage. Combination therapies: royal jelly + pollen + \nperga, royal jelly + pollen + propolis, honey + royal jelly + \npropolis, echinacea + pollen, tea from shepherd’s purse \nand common horsetail + honey\nNo evidence for treatment with bee prod-\nucts, treatment with bee venom may cause \nproblem [9]\n2. Breast lumps 1 (.7) 1 Combination therapy: Honey + propolis + propolis \nointment\nNo evidence for treatment with bee prod-\nucts\n3. Chlamydia 14 (10.4) 5\nMonotherapies: propolis [11], propolis intravaginally, \nhoney Combination therapies: acupuncture + acupres-\nsure + bee ointment, bee venom ointment acupressure + \npropolis + royal jelly + apilarnil + pollen + honey\nNo evidence for treatment with bee prod-\nucts\n4. Condylomata/\ndysplasia (Papilloma-\nviruses)\n23 (17.0) 6\nMonotherapies: propolis [14], propolis ointment [3], \nhoney [3], royal jelly Combination therapies: honey + \ncod liver oil, honey + propolis + royal jelly + propolis \nointment\nPropolis [10]\n5. Decreased libido 9 (6.7) 5\nMonotherapies: royal jelly (4), honey (acacia and citrus) \nCombination therapies: royal jelly + hyaluronic acid, royal \njelly + pollen, honey + herbs + royal jelly [2]\nMad honey [11,12]. However, mad honey is \nmainly used by men.\n6. Dysmenorrhea 39 (28.8) 20\nMonotherapies: royal jelly [5], honey [3], pollen, ho-\nmoeopathy Apis, bee venom acupuncture, royal jelly [2], \nhoney massage, propolis [3] Combination therapies: royal \njelly + pollen + perga [3], tea from lady’s mantle + mar-\njoram + honey, royal jelly + honey + pollen [3], royal jelly \n+ pollen + propolis [2], royal jelly + pollen [6], royal jelly \n+ honey [2], pollen + melbrosia, pollen + perga + royal \njelly, royal jelly + propolis [2], propolis + honey, oxymel + \nadditives, royal jelly + pollen + perga + honey + aromiel \n(chestnut honey with essential oils, here sage, chamomile \nand cypress oil), royal jelly + aromiel, pollen + perga + \naromiel (honey with essential oils, here thyme honey \nwith marjoram, rosemary and peppermint oil),\nHoney, royal jelly [5]\n7. Dyspareunia 1 (.7) 1 Combination therapy: propolis, honey, pollen No evidence for treatment with bee prod-\nucts\n8. Endometriosis   No treatments suggested Honey and propolis containing chrysin - in \nvitro data [13]\n9. Gonorrhea and \nvaginitis 7 (5.2) 5\nMonotherapies: propolis [3], honey massage Combination \ntherapies: propolis + honey + royal jelly + apilarnil + oint-\nment with propolis and bee venom, honey intravaginally \n+ propolis + hip bath, propolis + marjoram oil + myrtle oil\nHoney for vulvovaginal candidiasis [14]; \npropolis for chronic vaginitis [10].\n10. Incontinence \n(urinary) 2 (1.5) 1 Monotherapy: royal jelly [2] \nSkin protectant containing manuka honey \nfor moisture-associated skin damage [15]; \ncytoplasmic extracts of pollen, pumpkin \nseed extract and vitamin E [16]; xyloglu-\ncan-gelose-hibiscus-propolis [17]\n11. Infertility 9 (6.7) 7\nMonotherapies: royal jelly [3], honey Combination ther-\napies: pollen + royal jelly, royal jelly + bee venom, royal \njelly + honey (heather) + oil from cypresses and sage, \nhoney and royal jelly intravaginally, honey + pollen + \nroyal jelly + whole foods\nVaginal natural product based on honey and \n1% extract of Myristica fragrans improves \nthe success of intrauterine insemination \n[18]; experimental data show that royal \njelly promotes ovarian follicles growth and \nincreases steroid hormones [19]\n12. Lichen sclerosus 3 (2.2) 1 Two unspecific mentions Combination therapies: mix of \npropolis and pollen or honey\nNo evidence for treatment with bee prod-\nucts\n\nCitation: Karsten Münstedt MD, Ph.D, Jutta Hübner MD, Ph.D, Heidrun Männle MD. Apitherapy and Gynaecology –To What Extent Can \nMethods from This Area Be Alternatives to Conventional Ones?. 5(1): 2021. WJGWH.MS.ID.000605. \nDOI: 10.33552/WJGWH.2021.05.000605.\nPage 4 of 7\nWorld Journal of Gynecology & Women’s Health                                                                                                             Volume 5-Issue 1\n13. Menopausal \ncomplaints 40 (28.6) 24\nMonotherapies: royal jelly [8], pollen [5], propolis [2], \nhoney, oxymel Combination therapies: pollen + royal \njelly [4], honey and pollen, honey and royal jelly, perga + \npollen, tea + honey, honey + propolis + pollen + aromiel, \nhoney + propolis + pollen + royal jelly + bee venom + \napilarnil, bee venom ointment + propolis ointment, honey \n+ propolis + pollen + royal jelly + apilarnil + bee venom \nointment + chewing wax, honey + pollen + royal jelly \nointment, honey + pollen + royal jelly, honey + pollen + \nroyal jelly + tea, propolis + propolis ointment + royal jelly \nointment, propolis + pollen + royal jelly, propolis + royal \njelly +  baths with honey, royal jelly and rose oil, propolis \n+ royal jelly + tea, pollen + perga + royal jelly + ginseng, \npollen + royal jelly + aromiel, pollen + royal jelly + acu-\npressure, mix of honey and pollen + bee venom massage \n+ bee venom acupuncture, pollen + perga + royal jelly\nRoyal jelly, pollen [6]\n14. Osteoporosis 15 (11.1) 7\nTwo unspecific mentions Monotherapies: honey [4], royal \njelly [3], pollen Combination therapies: propolis from \ndalbergia, honey + pollen, oxymel + calcium, royal jelly + \npollen + perga [2]\nHoney, royal jelly, pollen, propolis - in-vitro \ndata [20-22]\n15. Ovarian cysts   No treatments suggested No evidence for treatment with bee prod-\nucts\n16. Pelvic pain   No treatments suggested No evidence for treatment with bee prod-\nucts\n17. Premenstrual \nsyndrome 9 (6.7) 5\nMonotherapies: royal jelly (3) Combination therapies: \npollen + perga + royal jelly (3), royal jelly + evening prim-\nrose oil, honey (heather) + oil from cypresses and sage + \nroyal jelly, herbal tea + propolis\nRoyal Jelly, pollen [23,24]\n18. Polycystic ovary \nsyndrome 1 (.7) 1 Monotherapy: apilarnil Bee venom – in vitro data [25], royal jelly – \nexperimental data [26]\n19. Urinary tract \ninfection 24 (17.8) 16\nMonotherapies: propolis (8), royal jelly, honey Combina-\ntion therapies: honey + proplis + cranberry + herbs (2), \ntea from dead bees + honey + propolis, tea from acorns \nand chestnuts + propolis + pollen + red wine, honey \n(heather and eucalyptus) + cranberry, honey + propolis + \nroyal jelly + pollen + perga + propolis massage, honey and \npropolis locally, herbal tea + propolis + honey, hip bath + \nhoney +  herbal tea + propolis, honey (manuka) + green \ntea, propolis + honey + pollen + propolis on tampon, \npropolis + intraurethral instillation of honey and propo-\nlis, cinnamon and honey in warm water, onions + white \nwine + honey (eucalyptus)\nPropolis and cranberry [27].\n20. Vulvodynia   No treatments suggested No treatment with bee products\nFigure 1: Number of the various gynaecological topics in the various apitherapy books.\n\n\nCitation: Karsten Münstedt MD, Ph.D, Jutta Hübner MD, Ph.D, Heidrun Männle MD. Apitherapy and Gynaecology –To What Extent Can \nMethods from This Area Be Alternatives to Conventional Ones?. 5(1): 2021. WJGWH.MS.ID.000605. \nDOI: 10.33552/WJGWH.2021.05.000605.\nPage 5 of 7\nWorld Journal of Gynecology & Women’s Health                                                                                                             Volume 5-Issue 1\nOur first analysis assessed the number of topics which are \ndealt with in the books. Figure 1 shows that fifty-one books \n(37.8%) did not cover any gynaecological topics at all. Four books \n(3.0%) covered 6 topics; four books covered only 5 topics and five \nother books (3.7%) only four topics. Further details are depicted \nin Figure 1. The mean number of topics covered is 1.4 (median \n1 topic). Some topics were intensively covered like climacteric \ncomplaints (40 times), dysmenorrhea (39 times), urinary tract \ninfections (24 times), condyloma and herpes virus infections (23 \ntimes), vaginal infections (21 times), osteoporosis (15 times) and \nabnormal uterine bleedings (10 times) (Table 1). Endometriosis, \novarian cysts, pelvic pain and vulvodynia were not mentioned \nin any book. We also found significant variations regarding the \ntreatment recommendations indicating that there is no consensus \non the best treatment (Table 1). \nA comparison of the methods suggested by apitherapists and \nscientific evidence shows that there is no scientific evidence for \nthe apitherapy endorsed treatment of abnormal uterine bleedings, \nbreast lumps, chlamydia, dyspareunia, infertility, ovarian cysts, \npelvic pain, and vulvodynia. And in the case of abnormal uterine \nbleedings there is evidence against the use of bee venom. Regarding \nendometriosis, lichen sclerosis, and polycystic ovary syndrome \nthere is only preclinical evidence. Interesting though, is that \nendometriosis is the only disease condition that was not mentioned \nby apitherapists for which there is some in-vitro evidence. \nConcerning decreased libido, the types of honey recommended \nby apitherapists differ from those which have been found to be \neffective and in the case of the polycystic ovary syndrome; the bee \nproducts which have shown efficacy in preclinical studies (bee \nvenom, royal jelly) are not mentioned. With respect to many other \ndisease conditions, the multitude of recommendations also includes \nmethods with evidence. The widest spectrum of recommendations \ncan be found for abnormal uterine bleedings and infertility. \nDiscussion\nThis analysis shows that gynaecological topics are not \nwell represented in the apitherapeutic literature. Even though \nthis analysis only focused on the 20 most relevant topics of \ngynaecology, the coverage of these topics in apitherapeutic books \nis extremely low (maximum 6). Furthermore, even when all the \navailable information from the apitherapeutic books is gathered, \nit is not sufficient when considering the most important fields of \ngynaecology, especially when important topics like endometriosis, \novarian cysts, pelvic pain and vulvodynia are not covered. \nTo the best of our knowledge, this is the first analysis on \nthe question if and to what extent can methods from the field of \napitherapy be alternatives to conventional ones. So far, there has \nbeen only a summary on dermatological problems which can be \ntreated with apitherapeutic methods [28]. \nApart from the low coverage of gynaecological topics in \napitherapy books another problem would be to decide which \ntreatments should be recommended. Looking at the multitude of \nrecommendations, decisions must be made. This could be easy \nwith respect to condylomas and genital dysplasia where there \nis a clear majority for the treatment with propolis or for breast \nlumps where there is only one option to choose from. However, in \nthe case of abnormal uterine bleedings there are 10 books, each \nrecommending a different concept.\nThe next question should be the evidence behind the \nrecommendations. As shown, only the recommendation for \nthe treatment of Human-Papilloma-Virus-associated problems \ncan be considered reasonable. Here, about 74 % (17/23) of the \nrecommendations were correct. Some recommendations regarding \nurinary tract infections must be considered correct too. This clearly \ncontrasts with almost all the other indications suggesting that there \nis no scientific background for the recommendations. This fact has \nbeen shown for several other health problems; however, the current \nanalysis demonstrates that holistic apitherapy as it is widely \npromoted via books and the internet, offers a multitude of different \napitherapeutic approaches of which only a minority are supported \nby clinical evidence [2-6]. Therefore, it would be interesting to \ndetermine the basis for the recommendations. Another interesting \nquestion is if an analysis conducted in other fields of medicine \nwould have come to a different conclusion.\nThe next problem would be whether it would be wise to \nrecommend apitherapy to patients who ask for natural or \nalternative treatments in all cases. As shown in an example on \nprimary dysmenorrhea, apitherapy is not always the first choice. \nWith respect to the evidence, royal jelly and honey cannot be \nconsidered to be the best options. These would be (1) local heat \napplications, (2) exercise, (3) aromatherapy with lavender oil or \nlavender oil massage or (4) vitamin B1, (5) omega-3 fatty acids, (6) \nacupressure, (7) ginger, and (8) chaste berry must be considered \nbetter options if it comes to simplicity, safety, costs and availability \n(5). Furthermore, it must be considered that apitherapy is not \nalways attractive to patients. When asked about their therapeutic \npreferences regarding primary dysmenorrhea, patients answered \nthat they would prefer pain relievers and contraceptive pills from \nconventional medicine as well as homoeopathy, order therapy, local \nheat applications and diet recommendations from complementary \nand alternative medicine. Honey and royal jelly are among the least \nappealing/attractive methods [29]. Thus, it must also be recognized \nthat many bee products are not very appealing to patients. This \nespecially refers to live bee stings but, apart from honey and \npropolis, the acceptance of all bee products is very poor [30,31].\nTaking together the available information on apitherapy as a \npotential option to replace conventional medicine in the field of \ngynaecology it can be summarized that the claims of apitherapists \nare not justified in many cases because\n1. There are no apitherapeutic concepts for several relevant \ntopics.\n\nCitation: Karsten Münstedt MD, Ph.D, Jutta Hübner MD, Ph.D, Heidrun Männle MD. Apitherapy and Gynaecology –To What Extent Can \nMethods from This Area Be Alternatives to Conventional Ones?. 5(1): 2021. WJGWH.MS.ID.000605. \nDOI: 10.33552/WJGWH.2021.05.000605.\nPage 6 of 7\nWorld Journal of Gynecology & Women’s Health                                                                                                             Volume 5-Issue 1\n2. There is no common doctrine with respect to \napitherapeutic concepts for various diseases. \n3. Apitherapy is not always the best choice with respect to \nclinical evidence.\n4. The acceptance of various apitherapeutic treatments is \nnot very high.\nIf apitherapy wants to overcome the referred problems it \nwould be reasonable that comprehensive treatment concepts are \npresented. Many of the concepts presented by apitherapists appear \narbitrary. It seems advisable that instead of claiming that apitherapy \ncould replace other types of medicine, its protagonists should focus \non individual recommendations with scientific evidence. Examples \nfor a very reasonable use of apitherapy are treatment of various types \nof wounds with honey (wound infections, tonsillectomy, diabetic \nfoot ulcers, radiotherapy and/or chemotherapy induced oral \nmucositis, burns), treatment of Herpes virus associated skin lesions \n(HSV-1, HSV-2) with propolis, honey for acute coughs in children, \npropolis for oral health (dental plaque and gingival inflammation), \nbee venom for post-stroke shoulder pain and musculoskeletal pain \n[32-39]. The clinical evidence for these problems is supported \nby the results of systematic reviews and meta-analyses. In these \nindications bee products often surpass other therapeutic options. \nIn the view of the authors, apitherapists should focus on evidence \nand explore further reasonable applications without promoting \nthem until there is sufficient evidence. This will improve credibility \nof apitherapy and could lead to integrative approaches from which \npatients could benefit. \nAcknowledgement\nNone.\nConflict of Interest\nAuthors declare no conflict of interest.\nReferences\n1. Johnson SB, Park HS, Gross CP , Yu JB (2018) Use of alternative medicine \nfor cancer and its impact on survival. J Natl Cancer Inst 110(1): 121-124.\n2. Münstedt K, Männle H (2020) Bee products and their role in cancer \nprevention and treatment. Complement Ther Med 51: 102390.\n3. Münstedt K, Männle H (2020) Seasonal allergic rhinitis and the role of \napitherapy. Allergol Immunopathol (Madr): 48(2): 582-588. \n4. Münstedt K, M ännle H (2020) Benign prostatic hyperplasia – Is \napitherapy a reasonable therapeutic option? Urologic Nursing 40(5): \n239-243. \n5. Münstedt K (2018) Meaningfulness of apitherapeutic approaches using \nthe example of primary dysmenorrhea. J Apither 3: 9-16. \n6. Münstedt K, Mä nnle H (2020) Apitherapy for menopausal problems. \nArch Gynecol Obstet 302(6): 1495-1502.\n7. Gupta RK, Stangaciu S (2014) Apitherapy: holistic healing through the \nhoneybee and bee products in countries with poor healthcare system. \nIn: Gupta RK, Reybroeck PR, van Veen J, Gupta A (eds). Beekeeping for \npoverty alleviation and livelihood security. (Springer) 2014: 413-446. \n8. Zhu F, Wongsiri S (2011) A Brief introduction to apitherapy health care. \nJ Thai Tradit Altern Med 6(3): 303-312.\n9. Mingomataj EC, Bakiri AH (2012) Episodic hemorrhage during \nhoneybee venom anaphylaxis: potential mechanisms. J Investig Allergol \nClin Immunol 22(4): 237-244.\n10. Imhof M, Lipovac M, Kurz Ch, Barta J, Verhoeven HC, et al. (2005) \nPropolis solution for the treatment of chronic vaginitis. Int J Gynaecol \nObstet 89(2): 127-132. \n11. Silici S, Atayoglu AT (2015) Mad honey intoxication: A systematic review \non the 1199 cases. Food Chem Toxicol 86: 282-290. \n12. 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Costache RC, Novac B, Bardan TR, Agapie DN, Edu A (2019) Xyloglucan \n+ gelose combination versus placebo as adjuvant therapy to first-line \nantimicrobials for uncomplicated urinary tract infection in adults. Urol \nInt 102(4): 468-475. \n18. Kavousi M, Khadem Ghaebi N, Najaf Najafi M, Mokaberinejad R, \nFeyzabadi Z, et al. (2019) The effect of a natural vaginal product based \non honey on the success of intrauterine insemination (IUI) in infertility \ntreatment. Avicenna J Phytomed 9(4): 310-321.\n19. Ghanbari E, Khazaei MR, Khazaei M, Nejati V (2018) Royal jelly promotes \novarian follicles growth and increases steroid hormones in immature \nrats. Int J Fertil Steril 11(4): 263-269. \n20. Kamaruzzaman MA, Chin KY, Mohd Ramli ES (2019) A review of potential \nbeneficial effects of honey on bone health. Evid Based Complement \nAlternat Med 2019: 8543618. \n21. 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Karimzadeh L, Nabiuni M, Kouchesfehani HM, Adham H, Bagheri A, et al. \n(2013) Effect of bee venom on IL-6, COX-2 and VEGF levels in polycystic \novarian syndrome induced in Wistar rats by estradiol valerate. J Venom \nAnim Toxins Incl Trop Dis 19(1): 32. \n26. Ab Hamid N, Abu Bakar AB, Mat Zain AA, Nik Hussain NH, Othman ZA, et \nal. (2020) Composition of royal jelly (RJ) and its anti-androgenic effect \non reproductive parameters in a polycystic ovarian syndrome (PCOS) \nanimal model. Antioxidants (Basel) 9(6): 499. \n\nCitation: Karsten Münstedt MD, Ph.D, Jutta Hübner MD, Ph.D, Heidrun Männle MD. Apitherapy and Gynaecology –To What Extent Can \nMethods from This Area Be Alternatives to Conventional Ones?. 5(1): 2021. WJGWH.MS.ID.000605. \nDOI: 10.33552/WJGWH.2021.05.000605.\nPage 7 of 7\nWorld Journal of Gynecology & Women’s Health                                                                                                             Volume 5-Issue 1\n27. Bruyère F, Azzouzi AR, Lavigne JP , Droupy S, Coloby P , et al. (2019) A \nmulticenter, randomized, placebo-controlled study evaluating the \nefficacy of a combination of propolis and cranberry (Vaccinium \nmacrocarpon) (DUAB ®) in preventing low urinary tract infection \nrecurrence in women complaining of recurrent cystitis. Urol Int 103(1): \n41-48. \n28. Männle H, Münstedt K (2020) Application of bee products for \ndermatological problems. J Skin Stem Cell. Online ahead of Print \n7(1):e103472. \n29. Münstedt K, Riepen T (2019) Patients’ decisions regarding the treatment \nof primary dysmenorrhoea. Complement Ther Med 45: 1-6. \n30. Münstedt K, Funk D, Riepen T , Berkes E, Hübner J (2019) Acceptance \nof apitherapeutic methods in patients consulting general physicians or \ngynaecologists. Complement Ther Clin Pract 35: 154-157. \n31. Münstedt K, Männle H (2020) What is wrong with the meta-analyses \non honey and oral mucositis due to cancer therapies? Complement Ther \nMed 49: 102286. \n32. Münstedt K, Männle H, Riepen T (2020) Survey of reasons why women \nutilize honey therapeutically, and reasons for not utilizing honey. Heliyon \n6(10): e05231. \n33. Münstedt K, Männle H (2019) Using bee products for the prevention \nand treatment of oral mucositis induced by cancer treatment. Molecules \n24(17): 3023. \n34. Münstedt K, Momm F, Hübner J (2019) Honey in the management of side \neffects of radiotherapy- or radio/chemotherapy-induced oral mucositis. \nA systematic review. Complement Ther Clin Pract 34: 145-152. \n35. Kuo CC, Wang RH, Wang HH, Li CH (2018) Meta-analysis of randomized \ncontrolled trials of the efficacy of propolis mouthwash in cancer therapy-\ninduced oral mucositis. Support Care Cancer 26(12): 4001-4009. \n36. Lal A, Chohan K, Chohan A, Chakravarti A (2017) Role of honey after \ntonsillectomy: a systematic review and meta-analysis of randomised \ncontrolled trials. Clin Otolaryngol 42(3): 651-660. \n37. Aziz Z, Abdul Rasool Hassan B (2017) The effects of honey compared \nto silver sulfadiazine for the treatment of burns: A systematic review of \nrandomized controlled trials. Burns 43(1): 50-57. \n38. Wang C, Guo M, Zhang N, Wang G (2019) Effectiveness of honey dressing \nin the treatment of diabetic foot ulcers: A systematic review and meta-\nanalysis. Complement Ther Clin Pract 34: 123-131. \n39. Münstedt K (2019) Bee products and the treatment of blister-like \nlesions around the mouth, skin and genitalia caused by herpes viruses-A \nsystematic review. Complement Ther Med 43: 81-84.","source_license":"CC0","license_restricted":false}