Cochrane Review Brief: Chinese Herbal Medicine for Endometriosis

Keywords: Chinese herbal medicine; endometriosis; gestrinone; danazolReview question:What is the effectiveness and safety of Chinese herbal medicine (CHM), compared with conventional treatment, on endometriosis-related pain and infertility in women with endometriosis?Nursing Implications:Endometriosis is a disease characterized by the presence of tissue that is morphologically and biologically similar to normal endometrium in locations outside the uterine cavity. Primary symptoms of endometriosis are endometriosis-related pain and infertility. The conventional treatment of endometriosis involves surgery and hormonal drugs, with short term benefits and high rates of rates of symptom recurrence (or return).In China, treatment of endometriosis using CHM is routine. CHM is thought to act via improvement of blood circulation and anti-inflammatory activity. There is considerable anecdotal evidence supporting the use of CHM as a potential treatment for endometriosis. Analyzing the evidence on the effectiveness and safety of CHM in the treatment of endometriosis can promote the development of treatment strategies for endometriosis which may reduce the suffering of patients and improve their quality of life.Study Characteristics:The review included two small, Chinese randomized controlled trials (RCTs), with a total of 158 women aged 23 to 45 years and an average age of 30 years. All participants had a laparoscopically confirmed diagnosis of endometriosis.The two trials, conducted by the same researchers, took place in a hospital outpatient department in China. One trial compared CHM endometriosis pills plus CHM enema (24 participants) and CHM endometriosis pills only (16 participants) with danazol (18 participants), and the other compared CHM endometriosis pills plus a herbal enema (48 participants) with gestrinone (52 participants).Treatment durations were for 3 months. One trial followed up for 1-24 months, while the other one did not follow up. The primary outcome was relief of endometriosis-related pain (both in the long term and short term) while secondary outcomes included improvement in fertility rates (live birth or pregnancy); reduction in the size and extent of endometrial cysts; improvement in quality of life scores; improvement of endometriosis-related symptoms apart from pain (e.g. fatigue); adverse effects resulting from the CHM intervention and rates of reoccurrenceand adverse effects.Both trials described adequate randomization and allocation concealment methods. The trials also reported single blinding for participants, and assessor blinding. Few or no participants were excluded from the analysis. Both studies were evaluated as a moderate risk of bias. …