Kuntai capsule for the treatment of menopausal symptoms induced by GnRH-a therapy: A systematic review and meta-analysis of randomized controlled trials

ETHNOPHARMACOLOGICAL RELEVANCE: Gonadotropin-releasing hormone agonists (GnRH-a) often induce menopausal symptoms, negatively affecting women's psychological, emotional, and physical health. Kuntai capsule is widely used in clinical practice to alleviate various menopausal symptoms. Exploring the potential of Kuntai capsule in GnRH-a therapy holds significant clinical value. AIM OF THE STUDY: This study aims to evaluate the efficacy and safety of Kuntai capsule in treating menopausal symptoms induced by GnRH-a therapy. MATERIALS AND METHODS: Databases namely China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Journal Database, Chinese Biomedical Literature Database, PubMed, Cochrane Library, and Embase were searched from their inception to November 2024. We included randomized controlled trials (RCTs) comparing Kuntai capsule combined with GnRH-a to GnRH-a alone or GnRH-a combined with hormone therapy (HT) for endometriosis, uterine fibroids or adenomyosis treatment. The risk of bias was evaluated using RoB 1.0. A meta-analysis was performed using RevMan 5.4 software. The primary outcomes were Kupperman Index (KI) and menopausal symptoms, including the incidence of hot flashes, insomnia, and vaginal dryness. The secondary outcomes were adverse events, including the incidence of vaginal or uterine bleeding and breast tenderness, and recurrence rate. RESULTS: A meta-analysis of 36 RCTs, including a total of 3577 patients, was conducted. The results indicated that, compared to GnRH-a alone, Kuntai capsule combined with GnRH-a significantly reduced KI (MD = -5.88, 95 % CI [-9.80, -1.96], P = 0.003) as well as the incidence of hot flashes (RR = 0.49, 95 % CI [0.36, 0.68], P < 0.0001), insomnia (RR = 0.42, 95 % CI [0.29, 0.62], P < 0.0001), and vaginal dryness (RR = 0.38, 95 % CI [0.26, 0.57], P < 0.00001). CONCLUSIONS: Kuntai capsule is effective and safe in improving menopausal symptoms induced by GnRH-a therapy. However, due to the methodological limitations of the included RCTs, further high-quality evidence from large-sample and well-designed research is needed in the future.