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- Black Cohosh (Actaea racemosa syn. Cimicifuga racemosa)
- Menopause
- Uterine Fibroids
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Date:
09-30-2014 | HC# 041453-505
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Re: Black Cohosh Reduces the Size of Uterine Fibroids in Menopausal Women
Xi
S, Liske E, Wang S, et al. Effect of isopropanolic Cimicifuga racemosa extract on uterine fibroids in comparison with
tibolone among patients of a recent randomized, double blind,
parallel-controlled study in Chinese women with menopausal symptoms. Evid Based Complement Alternat Med.
2014;2014:717686. doi: 10.1155/2014/717686.
Uterine
fibroids (also called myomas) are the most common benign tumors in women. The
use of hormone replacement therapy (HRT) to ameliorate menopausal symptoms in
women with uterine fibroids is controversial because there is some evidence
that estrogens can increase the growth of uterine fibroids. The drug tibolone
(a hormone-like medication) and isopropanolic black cohosh (Actaea racemosa syn. Cimicifuga racemosa) root extract (iCR)
are used to treat menopausal symptoms. The purpose of this randomized, double-blind,
parallel-controlled study was to compare the effect of tibolone and iCR
treatment on uterine fibroid size in women treated for menopausal complaints.
This
study constitutes a subgroup analysis of a previously published report on 244
patients.1 The present study included only the women in the original
trial who had uterine fibroids (n = 62, aged 41-60 years). Study participants
were recruited from 5 hospitals in China. The patients were treated with 40
mg/day iCR (n = 34, Remifemin®; Schaper & Brümmer GmbH;
Salzgitter-Ringelheim, Germany) or 2.5 mg/day tibolone (n = 28, Zizhu Pharm;
Beijing, China) for 12 weeks. At baseline, 4 weeks, and 12 weeks of treatment,
the patients underwent transvaginal ultrasonography to measure the myoma. If
the patient had multiple myomas, the largest one was used for the analysis.
At
baseline, there was no significant difference between groups. The median volume
of the largest myoma at study end decreased in the iCR group (P = 0.085). The
volume was decreased in 24 (70.1%) women of the iCR group with a volume
reduction of 30.3%. In comparison, a decrease was observed in only 10 (35.7%)
women of the tibolone group; the difference between groups was significant (P =
0.016). Similarly, the mean diameter and the geometric mean diameter of the
myomas significantly decreased with iCR treatment (P = 0.006 and P = 0.006,
respectively), but not with tibolone treatment (P = 0.819 and P = 0.778,
respectively); again, the difference between the groups was significant (P =
0.021 and P = 0.016, respectively). For the tibolone group, no statistical
difference from baseline was observed for these parameters.
In
over one-half (53.6%) of the women treated with tibolone, fibroid volume
increased by an average of 4.7% (equivalent to 21% per year). However, these
findings are in agreement with 2 other studies assessing the natural change in
fibroid volume over time. The authors conclude that 2.5 mg/day tibolone for 12
weeks does not interfere with the natural course of uterine fibroids but
caution that regular reexaminations should be conducted.
The
authors conclude that while both groups had a significant improvement in
menopause symptoms,1 iCR decreased uterine fibroid size and tibolone
did not. They state, "iCR seems to be the better choice in alleviating
menopausal symptoms in women with uterine fibroid … as it provides adequate
relief from menopausal symptoms and avoids increase in uterine fibroid size,
which is usually a cause of concern for the patient." The study is limited
by the small population size and the short duration of the study. Women using
therapeutics to ameliorate complaints associated with menopause typically take
a treatment for more than 12 weeks. Therefore, the effect of iCR on uterine
fibroids needs to be evaluated in trials of longer duration. With respect to
the known non-hormone-like/non-estrogenic effects of this herbal extract, similar
results are also expected.2
—Heather
S. Oliff, PhD
Reference
1Bai W, Henneicke-von
Zepelin H-H, Wang S, et al. Efficacy and tolerability of a medicinal product
containing an isopropanolic black cohosh extract in Chinese women with
menopausal symptoms: a randomized, double blind, parallel-controlled study
versus tibolone. Maturitas.
2007;58(1):31-41.
2Liske
E, Hänggi W, Henneicke-von Zepelin H-H, Boblitz N, Wüstenberg P, Rahlfs VW. Physiological investigation of a unique extract of
black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study
demonstrates no systemic estrogenic effect. J
Womens Health Gend Based Med. 2002;11(2):163-174.
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