Pharmacol Rev. 2016 Oct; 68(4): 1026–1073.
Published online 2016 Oct. doi: 10.1124/pr.115.010843
PMCID: PMC5050441
Eric Barker, ASSOCIATE EDITOR
University of Illinois at
Chicago/National Institutes of Health Center for Botanical Dietary
Supplements, Department of Medicinal Chemistry and Pharmacognosy,
College of Pharmacy, University of Illinois at Chicago, Chicago,
Illinois
Corresponding author.Abstract
Botanical
dietary supplements are increasingly popular for women’s health,
particularly for older women. The specific botanicals women take vary as
a function of age. Younger women will use botanicals for urinary tract
infections, especially Vaccinium macrocarpon (cranberry), where
there is evidence for efficacy. Botanical dietary supplements for
premenstrual syndrome (PMS) are less commonly used, and rigorous
clinical trials have not been done. Some examples include Vitex agnus-castus (chasteberry), Angelica sinensis (dong quai), Viburnum opulus/prunifolium (cramp bark and black haw), and Zingiber officinale (ginger). Pregnant women have also used ginger for relief from nausea. Natural galactagogues for lactating women include Trigonella foenum-graecum (fenugreek) and Silybum marianum
(milk thistle); however, rigorous safety and efficacy studies are
lacking. Older women suffering menopausal symptoms are increasingly
likely to use botanicals, especially since the Women’s Health Initiative
showed an increased risk for breast cancer associated with traditional
hormone therapy. Serotonergic mechanisms similar to antidepressants have
been proposed for Actaea/Cimicifuga racemosa (black cohosh) and Valeriana officinalis (valerian). Plant extracts with estrogenic activities for menopausal symptom relief include Glycine max (soy), Trifolium pratense (red clover), Pueraria lobata (kudzu), Humulus lupulus (hops), Glycyrrhiza species (licorice), Rheum rhaponticum (rhubarb), Vitex agnus-castus (chasteberry), Linum usitatissimum (flaxseed), Epimedium species (herba Epimedii, horny goat weed), and Medicago sativa
(alfalfa). Some of the estrogenic botanicals have also been shown to
have protective effects against osteoporosis. Several of these
botanicals could have additional breast cancer preventive effects linked
to hormonal, chemical, inflammatory, and/or epigenetic pathways.
Finally, although botanicals are perceived as natural safe remedies, it
is important for women and their healthcare providers to realize that
they have not been rigorously tested for potential toxic effects and/or
drug/botanical interactions. Understanding the mechanism of action of
these supplements used for women’s health will ultimately lead to
standardized botanical products with higher efficacy, safety, and
chemopreventive properties.
I. Introduction
A. Women’s Health as a Function of Age
Women’s
health and wellbeing are profoundly affected by hormone levels, which
can vary dramatically with age, as shown for estrogen in Fig. 1. In addition, older women are more susceptible to illnesses such as cancer, cardiotoxicity, and neurodegenerative diseases (Abouzahr, 2014; de la Cruz et al., 2014; Alzheimer's Association, 2014). These illnesses are stimulated by inflammation as well as exogenous and endogenous stressors (Clark and Vissel, 2013; Wright et al., 2013; Djaldetti and Bessler, 2014; Ren and Xu, 2015).
Hormone balance is crucial to stabilizing women’s physiology, because
hormones control vital biological functions including cardiovascular,
respiratory, digestive, reproductive, cerebral, and immune systems. The
two main sex hormones in women are estrogen and progesterone (Fig. 2).
Estrogen is synthesized in the ovaries and adipose tissue and is
responsible for secondary sex characteristics and cell growth.
Progesterone balances estrogen’s proliferative effect. Hormonal
imbalance can lead to several health issues such as obesity,
cardiovascular disease, autoimmune disease, breast cancer, and
osteoporosis. It is now recognized that women’s healthcare must take
aging and hormone balance into consideration for quality of life and
prevention of disease (Morris and Currie, 2013).
However, many women have lost faith in conventional pharmaceuticals
because of confusion in recommendations as well as distrust in the
medical system that seems to view natural aging and menopause in
particular as diseases (Taylor, 2015).
This review will focus on women’s health botanicals as natural
alternatives to traditional pharmaceutical therapies used by
premenopausal, menopausal, and postmenopausal women.
