Elsevier

Reproductive Toxicology

Volume 17, Issue 2, March–April 2003, Pages 137-152
Reproductive Toxicology

Review
Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials

https://doi.org/10.1016/S0890-6238(02)00128-4Get rights and content

Abstract

Purpose: Complementary and alternative medicine (CAM) therapies are widely used in the general population. This paper reviews randomized controlled trials of CAM therapies for obstetrical and gynecologic conditions and presents therapies that are likely to be used by women of reproductive age and by pregnant women.

Data Sources: Sources included English-language papers in MEDLINE 1966–2002 and AMED (1985–2000) and the authors’ extensive holdings.

Study Selection: Randomized controlled clinical trials of CAM therapies for obstetric and gynecologic conditions.

Data Extraction: Clinical information was extracted from the articles and summarized in tabular form or in the text.

Data Synthesis: Ninety-three trials were identified, 45 of which were for pregnancy-related conditions, 33 of which were for premenstrual syndrome, and 13 of which were for dysmenorrhea. Data support the use of acupressure for nausea of pregnancy and calcium for PMS. Preliminary studies indicate a role for further research on Vitamin B6 or ginger for nausea and vomiting of pregnancy; calcium, magnesium, Vitamin B6, or chaste-tree berry extract for PMS; and a low-fat diet, exercise, or fish oil supplementation for dysmenorrhea.

Conclusions: Limited evidence supports the efficacy of some CAM therapies. Exposure of women of reproductive age to these therapies can be expected.

Introduction

Women are frequent users of complementary and alternative medicine (CAM) in many countries [1], [2], [3], [4], [5] including the US, where women use CAM more than do men (48.9% versus 37.8%) [6]. Pharmacologically active CAM treatments may be used by women at risk for pregnancy, or women who are trying to become pregnant. The current stage of knowledge is still inadequate to sufficiently inform clinicians, researchers, and the public about either benefits or potential risks. The following is a review of prospective, randomized controlled clinical trials of CAM therapies relevant to obstetrics and gynecology. Our purpose in this review is to identify exposures that can be expected in women of reproductive age. Possible reproductive effects of such exposures will be the subject of a future review.

Sources for this review included MEDLINE, (1966–2002), the Alternative and Complementary Database (AMED) of the British Library (1985–2000), and the authors’ own extensive files. Databases were searched under the terms women’s health, pregnancy, labor, postpartum, morning sickness, infertility, premenstrual syndrome, endometriosis, and fibroids; combined with alternative medicine, herbal medicine, herbs, traditional medicine, Traditional Chinese Medicine (TCM), Ayurveda, Ayurvedic medicine, naturopathy, chiropractic, osteopathy, massage, shiatsu, reiki, relaxation therapy, yoga, homeopathy, aromatherapy, and therapeutic touch. Most studies are summarized in the tables; conditions with two or fewer studies are summarized only in the text.

Section snippets

Premenstrual syndrome (PMS)

PMS is a spectrum of physical, emotional, and behavioral symptoms of unclear etiology. Women experiment extensively with self-medication in search of relief. Thirty-three randomized controlled trials have been performed on herbs, vitamins, minerals, manual therapies, diet and exercise, and mind–body approaches (Table 1) [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36],

Infertility

There is little evidence that CAM therapies are effective for female infertility. Only two studies were identified. Cognitive behavioral therapy or a support group intervention as adjuncts to conventional treatment were compared to routine care in a year-long, randomized, single-blind controlled trial in 184 infertile women, all receiving fertility drugs [53]. Intervention groups met weekly for two hours. Cognitive-behavioral treatment included relaxation techniques, cognitive restructuring,

Fibroids, endometriosis, and pelvic pain

No controlled trials of CAM treatments were identified for the treatment of fibroids, endometriosis, or pelvic pain.

Pregnancy

Many women are concerned about taking drugs during pregnancy, and may explore CAM therapies to treat symptoms. A surprisingly large number of CAM trials were identified for relieving pregnancy-related conditions. These 42 studies are summarized in Table 3 [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97]

Discussion

Most controlled trials of alternative approaches for the conditions we have reviewed have been small. Definitive efficacy studies are lacking, and mechanisms of action are largely unexplored. But encouraging and intriguing studies do exist.

Substantial evidence supports the use of acupuncture point stimulation (primarily by acupressure) for nausea of pregnancy. Calcium, magnesium, Vitamin B6, and Vitex may be helpful for PMS, and there is intriguing preliminary information on ginger or Vitamin

Acknowledgements

Financial support: Supported in part by NIH NCCAM Grant P50 AT00090.

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