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Review & meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms - an update on the evidence.
Castelo-Branco, C, Gambacciani, M, Cano, A, Minkin, MJ, Rachoń, D, Ruan, X, Beer, AM, Schnitker, J, Henneicke-von Zepelin, HH, Pickartz, S
Climacteric : the journal of the International Menopause Society. 2021;(2):109-119
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Abstract
A systematic literature search revealed 35 clinical studies and one meta-analysis comprising 43,759 women, of which 13,096 were treated with isopropanolic Cimicifuga racemosa extract (iCR). Compared to placebo, iCR was significantly superior for treating neurovegetative and psychological menopausal symptoms, with a standardized mean difference of -0.694 in favor of iCR (p < 0.0001). Effect sizes were larger when higher dosages of iCR as monotherapy or in combination with St. John's wort (Hypericum perforatum [HP]) were given (-1.020 and -0.999, respectively), suggesting a dose-dependency. For psychological symptoms, the iCR+HP combination was superior to iCR monotherapy. Efficacy of iCR was comparable to low-dose transdermal estradiol or tibolone. Yet, due to its better tolerability, iCR had a significantly better benefit-risk profile than tibolone. Treatment with iCR/iCR+HP was well tolerated with few minor adverse events, with a frequency comparable to placebo. The clinical data did not reveal any evidence of hepatotoxicity. Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment. As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms. With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.
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The effect of programmed exercise over anxiety symptoms in midlife and older women: a meta-analysis of randomized controlled trials.
Martínez-Domínguez, SJ, Lajusticia, H, Chedraui, P, Pérez-López, FR, ,
Climacteric : the journal of the International Menopause Society. 2018;(2):123-131
Abstract
We aimed to perform a systematic review and meta-analysis in order to clarify the effect of programmed exercise over mild-to-moderate anxiety symptoms (ASs) in midlife and older women. A structured search of PubMed, Medline, Web of Science, Scopus, Embase, Cochrane Library, Scielo, and the US, UK and Australian Clinical Trials databases (from inception through July 27, 2017) was performed, with no language restriction using the following terms: 'anxiety', 'anxiety symptoms', 'exercise', 'physical activity', 'menopause', and 'randomized controlled trial' (RCTs) in mid-aged and older women. We assessed RCTs that compared the effect of exercise for at least 6 weeks versus no intervention over ASs as outcome (as defined by trial authors). Exercise was classified according to duration as 'mid-term exercise intervention' (MTEI; for 12 weeks to 4 months), and 'long-term exercise intervention' (LTEI; for 6-14 months). Mean ± standard deviations of changes for ASs, as assessed with different questionnaires, were extracted to calculate Hedges' g and then used as effect size for meta-analyses. Standardized mean differences (SMDs) of ASs after intervention were pooled using a random-effects model. Ten publications were included for analysis related to 1463 midlife and older women (minimum age 54.2 ± 3.5 and maximum age 77.6 ± 5.4 years). Eight MTEIs were associated with a significant reduction of ASs (SMD = -0.42; 95% CI -0.81 to -0.02) as compared to controls. There was no reduction of ASs in seven LTEIs (SMD = -0.03; 95% CI -0.18 to 0.13). It can be concluded that MTEIs of low-to-moderate intensity seem to improve mild-moderate ASs in midlife and older women.