Herbs and their biologically active compounds are proving highly effective in treating endometriosis. Herbs; especially tried and tested combinations of herbs, are effective at addressing the disease’s main drivers (inflammation, immune imbalance and excess estrogens).
Herbs are the basis of 70% of modern medicines and can exert powerful effects. For this reason, we strongly advise consulting a qualified herbalist for a proper assessment and personalised prescription. Research into herbs reveals few adverse side effects and increased fertility rates, which are significant advantages over most conventional approaches.
Extensive research into several well-known herbal combinations for endometriosis treatment has shown the following results (bearing in mind some formulas have had more research than others):
|Effect||Formula #1||Formula #2||Formula #3||Formula #4||Formula #5|
|Reduce cell proliferation||√||√||√||√|
|Reduce cell invasion, attachment or migration||√||√||√||√|
|Reduce immune abnormalities||√||√||√|
|Reduce lesion size||√||√||√|
* angiogenesis is the growth of a new blood supply, ** apoptosis is “programmed cell death” where old, misplaced and unhealthy cells are “recycled” (around 10 billion cells a day in adult humans).
An analysis of 8 randomly controlled trials involving 844 patients with endometriosis found that herbal medicine significantly improved estradiol (E2) levels and ovarian function. There was no difference in whether women had surgery, and no adverse events were reported, indicating herbal medicine is a safe treatment for endometriosis.
Single herbs to treat endometriosis
Much of this information on single herbs is derived from Meresman GF, et al. “Plants as source of new therapies for endometriosis: a review of preclinical and clinical studies”.
|General Info||The berries of the Amazonian Acai palm tree (Euterpe oleracea)|
|Evidence||Acai extract (AE) significantly induces the regression and decreases the size of endometriotic lesions, and the treated lesions show lower levels of VEGF, MMP-9, COX-2, PGE2 and nitric oxide than controls|
|General Info||Uncaria tomentosa (cat’s claw) is an Amazonian rainforest vine whose thorns resemble cat’s claws.|
|Actions||U. tomentosa has been successfully used to treat
· Rheumatoid arthritis
The plant mediates cell function by inhibiting PGE2, and its actions include:
· Inducing apoptosis (programmed cell death)
|Evidence||Giving Uncaria tomentosa extract (UTE) to rats with surgically induced endometriosis reduces the growth of ectopic lesions compared to controls.|
|General Info||Cannabinoids from the cannabis plant (Cannabis sativa) include delta-9-tetrahydrocannabinol (THC) and the principal psychoactive constituent cannabidiol (CBD).
There are two kinds of cannabinoid receptors: cannabinoid 1 (CB1) and 2 (CB2) receptors.
· CB1 receptors are highly expressed in the uterus, spleen, heart, adrenal gland, ovaries and testes.
· CB2 receptors are preferentially expressed in the immune system and intestine
Women with endometriosis have lower levels of CB1 receptors in their endometrial tissue, which could be causing a more severe pain experience i
|Evidence||· 2 mg/kg of THC was effective in alleviating mechanical hypersensitivity and pain and restoring cognitive function
· THC also inhibited the development of endometrial cysts ii
|Chinese skullcap (Huang Qin)|
|General Info||Scutellaria baicalensis root has two main flavonoids; Wogonin and baicalein|
|Evidence||· Wogonin inhibits the growth of endometriotic lesions iv
· Baicalein significantly reduces the viability of human endometriotic stromal cells and may induce apoptosis v
|General Info||Andrographolide is the main active constituent in Green Ciretta (Andrographis paniculate), a medicinal plant of Southeast Asia, China and India.|
|Evidence||· Andrographolide inhibits cell cycle progression and cell proliferation in cell cultures of endometriotic stromal cells.
· Endometriotic lesions reduce in size, and pain scores are lower
· Andrographolide is a potent anti-inflammatory and analgesic in endometriosis treatment vii
|Fire Bush extract|
|General Info||Calligonum comosum (Fire Bush) is a leafless perennial shrub of sand dunes, traditionally used for abnormally heavy or prolonged menses.|
· Anti-cancer activity
|Evidence||Administration of Calligonum comosum extract (CCE) to mice with surgically induced endometriosis resulted in the lesions showing ix
· Inhibited growth and cyst formation
· Reduced vascularisation
· Less cell proliferation
· less immune cell infiltration
|Aged Black Garlic|
|General Info||Garlic (Allium sativum) is a commonly used spice, food and medicine worldwide and one of the most widely researched medicinal plants. Several studies have shown that aged (and fermented) black garlic extracts have a broad pharmacological effect spectrum.|
· Anti-cancer activity
|Evidence||The hexane extract of aged black garlic (HEABG) is effective in the prevention and treatment of endometriosis:
· HEABG inhibits cell proliferation and cell cycle progression of tumour necrosis factor (TNF)- activated human endometriotic stromal cells
· Treating endometriotic stromal cells with HEABG strongly suppresses adhesion molecules
· HEABG may inhibit immune cells’ recruitment into endometriotic lesions and help reduce inflammation.
|Gastrodia elata Blume (Tian Ma)|
|General Info||Gastrodia elata is a symbiotic orchid (with a fungus that feeds on rotting wood) used in herbal medicine for over 2,000 years. Over 80 biologically active compounds have been isolated from the plant, and 4-Hydroxybenzyl alcohol (4-HBA) is a phenolic constituent effective against several central and peripheral nerve disorders.|
|Evidence||· 4-HBA suppresses vascularisation and growth of developing endometriotic lesions
· 4-HBA inhibits the proliferation and migration of murine endothelial-like eEND2 cells x
|General Info||Pharmacologic studies show ginsenosides provide most of the biological activities of ginseng (Panax ginseng) root. These include ginsenoside-Rg3 and ginsenoside Rh2 and their metabolites (protopanaxadiol, PPD and protopanaxatriol, PPT).|
|Evidence||· Rg3 inhibits endometriotic stromal cells in a time and dose dependent manner xi
· Ginsenoside Rf decreases the volume of endometriotic lesions and reduces the expression levels of VEGF and inflammation-related cytokines xii
· PPD, PPT, Rg3, Rh2 and esculentoside-A affect endometrial stromal cell viability and induce autophagy in ectopic cells. In addition, they all reduce the number and growth of ectopic lesions xiii
|Guelder rose extract|
|General Info||The European cranberry bush or guelder rose (Viburnum opulus) fruit is used as food, herbal tea and medicine to treat many illnesses.|
· Cardioprotective xv
|Evidence||· Animal studies show V. opulus extracts protect the male reproductive system from damage by taxanes. xvi
· Oral V. opulus extract significantly reduces the volume of endometriotic lesions and the levels of peritoneal TNF-a, VEGF and interleukin (IL)-6 in rats. xvii
|General Info||Xanthohumol is a flavonoid isolated from hops (Humulus lupulus L.) with well-documented broad anti-cancer and anti-metastatic activities|
· Anti-angiogenic properties
|Evidence||· 100 mM xanthohumol in the drinking water of mice with surgically induced endometriosis suppressed angiogenesis and cell proliferation in the lesions to prevent their growth in all locations in the peritoneal cavity xix
· Interestingly, no side effects are reported within reproductive organs after treatment
|General Info||Milk thistle (Silybum marianum) provides Silymarin extract (SE), a traditional treatment for liver diseases and low milk production. SE is a mixture of flavonolignan and flavonoid polyphenolic compounds with powerful actions.
Clinical trials indicate that SE is safe in humans and well tolerated at high doses (>1500 mg/ day) xxi
However, the compound has low water solubility, low bioavailability and poor intestinal absorption.
Nanotechnology is a promising way to improve its bioavailability with sustained release and increased therapeutic action. xxii
· Pro-apoptotic effects
|Evidence||· The anti-oxidant activity was significantly higher in SE-treated animals with endometriosis than in controls.
· SE induces regression of endometriotic lesions in rat models. xxiii
· SE-treated endometriotic lesions show less angiogenesis and more apoptosis and fibrosis. xxiv
|Pueraria flower extract|
|General Info||A perennial climbing leguminous plant of East Asia|
· Aromatase inhibiting activity in endometrial cells
|Evidence||· Pueraria flower extracts (PFE) reduce MMP-2 and MMP-9 mRNA and protein levels in endometriotic cells and suppress their adhesion and migration (Kim et al., 2017). xxvi
· Mice treated with PFE orally for five weeks (starting a week before endometrial fragment inoculation) had fewer newly developing endometriotic lesions than controls (Kim et al., 2017), suggesting PFE is a potential therapy for preventing and treating endometriosis.
|Pueraria root extract|
|General Info||The main component of Pueraria lobata root (Kudzu or Ge Gen) is Puerarin, which possesses a wide range of pharmacological properties|
· Anti-oxidative stress and free-radical damage
· Apoptosis-inducing (programmed cell death)
· Reduces estrogen receptors
|Evidence||· A significant decrease in aromatase P450 expression in endometrial carcinoma cell lines
· Suppression of estradiol (E2) induced proliferation of endometriotic stromal cells xxvii
· Inhibits the invasion of endometriotic stromal cells
· Inhibits the vascularisation of ectopic endometrial tissues
· Oral puerarin at 60, 200 or 600 mg/kg/day significantly reduced endometriotic tissue weight and serum oestrogen levels (at all doses) without adverse effects. xxviii
· Puerarin prevents rat endometriotic lesions’ growth by inhibiting P450arom and COX-2 expression.
· Puerarin reduces E2 (estradiol) and PGE2 levels and blocks the positive feedback mechanism of E2
|General Info||Quercetin is ubiquitous in fruits and vegetables and is one of the Western diets’ most common dietary flavonols.|
|Evidence||· Quercetin inhibits endometriotic lesions growth by reducing serum FSH and LH levels and oestrogen content
· Quercetin decreases estrogen receptor expression in the hypothalamus, pituitary and endometrium xxx
· Quercetin inhibits cell proliferation and induces cell cycle arrest and apoptosis of the endocervical cell lines xxxi
|General Info||Resveratrol is a natural phytoalexin polyphenol synthesised by plants to protect against fungal infections and is found in high levels in grapes, wine, berries and nuts.|
|Evidence||· Resveratrol dose-dependently suppresses the invasiveness of human endometrial stromal cells xxxiii
· Inhibits cell proliferation and induces apoptosis in endometrial cell cultures xxxiv
· Doses between 10 and 40 mg/kg per day suppressed cell proliferation and angiogenesis and stimulated apoptosis, resulting in endometriotic growth
· Resveratrol is a potent inhibitor of endometriosis-associated inflammation and angiogenesis. xxxv
· Adding 30 mg resveratrol to women with endometriosis’s daily oral contraceptive regimen caused a significant reduction in pain, with 82% of patients reporting complete resolution of dysmenorrhea and pelvic pain after two months of therapy xxxvi
· Adding 40 mg/day of resveratrol to help manage endometriosis for women taking monophasic contraceptive pills did not improve endometriosis-related symptoms xxxvii
· Resveratrol has been suggested for peri-menopausal women to prevent osteoporosis arteriosclerosis, osteoporosis, and endometriosis xxxviii
|General Info||Rosemary leaves (Rosmarinus officinalis) contain a multitude of active ingredients, especially carnosic acid, rosmarinic acid and diterpene|
|Evidence||· Carnosic acid and rosmarinic acid significantly reduce endometriotic lesion size
· Both significantly suppress cell proliferation, and rosmarinic acid also promotes apoptotic cell death within lesions xxxix
|Tea – Green
|General Info||Green tea (Camellia sinensis) contains the flavonoid Epigallocatechin-3-gallate (EGCG), with a wide range of therapeutic effects. A prodrug of EGCG (pro-EGCG, EGCG octaacetate) has been developed with improved stability, bioavailability and stronger anti-oxidant activity.|
· Anti-cancer activity
|Evidence||· Oral EGCG for 4 weeks inhibits the development of endometriotic lesions by diminishing cell proliferation and increasing apoptosis.
· EGCG treatment reduces the number of established lesions and suppresses cell proliferation, and induces cell death xli
· EGCG inhibits cell proliferation, migration, invasion and collagen gel contraction of endometrial and endometriotic stromal cells
· EGCG more strongly suppresses cell proliferation of diseased cells than of their normal cell counterparts xlii
|General Info||Turmeric (Curcuma longa Linn) rhizomes contain “curcumin”, a powerful polyphenolic compound with well-documented anti-inflammatory and cytoprotective properties|
· Anti-cancer activity
|Evidence||· Curcumin inhibits the proliferation of endometrial cells by reducing estradiol (E2) levels xliii
· Reduces VEGF expression in endometriosis lesions and reduces cell proliferation xliv
· Curcumin treatment reduces secretions of pro-angiogenic chemokines and pro-inflammatory cytokines in endometrial cells xlv
· Curcumin upregulates anti-inflammatory cytokines IL-10 and IL-12 in endometrial stromal cells from endometriosis patients
· 40 mg/kg/day of curcumin encapsulated in poly(lactic-co-glycolic acid) nanoparticles suppressed oxidative stress parameters, angiogenic markers, matrix-degrading molecules, oestrogen levels, endometriotic lesion size and micro-vessel density in the peritoneum of mice xlvi
· A clinical trial is ongoing in Vienna, with participants taking two capsules of 42 mg of curcumin twice a day (Flexofytol) to treat endometriosis xlvii
Combined quercetin, turmeric and NAC trial
Thirty-three women clinically diagnosed with endometriosis were treated daily for two months (in one tablet of ALLIENDO®) which contains: xlviii
- 200 mg quercetin
- 210 mg dry curcuma longa (titrated at 95% curcuminoids)
- 150 mg N-acetylcysteine (NAC)
The assessment outcome of the treatment measured the women’s:
- Dysmenorrhea (period pain)
- Pelvic pain
- Dyspareunia (pain associated with sex)
- Frequency of taking non-steroidal anti-inflammatory drugs (NSAIDs)
There was a significant improvement for all endometriosis pain-related symptoms (P<0.001), plus NSAID dosage and the times of taking them reduced, without any significant reports of side effects.
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