PEARLS No. 203, September 2009, written by Brian R McAvoy 

Clinical question

How effective is Chinese herbal medicine (CHM) in alleviating endometriosis-related pain and infertility?

Bottom line

Following laparoscopic surgery, combined oral and enema administration of CHM has a comparable beneficial effect to gestrinone but with fewer adverse effects. Oral and enema administration of CHM may be more effective than danazol in providing extended relief of endometriosis symptoms (NNT* 2) and in shrinking adnexal masses, with fewer adverse effects. For lumbosacral pain, rectal discomfort, or vaginal nodules tenderness, there was no significant difference either between CHM and danazol. *NNT = number needed to treat to benefit 1 individual. Note that no range is given as there were only 2 small trials with identical baseline results  

Caveat

There are only very limited data available from 2 small trials comparing the same CHM interventions with 2 conventional treatments for endometriosis (danazol and gestrinone). Both trials are of poor methodological quality so these findings must be interpreted cautiously. More rigorous research is required to accurately assess the potential role of CHM as a stand-alone medical option or as a post-surgical adjuvant in treating endometriosis.  

Context

Endometriosis is characterised by the presence of tissue that is morphologically and biologically similar to normal endometrium, in locations outside the uterus. Surgical and hormonal treatment of endometriosis has unpleasant side effects and high rates of relapse. In China, treatment of endometriosis using CHM is routine.  

Cochrane Systematic Review

Flower A et al. Chinese herbal medicine for endometriosis. Cochrane Reviews 2009. Issue 3. Article No. CD006568. DOI:10.1002/14651858.CD006568.pub2. This review contains 2 studies involving 158 participants.