Herbal preparations for uterine fibroids

  • Review
  • Intervention




Uterine fibroids are the most common non-malignant growths in women of childbearing age. They are associated with heavy menstrual bleeding and subfertility. Herbal preparations are commonly used as alternatives to surgical procedures.


To evaluate the effectiveness and safety of Chinese herbal medicine for treatment of uterine fibroids.

Search methods

The authors with the guidance of the Trials Search Coordinator searched the following electronic databases: the Trials Registers of the Cochrane Menstrual Disorders and Subfertility Group and the Cochrane Complementary Medicine Field, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE, EMBASE, the Chinese Biomedical Database, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), AMED, and LILACS. The searches were up to 11 September 2012.

Selection criteria

Randomised controlled trials comparing herbal preparations with no intervention, placebo, medical treatment, or surgical procedures in women with uterine fibroids. We included trials of herbal preparations with or without conventional therapy.

Data collection and analysis

Two review authors collected data independently. We assessed trial risk of bias according to our methodological criteria. We presented dichotomous data as risk ratios (RR) and continuous outcomes as mean differences (MD), both with 95% confidence intervals (CI).

Main results

We included 21 randomised trials (involving 2222 women) and the majority of them had unclear or high risk of bias. There were several different herbal preparations used within the included trials. The average treatment duration was three to six months. The primary outcome of uterine fibroid related symptoms was not reported in any of the included trials. The majority of the trials reported fibroid volume and size of the uterus.

Compared with mifepristone, Tripterygium wilfordii extract was associated with a greater reduction in the fibroid volume (MD -23.03 cm3, 95% CI -28.39 to -17.67; 2 trials) and in uterine size (MD -51.25 cm3, 95% CI -77.70 to -24.80; 2 trials). There was no evidence of a significant difference between Nona Roguy herbal product and gonadotropin-releasing hormone (GnRH) agonist on the average fibroid volume or the uterine size. The combination of Guizhi Fuling formula and mifepristone was associated with a greater reduction in the fibroid volume (-1.72 [-2.42, -1.02] 7 trials) and in uterine size (MD -31.63 [95% CI -54.58, -8.68] 3 trials)) compared with mifepristone alone. Only 13/21 trials reported on adverse events and no serious adverse effects from herbal preparations were reported.

Authors' conclusions

Current evidence does not support or refute the use of herbal preparations for treatment of uterine fibroids due to insufficient studies with large sample sizes and of high quality. Further high quality trials evaluating clinically relevant outcomes are warranted.








著者らがTrials Search Coordinatorの指導に従って、下記の電子的データベースを検索した:Trials Registers of the Cochrane Menstrual Disorders and Subfertility Group and the Cochrane Complementary Medicine Field、Cochrane Central Register of Controlled Trials (CENTRAL)(コクラン・ライブラリ2012年第4号)、MEDLINE、EMBASE、Chinese Biomedical Database、Traditional Chinese Medical Literature Analysis and Retrieval System(TCMLARS)、AMEDおよびLILACS。 検索内容は2012年9月11日現在のものとした。







ミフェプリストン(中絶用ピル)と比較して、トリプテリジウム・ウィルフォルディ(Tripterygium wilfordii)抽出物により、筋腫の体積(MD -23.03 cm3、95%CI -28.39~-17.67;2試験)および子宮の大きさ(MD -51.25 cm3、95%CI -77.70~-24.80;2試験)が大幅に減少した。 筋腫の体積および子宮の大きさの平均値について、Nona Roguy漢方薬とゴナドトロピン放出ホルモン(GnRH)拮抗薬との間に有意差は認められなかった。ミフェプリストン単独と比較して、Guizhi Fuling剤とミフェプリストンとの併用により、筋腫の体積(MD -1.72 cm3、95%CI -2.42~-1.02;7試験)および子宮の大きさ(MD -31.63 cm3、95%CI -54.58~-8.68;3試験)が大幅に減少した。21試験中13試験でのみ、有害事象について報告されていたが、漢方薬による重篤な有害作用は認められなかった。




《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Herbal preparations for the treatment of women with uterine fibroids

Uterine fibroids are benign (non-cancerous) growths in the uterus. They are the most common type of growth found in a woman's pelvis, being present in about one in four or five women older than 35 years. Although many women with fibroids are not aware of them, the growths may cause symptoms or problems due to their size, number, or location. Common symptoms can include longer or more frequent menstrual periods, heavy bleeding, menstrual pain, pressure in the lower abdomen, infertility, or miscarriages. Women with these symptoms may require treatment. Fibroids can be treated with surgery, such as myomectomy (removal of the fibroids while leaving the uterus in place) or hysterectomy (removal of the uterus). Another approach is uterine artery embolization, by which the blood vessels to the uterus are blocked. Drugs such as gonadotropin-releasing hormone (GnRH) agonists may be used to shrink fibroids and to control bleeding.

Herbal preparations are commonly used alternatives to drug treatment, surgery, or both. This systematic review included 21 randomised clinical trials involving 2222 women with uterine fibroids. There is no evidence on the effectiveness of herbal preparations for symptom relief as no trials evaluated this properly. Compared with conventional medication, one herbal preparation, Tripterygium wilfordii, may have a more beneficial effect in reducing the volume of uterine fibroids. Another five herbal medicines appeared to be similar to conventional medication in reducing the volume of fibroids. The herbal medicine Guizhi Fuling formula showed a significantly greater effect in reducing the volume of the fibroids when combined with mifepristone versus mifepristone alone. However, these clinical trials were small in terms of the number of participants and the trial quality was low. Thirteen out of 21 included trials reported on adverse effects of herbal preparations and found some minor problems such as stomach discomfort, nausea, hot flushes, and poor appetite although no serious adverse effects were identified. The effect of herbal preparations for uterine fibroids is therefore not confirmed in this review and needs to be studied in large, good quality trials.




漢方薬は、薬剤、手術または双方の代わりとしてよく用いられる。このシステマティックレビューでは、子宮筋腫のある女性2,222例を対象とした21件のランダム化臨床試験を選択した。症状緩和について適切に評価した試験がなかったため、症状緩和に対する漢方薬の有効性を示すエビデンスはなかった。従来の薬剤と比較して、トリプテリジウム・ウィルフォルディ(Tripterygium wilfordii)という1種の漢方薬で、子宮筋腫の体積を減少させる上で有益な効果が認められた。その他の5種の漢方薬は、子宮筋腫の体積を減少させる上で従来の薬剤と同程度であると考えられる。Guizhi Fuling剤という漢方薬では、ミフェプリストンと併用した場合、ミフェプリストン単独と比較して子宮筋腫の体積を減少させる上で有意な効果が認められた。しかし、これらの臨床試験は、参加者数が少なく、試験の質も低かった。選択した21試験のうち13試験で、漢方薬の有害作用が報告されており、胃不快感、悪心、顔のほてりや食欲不振などの軽度な問題が認められたが、重篤な有害作用は認められなかった。本レビューでは、子宮筋腫に対する漢方薬の効果は確認できなかったため、大規模かつ質の高い試験で検証する必要がある。


《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。