Pueraria mirifica and vaginal health. (Research Update)
Title: Pueraria mirifica and vaginal health.(Research Update)
Date: May 1, 2008 Publication: Townsend Letter Author: Hudson, Tori
It’s not often that we see a study on the effects of a botanical on vaginal symptoms, vaginal health, vaginal cytology, or vaginal pH, so I was encouraged to see this research being done. This was a randomized, double-blind, placebo-controlled study of healthy postmenopausal women aged 45 to 60. They received either 20 mg, 30 mg, or 50 mg of Pueraria mirifica in capsules or placebo once daily, for 24 weeks. Fifty-one women received one of the three herbal doses, and 20 women received the placebo. After 12 weeks of treatment, significant improvement in vaginal symptoms was seen and maintained over the study period.
The mean vaginal dryness symptoms decreased with use of all the herbal doses, but were not significantly different than the placebo group. The frequency of dyspareunia decreased from 56.9% to 39.2% in the study group, whereas it did not change in the placebo group. The changes in the vaginal health index were significantly improved in the herbal group, noted in weeks 12 and 24. Before treatment, the mean vaginal pH was 8.41 in the study group, and after 12 and 24 weeks of treatment, the mean pH was 5.52 and 5.83, respectively. After 12 weeks of treatment, most measures of vaginal health in the Pueraria group were significantly higher than in the placebo group. The exceptions were vaginal elasticity and pH. However, in the intention-to-treat analysis, all measures were significantly different from those found in the placebo group.
After 12 and 24 weeks of treatment, the maturation value and maturation index was also significantly higher in the study group than in the placebo group. However, in the intention-to-treat analysis, the results were similar. There were no statistically significant changes in endometrial thickness and no significant difference in adverse effects between Pueraria mirifica and the placebo.
Manonai J, Chittacharoen A, Theppisai U, Theppisai H. Effect of Pueraria mirifica on vaginal health. Menopause: The J of the North American Menopause Society. 2007;14(5):919-924.
Commentary: I’m always keeping my eyes open for non-hormonal treatments of vaginal atrophic changes in postmenopausal women. In fact, vaginal estrogen can be considered a miracle treatment much of the time, and I’m very comfortable recommending this local use of estrogen. Given that atrophic vaginitis is a progressive condition, potentially leading not only to more discomfort, but also urinary incontinence, uterine prolapse, vaginal and urinary tract infections, and severe dyspareunia, vaginal estrogen is a key strategy in prevention of these outcomes. However, not all women want vaginal estrogen, and special populations, such as breast cancer survivors, have the benefit/risk and unknowns to weigh. Products such as local vitamin E might provide some temporary soothing comfort, but there is no evidence that they reverse the atrophic changes and declining vaginal health. I came across one small German study using a combination gel containing phytoestrogens from hops extract, hyaluronic acid, liposomes, and vitamin E. This pilot study in ten women demonstrated reductions in vaginal dryness, itching, burning, dyspareunia, and vaginal inflammation. (Morali G, Polatti F, Metelitsa E, et al. [Open, non-controlled clinical studies to assess the efficacy and safety of a medical device in form of gel topically and intravaginally used in postmenopausal women with genital atrophy]. Arzneimittelforschung. 2006; 56 : 230-238.)
Over-the-counter lubricants also provide moisturizing and lubrication but, again, no real evidence of long term restoration of the tissue. Replense, a non-hormonal moisturizing vaginal gel, does have efficacy in treating symptoms of vaginal atrophy and is a non-estrogen alternative to estrogen vaginal products.
There have been some previous studies that have found that soy isoflavones have no effect on vaginal symptoms or objective measurements of vaginal health. Pueraria mirifica does contain the phytoestrogens daidzin, daidzein, genistein, coumestrol, and genistin, but also the stronger estrogenic ingredients miroestrol and deoxymiroestrol. This could provide some explanation as to why the vaginal tissue is more responsive to Pueraria mirifica phytoestrogens than soy phytoestrogens.
One frustrating aspect of this paper was that it did not provide information as to differences in response between those who took the different doses of Pueraria. Overall, though, I’m encouraged by this report and that doses of 20mg, 30mg, and 50mg/day for a 24-week period was proven to exhibit some estrogenic activity on vaginal tissue and to alleviate symptoms of vaginal dryness and dyspareunia while also improving atrophic vaginal tissue in postmenopausal women. It’s always good to have options, and if this product is available, I will begin to use it while being certain to check for evidence of normal healthy postmenopausal vaginal tissue.
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