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Herbal Medicines and Ovarian Hyperstimulation Syndrome: a Retrospective Cohort Study

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Herbal Medicines and Ovarian Hyperstimulation Syndrome: a Retrospective Cohort Study Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2016, Article ID 7635185, 4 pages http://dx.doi.org/10.1155/2016/7635185 Research Article Herbal Medicines and Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study Athar Rasekhjahromi,1 Masoumeh Hosseinpoor,2 Farzaneh Alipour,2 Mehrnoosh Maalhagh,3 and Saeed Sobhanian4 1 Obstetrics and Gynecology Department, Jahrom University of Medical Sciences, Jahrom, Iran 2Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran 3Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran 4Department of Community Health, Jahrom University of Medical Sciences, Jahrom, Iran Correspondence should be addressed to Masoumeh Hosseinpoor; [email protected] Received 14 January 2016; Revised 11 June 2016; Accepted 12 July 2016 Academic Editor: Curt W. Burger Copyright © 2016 Athar Rasekhjahromi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The aim of this study was to assess the association between herbal medication and OHSS. Methods.Thisretrospective cohort study was conducted with 101 polycystic ovary syndrome patients. 66 patients took conventional pharmacological medications and 35 took herbal medications. Data were analyzed by statistical test including Fisher’s Exact and binominal logistic regression. < 0.05 was considered significant. Results. Of the 101 females, 53 were married and 48 were single. There was no significant association between the groups in marriage. No significant association was found in mean age between the two groups (23.9 ± 5.8 years in the control group versus 26.3 ± 6.7 years in the case group). There was a significant difference between the two groups .After adding the dependent (OHSS prevalence) and independent (marriage and group) variables into the model, the Hosmer-Lemeshow test showed suitability. Variances analyzed with this model ranged between 29.4% and 40.7%. Conclusion.The indiscriminate use of herbs is correlated with OHSS. Because patients increasingly consume herbs, they should be aware of potential side effects. However, appropriate dosages of herbs could be obtained for use instead of conventional treatments, which often have side effects. 1. Background and10%forsevereOHSS[6,7].Thesymptomsofmild OHSS include abdominal distention, ovaries up to 12 cm in Polycystic ovarian syndrome (PCOS) is an endocrine dis- diameter, nausea, vomiting, and diarrhea. Moderate OHSS order that is diagnosed by anovulation, hyperandrogenism, includes symptoms such as ascites and hydrothorax and and the polycystic ovary morphology [1]. PCOS is one of the severe OHSS includes symptoms such as rapid weight gain, main predispositions for ovarian hyperstimulation syndrome severe abdominal pain, severe persistent nausea, vomiting, (OHSS) [2]. OHSS is the most serious complication of andhypovolemicshock[8].ThepathogenesisofOHSSis ovulation induction [3]. Vasoactive products and follicle poorly understood. However, the ovarian renin-angiotensin stimulating hormone (FSH) medications can also lead to system and secretion of an angiotensin II-like substance in OHSS [4]. OHSS is characterized as mild, moderate, or the presence of high concentrations of estrogen and increased severe, based on signs, symptoms, and laboratory findings capillary permeability might play a role in OHSS develop- [5]. The prevalence of OHSS has increased because of the ment [9]. Egbase et al. hypothesized that OHSS cannot be useofmenotropinsforcontrolledovarianstimulationin prevented unless treatment is stopped [10]. assisted reproductive technologies. The incidence of OHSS Severe complications of OHSS are preventable. One pos- from gonadotropin usage varies between 8.4% and 23% for sible factor leading to OHSS is the usage of herbal medication. mild OHSS, 0.005% and 7% for moderate OHSS, and 0.008% Herbal remedies have been used for centuries, and their usage 2 Obstetrics and Gynecology International Table 1: Results of the Hosmer-Lemeshow test. in both Western and Eastern society is increasing [11]. One report found that 12% of Americans, 12% of Australians, Chi-square df Sig. and 36.8% of patients in the UK use herbal remedies [12]. 1.829 2 0.401 The World Health Organization estimates that up to 80% of the world’s population depends on herbal medicines [13]. 2.2. Design. The retrospective cohort study was conducted Although there has been concern in the medical community basedonhistoriesofPCOSpatientswhousedherbal about possible side effects arising from herbal medicines use, remedies (Zingiber officinale (ginger), Cinnamomum verum very few herbal remedies have been formally evaluated [14]. (cinnamon), Thymus vulgaris (thyme), Carum carvi (cumin), The belief among patients that these products are “natural” Matricaria recutita (chamomile), and Piper nigrum (black and therefore safe is potentially dangerous. Patients who pepper)) or conventional pharmacological treatment at a are at risk of developing OHSS should be identified before gynecology and obstetrics clinic affiliated to Jahrom Uni- treatment because of risk factors or clinical predictors. versity of Medical Sciences. Also patients were selected Both conventional pharmacological and herbal medica- through PCOS patients. Patients who used both conventional tions are used for treatment of PCOS by patients. Conven- treatment and herbal medication were excluded from the tional pharmacological treatments include spironolactone, study. Patients were followed up with ultrasound to diagnose metformin, clomiphene, and gonadotropin injections [15]. OHSS. Thirty-five patients took herbal remedies (case group), Popular herbal medicines used by women in Iran include Zin- and 66 patients took pharmacological treatment (control giber officinale (ginger), Cinnamomum verum (cinnamon), group) by the convenience sampling method. Thymus vulgaris (thyme), Carum carvi (cumin), Matricaria recutita (chamomile), and Piper nigrum (black pepper). 2.3. Diagnosis. Diagnosis of OHSS was based on histori- Black pepper (Piper nigrum) has been consumed since cal and clinical findings, ultrasound, laboratory data, and ancient times for its anti-inflammatory and antiflatulent physical examination. Ultrasound typically shows bilateral properties. The essential oil of pepper is composed of symmetrical enlargement of ovaries (often >12 cm in size) compounds such as piperine, an amine alkaloid, which is with multiple cysts varying in size, with a classic spoke-wheel responsible for the herb’s pungent character [16]. Ginger is appearance. OHSS was classified as mild, moderate, severe, commonly used to treat various types of stomach problems or critical [24]. and pain relief in arthritis, muscle soreness, menstrual pain, All patients taking herbal medicines had an ultrasonog- and bronchitis. Ginger often has few side effects but mild side raphy one month before starting treatment in the obstetrics effects include heartburn, diarrhea, stomach discomfort, and and gynecology clinic to diagnose with PCOS. After taking a extra-menstrual bleeding [17, 18]. Cinnamon is most com- history of herbal medicine usage, patients underwent another monly used in insulin resistance disorders. Administration ultrasonography. of large amounts of Cinnamomum cassia or Cinnamomum verum might cause side effects in some patients. Cinna- 2.4. Statistical Analysis. The frequency of OHSS was calcu- mon contains the compound coumarin, which can cause or lated in both groups. Data were analyzed using Fisher’s Exact worsen liver disease [19]. Chamomile is traditionally used for and binominal logistic regression. < 0.05 was considered intestinal gas, motion sickness, hay fever, nervous diarrhea, significant. attention deficit-hyperactivity disorder, and fibromyalgia. Chamomile has few side effects when taken with food, but 3. Results and Discussion it can cause uterine contractions that can invoke miscarriage. The National Institutes of Health recommend that pregnant Of the 101 female patients that participated in this study, 53 women and nursing mothers should not consume chamomile of the total (101) were married (71.7% of married women [20, 21]. Thyme is often taken orally for bronchitis, whoop- (number = 53) in the case group versus 28.3% of the married ing cough, sore throat, colic, arthritis, gastritis, diarrhea, women (number = 53) in the control group) and 48 were bedwetting, dyspraxia, flatulence, and skin disorders. It is single (58.3% of the single women (number = 48) in the case also used as a diuretic, to treat urinary tract infections, and group versus 41.7% of the single women (number = 48) in the as an appetite stimulant. Thyme is safe when consumed in control group). There was no significant association between food and taken as a medication for brief periods but it can the groups in number of married patients ( = 0.209). cause digestive problems [22]. Cumin is used for digestive No significant association was found in mean age between problems, heartburn, controlling urination, inducing men- the groups (control group: 23.9 ± 5.8 years versus in case struation, and increasing breast milk production [23]. We group: 26.4 ± 6.8 years, = 0.053). There was a significant aimed to assess whether herbal medications can induce OHSS association between group and OHSS prevalence (< in patients with PCOS. 0.001). Three variables were
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