600 Reviews Phytotherapy and Womenʼs Reproductive Health: The Cameroonian Perspective Authors Dieudonne Njamen1, Marie Alfrede Mvondo1,2, Sefirin Djiogue 1, Germain Jean Magloire Ketcha Wanda3, Chantal Beatrice Magne Nde4, Günter Vollmer 5 Affiliations The affiliations are listed at the end of the article Key words Abstract used during pregnancy for prenatal care, against l" women reproductive health ! fetal malposition or malpresentation, retained l" African pharmacopoeia Approximately 80% of the population in Africa dead fetus, and against threatened abortion. l" emmenagogue use traditional medicinal plants to improve their Some others are used as anti-fertilizing drugs for l" uterine flow suppressors state of health. The reason of such a wide use of birth control. Such plants may exert various activ- l" anti‑infertility l" abortifacient medicinal plants has been mainly attributed to ities, namely, anti-implantation or early abortifa- their accessibility and affordability. Expectation cient, anti-zygotic, blastocytotoxic, and anti-ovu- of little if any side effects, of a “natural” and there- latory effects. Some herbs could also act as sexual fore safe treatment regimen, as well as traditional drive suppressors or as a post-coital contraceptive beliefs additionally contribute to their popularity. by reducing the fertility index. A number of these Several of these plants are used by women to re- plants have already been subject to scientific in- lieve problems related to their reproductive vestigations and many of their properties have health, during or after their reproductive life, dur- been assessed as estrogenic, oxytocic, or anti-im- ing pregnancy, or following parturition. The Afri- plantation. Taking into account the diversity of can pharmacopoeia thus provides plants used for the African pharmacopoeia, we are still at an early preventing and/or treating gynecological infec- stage in the phytochemical and pharmacological tions, dysmenorrhea, irregular menstruations, characterization of these medicinal plants that af- oligomenorrhea or protracted menstruation, and fect the female reproductive system, in order to infertility. Such plants may then be used as anti- determine, through in vitro and in vivo studies, microbians, emmenagogues, or as suppressors of their pharmacological properties and their active uterine flow. African medicinal plants are also principles. received January 2, 2013 revised February 13, 2013 accepted February 16, 2013 Introduction In this traditional system of medicine, plant ex- ! tracts in forms of concoctions or infusions are Bibliography Traditional societies in Africa and elsewhere have used to treat a wide range of diseases. Some of DOI http://dx.doi.org/ always used herbs to promote health [1]. Accord- these plants are used in connection with female This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. 10.1055/s-0032-1328326 Published online March 28, ing to Okoli et al. [2], traditional medical practices reproductive health. Throughout history, women 2013 on the African continent date as far back as 4000 have tried to control or enhance their fertility Planta Med 2013; 79: 600–611 years and were the sole medical system for health with various levels of societal support. Since then, © Georg Thieme Verlag KG care before the advent of conventional medicine. plant drugs have been used for their effects on re- Stuttgart · New York · ISSN 0032‑0943 Even today, traditional medicine is still the pre- productive function particularly for suppressing dominant means of health care in developing fertility, regulating menstrual cyclicity, relieving Correspondence countries where about 80% of their total popula- dysmenorrhea, treating menopausal symptoms, Dr. Dieudonné Njamen Laboratory of Animal Physiology tion depends on it for their well-being [3]. The and breast pain. Plant materials have also been Department of Animal Biology reason of such a broad use of medicinal plants used during pregnancy against fetal malposition, and Physiology has been mainly attributed to their accessibility threatened abortion, or amnionitis affecting the Faculty of Science, University of Yaounde 1 and affordability. Expectation of little if any side newborn [4,5]. The sites of action of fertility and/ P.O. Box 812 effects, of a “natural” and therefore safe treatment or antifertility agents in females comprise the hy- Yaounde regimen, as well as traditional beliefs additition- pothalamus, the anterior pituitary, the ovary, the Cameroon Phone: + 23779424710 ally contribute to their popularity [3]. oviduct, the uterus, and the vagina. Plants in [email protected] question affect the reproductive system through Njamen D et al. Phytotherapy and Womenʼs… Planta Med 2013; 79: 600–611 Reviews 601 Table 1 Some Cameroonian medicinal plants with estrogenic properties. Name Family Plant part Extract Estrogenic effects Authors used Brenania brieyi Rubiaceae Fruits Methanolic extract " Stimulated uterine growth and vaginal epi- Magne Ndé et al. thelial proliferation. [12] Erythrina lysistemon Fabaceae Stem barks Ethyl acetate extract " Stimulated phosphatase alkaline in Ishikawa Tanee et al. [10] cells; " slightly stimulated uterine growth. " Prevented bone loss, increased HDL-choles- Njamen et al. [11] terol and decreased triglycerides. Millettia conraui Leguminoseae Stem barks Ethyl acetate extract " Increased uterine and vaginal epithelial Njamen et al. [13] Millettia drastica Leguminoseae Stem barks Ethyl acetate extract heights; Bridellia ferruginea Leguminoseae Leaves Methanolic extract " stimulated alkaline phosphatase in Ishikawa cells. Aloe buttneri Liliaceae Leaves Aqueous " Stimulated uterine growth, increased ovarian Telefo et al. [16, Dicliptera verticillata Acantahceae Leaves weight; 17] Justicia insularis Acanthaceae Leaves " increased ovarian and uterine levels; Hibiscus Malvaceae Stem leaves " increased serum estradiol levels and macranthus decreased ovarian cholesterol. Senecio biafrae Asteraceae Leaves Aqueous " Puberty onset and stimulation of folliculo- Lienou et al. [18] genesis. estrogenic/anti-estrogenic, anti-inflammatory, analgesic, and through either or both of the two estrogen receptors. To continue antinociceptive activities. Plant extracts with estrogen-like prop- with the pharmacological characterization of these extracts, ex- erties in particular have been reported to mostly contain com- tended phytochemical studies are required. In-depth phyto- pounds endowed with estrogenic activities. Such compounds chemical studies have already been conducted on some of these commonly known as phytoestrogens should be referred to as plants. plant secondary metabolites with estrogenic activity, as they As far as the Erythrina lysistemon extract is concerned, following mimic part of estrogen action through estrogen receptor-mediat- a phytochemical analysis, alpinumisoflavone and abyssinone V- ed mechanisms. In addition, their mechanism of action depends 4′-methyl-ether have been isolated as major estrogenic constitu- on the levels of endogenous estrogens [6]. The present review ents [19,20]. In the same study, alpinumisoflavone (an isofla- aimed to highlight Central African medicinal plants used by vone) and abyssinone V-4′-methyl-ether (a flavanone) were women to relieve problems related to their reproductive health found to be responsible for the estrogenic effects of the crude ex- during or after their reproductive life, during pregnancy, or fol- tract of Erythrina lysistemon, as they stimulated uterine growth lowing parturition, with an emphasis on plants originating from and/or vaginal proliferation. This estrogenic activity was shown Cameroon. to be estrogen receptor-mediated as both compounds bound both subtypes of the estrogen receptor in a ligand binding assay, although not with the same affinity and preference. Furthermore, Estrogen-like Acitivities of Secondary Metabolites alpinumisoflavone and abyssinone V-4′-methyl-ether reduced from Some Central African Medicinal Plants atherogenic risks by decreasing the two assessed atherogenic pa- ! rameters, namely, the total cholesterol/HDL-cholesterol ratio and As previously reported [7–9], xenobiotics with estrogenic prop- the atherogenic index of plasma in ovariectomized Wistar rats erties and plant secondary metabolites with this activity in par- serving as a preclinical model for postmenopausal conditions. In ticular preferentially exert their biological activity by: (1) mim- the same study, both compounds were found to decrease serum icking the action of endogenous estrogens; (2) acting as estrogen gonadotrophin levels and to reduce the hot flush activity by in- antagonists; (3) altering the pattern of synthesis and metabolism creasing the ratio of FSH on LH [19]. Finally, whereas alpinumiso- This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. of endogenous hormones; and (4) modifying hormone receptor flavone induced clear estrogenic effects both on classical and values. nonclassical estrogen targets, the flavanone abyssinone V-4′- Up to date, a large variety of studies have reported the estrogenic methyl-ether did affect only the vagina (suggesting the safety of properties of a number of Central African medicinal plants, treatment with this compound towards the uterus of female rats) namely, Eryhtrina lysistemon (Fabaceae) [10,11], Brenania brieyi and nonclassical estrogen targets such as the lipid metabolism, (Rubiaceae) [12], Millettia conraui (Leguminosae),