Effects of Chinese Herbal Medicine on ovarian functions in the patients with endometriosis: A systematic review and meta-analysis of randomized controlled trials

Abstract

When using Chinese Herbal Medicine (CHM) to treat endometriosis, the effects of CHM on the ovarian function have received little attention. This systematic review and meta-analysis aimed to evaluate the effects and safety of CHM on the ovarian function in patients with endometriosis. Eight electronic databases were searched from their inception to March 2, 2021. We compared those receiving CHM with controls, all studies included were randomized controlled trials (RCTs). Statistical analysis was performed using standard mean difference of hormonal levels: Estradiol(E2), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH). Subgroup analysis and sensitivity analysis were conducted. A total of 844 patients from 11 RCTs were included. In E2 levels, the analysis revealed a significant effect in favor of CHM group compared with the control group (SMD = 3.05, 95%CI = 0.29 to 1.32, P = 0.002). After subgroup analyses, there were still significant effects in both non-operative subgroup (SMD = 2.04, 95%CI = 0.04 to 1.88, P = 0.04) and post-operative subgroup (SMD = 2.19, 95%CI = 0.08 to 1.42, P = 0.03). There were no significant differences between the two subgroups in both FSH levels (P > 0.05) and LH levels (P > 0.05), and the subgroup analyses showed similar results. No adverse events were reported. CHM may improve ovarian function in patients with endometriosis through increasing E2 levels whether there is surgery or not, which may indicate a referable and safe treatment for endometriosis. Due to the weak evidence, high-quality clinical trials are needed to support this conclusion. (PROSPERO ID is CRD42021240162)