Whelan Anne Marie, Jurgens Tannis M, Naylor Heather
College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
Can J Clin Pharmacol. 2009 Fall;16(3):e407-29. Epub 2009 Oct 29.
As many women experiencing symptoms of premenstrual syndrome (PMS) seek relief from natural products (NP), health care providers should have quality information available to aid women in making evidence-based decisions regarding use of these products.
To identify herbs, vitamins and minerals advocated for the treatment of PMS and/or PMDD and to systematically review evidence from randomized controlled trials (RCTs) to determine their efficacy in reducing severity of PMS/PMDD symptoms.
Searches were conducted from inception to April 2008 in Clinical Evidence, The Cochrane Library, Embase, IBID, IPA, Mayoclinic, Medscape, MEDLINE Plus, Natural Medicines Comprehensive Database and the Internet to identify RCTs of herbs, vitamins or minerals advocated for PMS. Bibliographies of articles were also examined. Included studies were published in English or French. Studies were excluded if patient satisfaction was the sole outcome measure or if the comparator was not placebo or recognized therapy.
Sixty-two herbs, vitamins and minerals were identified for which claims of benefit for PMS were made, with RCT evidence found for only 10. Heterogeneity of length of trials, specific products and doses, and outcome measures precluded meta-analysis for any NP. Data supports the use of calcium for PMS, and suggests that chasteberry and vitamin B6 may be effective. Preliminary data shows some benefit with ginkgo, magnesium pyrrolidone, saffron, St. John's Wort, soy and vitamin E. No evidence of benefit with evening primrose oil or magnesium oxide was found.
Only calcium had good quality evidence to support its use in PMS. Further research is needed, using RCTs of adequate length, sufficient sample size, well-characterized products and measuring the effect on severity of individual PMS symptoms.
由于许多有经前综合征（PMS）症状的女性寻求天然产品来缓解症状，医疗保健提供者应掌握高质量信息，以帮助女性在使用这些产品时做出基于证据的决策。
识别被提倡用于治疗PMS和/或经前烦躁障碍（PMDD）的草药、维生素和矿物质，并系统回顾随机对照试验（RCT）的证据，以确定它们在减轻PMS/PMDD症状严重程度方面的疗效。
从创刊至2008年4月，检索了《临床证据》《考科蓝图书馆》《Embase》《IBID》《IPA》《梅奥诊所》《Medscape》《医学在线Plus》《天然药物综合数据库》和互联网，以识别被提倡用于PMS的草药、维生素或矿物质的RCT。还检查了文章的参考文献。纳入的研究以英文或法文发表。如果仅以患者满意度作为唯一的结局指标，或者对照不是安慰剂或公认的疗法，则排除这些研究。
共识别出62种声称对PMS有益的草药、维生素和矿物质，其中只有10种有RCT证据。试验长度、具体产品和剂量以及结局指标的异质性使得无法对任何天然产品进行荟萃分析。数据支持钙用于治疗PMS，并表明贞节树和维生素B6可能有效。初步数据显示银杏、吡咯烷酮镁、藏红花、圣约翰草、大豆和维生素E有一定益处。未发现月见草油或氧化镁有益的证据。
只有钙有高质量证据支持其用于PMS。需要进行进一步研究，采用足够长的RCT、足够的样本量、特征明确的产品，并测量对个体PMS症状严重程度的影响。
