The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial

https://doi.org/10.1016/j.ctim.2019.05.028Get rights and content

Highlights

  • Most postmenopausal women are suffering from hot flashes and also depression.

  • There are many studies about the effect of H. perforatumon mild to severe depression.

  • The connection of depression with the physiological changes in postmenopause, have insufficient information.

  • We examined the effect of H. perforatum on menopausal symptoms and depression.

  • Results showed that H. perforatum could decrease menopausal symptoms as well as depression.

Abstract

Objectives

Hypericum perforatum (St John's wort) is an herbal plant that has antidepressant activity and contains ingredients such as flavonols derivatives, bioflavonoids, proanthocyanidins, xanthones, phloroglucinol, and naphthodianthrones. This study was aimed to test the effect of Hypericum perforatum on hot flashes, menopausal symptoms, and depression in postmenopausal women.

Design & setting

This randomized controlled study was conducted on 80 postmenopausal women aged 45–60 in Izeh, Iran.

Intervention

Two groups received 270–330 μg of H. perforatum (n = 40) or placebo (n = 40) tablets three times a day for two months.

Main outcomes

Data were collected using a socio-demographic questionnaire, the modified Kupperman index before the intervention and 2, 4, 6 and 8 weeks after intervention. The Hamilton Depression Rating Scale was used to gather data before the intervention and in the 8th week of intervention. The data were analyzed using an independent t-test, chi-square test, and repeated measure test.

Results

Seventy women completed the study and five women from each group withdrew the study. The frequency and intensity of hot flashes and the score of Kupperman scale significantly decreased in the H. perforatum group compared to the control group (p < 0.001). In addition, the intensity of depression significantly decreased in the H. perforatum group compared to the control group. At the end of the study, 80% of women in the intervention group did not have depression compared to only 5.7% in the control group (p < 0.001).

Conclusion

Treatment with Hypericum perforatum is an efficient way of reducing hot flashes, menopausal symptoms, and depression in postmenopausal women.

Introduction

One of the most critical periods in a woman’s life is menopause1 which is characterized by the end of the reproductive period. Although menopause is a physiological and common event, complications like physical and psychological conditions, as well as emotional and social health experience of postmenopausal women may affect their quality of life.2 Early postmenopausal symptoms include: hot flashes, insomnia, anxiety, depression, lack of concentration, change of sexual desires, and skin and mucus atrophy. The late menopausal symptoms include cardiovascular disorder and osteoporosis.3 Menopausal symptoms can be treated using hormone replacement therapy and non-hormonal treatments.4 Hormone replacement therapy will improve the symptoms of menopause, but it also causes some side effects.5 For instance, estrogen may cause breast and endometrial cancers, thromboembolism, uterine dysfunctional bleeding and liver diseases; thus, there have been some trends toward using herbs as an alternative and auxiliary treatment.6

Hypericum perforatum (St John's wort) is one of the herbal plants that has antidepressant and analgesia like activity and contains components such as flavonol derivatives, biflavones, proanthocyanidines, xanthones, phloroglucinols and naphthodianthrones.7,8 H. perforatum can be used in the treatment of mild to moderate depression. The antidepressant mechanism of this herbaceous plant is due to the suppression of the ingestion of serotonin (5-HT), dopamine (DA) and norepinephrine (NE) from the synaptic cleft of interconnecting neurons.7, 8, 9 This herb could reduce the symptoms of depression and may be used in reducing the symptoms of Alzheimer disease such as pain and depression.10 Some studies measured the effect of H. perforatum on hot flashes among postmenopausal women.11,12 The effect of this herbal plant on postmenopausal women’s quality of life was also examined in another study.11

Although there are studies that have assessed the effect of H. perforatum on either postmenopausal hot flashes or depression alone, there is a paucity of studies to consider both these menopausal complications in combination. Thus, this study was designed to examine the effect of H. perforatum on menopausal symptoms, hot flashes, and depression among postmenopausal women.

Section snippets

Materials and methods

This was a double blind randomized controlled trial conducted on 80 postmenopausal women. Illegible for the study were literate women aged45–60 with at least 12 months of amenorrhea, and having at least two menopause symptoms according to the modified Kupperman index. Excluded from the study were; women with unnatural menopause such as oophorectomy, endocrine dysfunction, history of using phytoestrogens, allergy to herbal medicine, severe depression, and body mass index (BMI) more than 30 kg/m2

Results

At the end of the study, 10 women dropped-out and 70 women completed the study. The reasons for withdrawal are listed in Fig. 1. Table 1 shows the socio-demographic characteristics of the participants in two groups of H. perforatum and control. As evident from this table, the mean age of women was 50.49 ± 2.74 and 50.63 ± 2.87 in the H. perforatum and control groups, respectively (p = 0.83). The two groups did not show any significant difference regarding body mass index, time span from

Discussion

This work was designed to assess the effect of H. perforatum on hot flashes and depression among postmenopausal women. The results of this study showed that H. perforatum could significantly reduce the mean and frequency of hot flashes as well as the modified Kupperman’s score compared to the control group.

Al-Akoum et al, conducted a study on 47 women who were randomly assigned into two groups of H. perforatum and control and followed them for 12 weeks. According to their results, after 12

Conclusion

Treatment with H. perforatum is an efficient way for reducing the frequency and severity of hot flashes, menopausal symptoms, as well as depression in postmenopausal women. Using this herb in postmenopausal women is recommended.

Funding

All expenses of this research work were provided by Ahvaz Jundishapur University of Medical Sciences.

Declaration of interest

None

Authors’ contribution

AE, SN, SA and PA were involving in design and conception of the study. AE was responsible for data gathering. SN, AE, SA and PA were responsible for data analyzing and interpretation. SA and PA were involving in writing of paper. All authors are in agreement with the content of the manuscript.

Acknowledgements

This work was extracted from the master thesis of (AE). We would like to thank all women who participated in this study. The sponsor did not have any role in study design, data collection, analysis and interpretation, as well as writing and submitting of manuscript. We also would like to thank Dr. Maniati to editing this paper.

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      A randomized controlled study of 80 Iran postmenopausal 45-60-year-old women treated with Hypericum perforatum L. showed significant reduction in frequency and intensity of hot flashes and Kupperman score scale, with marked decreased depression intensity in the H. perforatum group. Hypericum perforatum L. treatment is an efficient way to reduce hot flashes, menopausal symptoms and depression in postmenopausal women (Eatemadnia et al., 2019). H. perforatum monotherapy for mild and moderate depression has been reported to be superior to placebo in improving depressive symptoms and not significantly different from antidepressant medication.

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