J Menopausal Med.  2018 Aug;24(2):92-99. 10.6118/jmm.2018.24.2.92.

A Systematic Review and Meta-analysis on the Effect of Herbal Medicine to Manage Sleep Dysfunction in Peri- and Postmenopause

• Khadivzadeh T
• Abdolahian S
• Ghazanfarpour M
• Kargarfard L
• Dizavandi
• Khorsand I

• KMID: 2419617
• DOI: http://doi.org/10.6118/jmm.2018.24.2.92

Abstract

OBJECTIVES
Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there is a growing interest in the use of herbal medicine. The aim of this systematic review is to assess the effects herbal medicines have on sleep disorders of peri- and postmenopausal women.
METHODS
Three databases were searched including MEDLINE, Scopus, and the Cochrane Library from inception to March 2018.
RESULTS
Six trials assessed the effect of soy on sleep disorders. Forrest plot for 2 studies showed that the standardized mean difference (SMD) of the sleep problems was lower in the soy group than the placebo group (SMD = −0.996; P < 0.001; 95% confidence interval, −1.42 to −0.563). Three trials showed soy had no significant effect on sleep disorders and one study showed a positive effect on sleep disorders. Accordingly, it is difficult to reach a definite conclusion regarding the effects of soy on sleep disorders based on these findings. According to a trial, significant beneficial effect associated with taking Schisandra chinensis. Findings suggested that some herbal medicines like red clover, lavender combined with bitter orange and pin bark extract had attenuating effects on sleep disorders. After intake of 530 mg of valerian twice a day for one month, statistically significant effects were observed regarding the quality of sleep of postmenopausal women.
CONCLUSIONS
The present systematic review and meta-analysis found inadequate evidence to draw conclusions regarding the effectiveness of herbal medications, especially soy.

Keyword

Herbal medicine; Insomnia; Maintenance disorders; Meta-analysis; Sleep disorders

MeSH Terms

Benzodiazepines
Citrus sinensis
Female
Herbal Medicine*
Humans
Lavandula
Postmenopause*
Schisandra
Sleep Initiation and Maintenance Disorders
Sleep Wake Disorders
Trifolium
Valerian
Benzodiazepines

Figure

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  Fig. 1 Process of selecting articles for systematic review.

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  Fig. 2 Effect of soy on sleep disorders among peri- and postmenopausal women. CI: confidence interval, ■: point estimate, ♦: combined overall effect of intervention.

Reference

1. Taavoni S, Ekbatani NN, Haghani H. Postmenopausal women's quality of sleep and its related factors. J Midlife Health. 2015; 6:21–25.

2. Timur S, Sahin NH. Effects of sleep disturbance on the quality of life of Turkish menopausal women: a population-based study. Maturitas. 2009; 64:177–181.

3. Eichling PS, Sahni J. Menopause related sleep disorders. J Clin Sleep Med. 2005; 1:291–300.

4. Ameratunga D, Goldin J, Hickey M. Sleep disturbance in menopause. Intern Med J. 2012; 42:742–747.

5. Freedman RR. Menopause and sleep. Menopause. 2014; 21:534–535.

6. Ghazanfarpour M, Sadeghi R, Roudsari RL. The application of soy isoflavones for subjective symptoms and objective signs of vaginal atrophy in menopause: a systematic review of randomised controlled trials. J Obstet Gynaecol. 2016; 36:160–171.

7. Lipovac M, Chedraui P, Gruenhut C, Gocan A, Kurz C, Neuber B, et al. Effect of red clover isoflavones over skin, appendages, and mucosal status in postmenopausal women. Obstet Gynecol Int. 2011; 2011:949302.

8. Shamshad Begum S, Jayalakshmi HK, Vidyavathi HG, Gopakumar G, Abin I, Balu M, et al. A novel extract of fenugreek husk (FenuSMART) alleviates postmenopausal symptoms and helps to establish the hormonal balance: a randomized, double-blind, placebo-controlled study. Phytother Res. 2016; 30:1775–1784.

9. Balk JL, Whiteside DA, Naus G, DeFerrari E, Roberts JM. A pilot study of the effects of phytoestrogen supplementation on postmenopausal endometrium. J Soc Gynecol Investig. 2002; 9:238–242.

10. Kotsopoulos D, Dalais FS, Liang YL, McGrath BP, Teede HJ. The effects of soy protein containing phytoestrogens on menopausal symptoms in postmenopausal women. Climacteric. 2000; 3:161–167.

11. Liu ZM, Ho SC, Woo J, Chen YM, Wong C. Randomized controlled trial of whole soy and isoflavone daidzein on menopausal symptoms in equol-producing Chinese postmenopausal women. Menopause. 2014; 21:653–660.

12. Davinelli S, Scapagnini G, Marzatico F, Nobile V, Ferrara N, Corbi G. Influence of equol and resveratrol supplementation on health-related quality of life in menopausal women: a randomized, placebo-controlled study. Maturitas. 2017; 96:77–83.

13. Carmignani LO, Pedro AO, Costa-Paiva LH, Pinto-Neto AM. The effect of dietary soy supplementation compared to estrogen and placebo on menopausal symptoms: a randomized controlled trial. Maturitas. 2010; 67:262–269.

14. Hanachi P, Golkho S. Assessment of soy phytoestrogens and exercise on lipid profiles and menopause symptoms in menopausal women. J Biol Sci. 2008; 8:789–793.

15. Kamalifard M, Farshbaf-Khalili A, Namadian M, Ranjbar Y, Herizchi S. Comparison of the effect of lavender and bitter orange on sleep quality in postmenopausal women: a triple-blind, randomized, controlled clinical trial. Women Health. 2017; 1–15.

16. Taavoni S, Ekbatani N, Kashaniyan M, Haghani H. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause. 2011; 18:951–955.

17. Park JY, Kim KH. A randomized, double-blind, placebo-controlled trial of Schisandra chinensis for menopausal symptoms. Climacteric. 2016; 19:574–580.

18. Yang HM, Liao MF, Zhu SY, Liao MN, Rohdewald P. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in perimenopausal women. Acta Obstet Gynecol Scand. 2007; 86:978–985.

19. Taibi DM, Vitiello MV, Barsness S, Elmer GW, Anderson GD, Landis CA. A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia. Sleep Med. 2009; 10:319–328.

20. Leach MJ, Page AT. Herbal medicine for insomnia: a systematic review and meta-analysis. Sleep Med Rev. 2015; 24:1–12.