Guizhi Fuling Wan for uterine fibroids: A systematic review of in vivo studies

Abstract

Ethnopharmacological relevance: The therapeutic effects of Guizhi Fuling Wan (GFW) on uterine fibroids have been tested on various animal models, but to date, the findings of these studies have not been comprehensively synthesised. This study aimed to evaluate the preclinical effects of GFW on uterine fibroids in different animal models.

Materials and methods: Twenty databases were searched from their earliest recorded publications to March 2019 to identify in vivo studies of non-modified GFW compared with no treatment for animal models with uterine fibroids. The methodological quality was assessed using the ARRIVE guidelines. Two groups of outcome measures were evaluated: fibroid characteristics (uterine weight, coefficient or smooth muscle thickness) and sex hormones indexes (oestradiol, progesterone or the gene expression of their receptors).

Results: A total of 21 studies (22 experiments) involving 461 female animals met the eligibility criteria. The quality of the included studies scored at 14.24 ± 1.00 out of 20. Four animal species were used and induced by oestrogen or oestrogen combined with progesterone, including guinea pig (n = 20), rats (n = 385, SD and Wister) and mice (n = 56). Overall, the available evidence suggests that GFW has potentially beneficial effects over placebo on both fibroid characteristics and sex hormones in SD rats (except progesterone), Wister rats (except progesterone receptor [PR] gene expression) and ICR mice (except PR gene expression). GFW appears to reduce uterine weight and smooth muscle thickness in the guinea pig, but no data on sex hormone index was available.

Conclusion: Noting the unevenly distributed covariates of animal model types, experimental evidence suggested that GFW may be a promising intervention for the management of uterine fibroids in animal models. Future natural product studies should be optimised by reporting the voucher specimen. More studies on composition and providing evidence of the involvement of relevant cell signalling pathways are required.

Keywords: Experimental study; Gynaecology; Herbal medicine; Natural product; Translational medicine; Women's health.