Research Database -
International Updates

Women's Health

Issue 52

LABRECQUE and colleagues, Department of Family Medicine and Social and Preventive Medicine, Laval University, Ottawa, Ontario, Canada evaluated the effect of perineal massaged performed during pregnancy upon perineal symptoms 3 months following delivery.
Methods: A total of 949 pregnant women from five hospitals in the Province of Quebec, Canada participated in this single-blind, randomized controlled trial. All participants were provided oral and written information regarding the prevention of perineal trauma. Women in the experimental group were taught the perineal massage technique and asked to perform a 10-minute perineal massage daily from the 34th through 35th weeks of pregnancy until delivery. Participants completed a self-administered questionnaire regarding perineal pain, dyspareunia, sexual satisfaction and incontinence of urine, flatus, and stool at time of enrollment and 3 months following delivery.
Results: In participants without a previous vaginal birth there were no differences between the massage (n = 283) and the control (n = 289) groups regarding perineal pain, dyspareunia, sexual satisfaction, and incontinence of urine, gas or stool 3 months post partum. In women with a previous vaginal birth, more women in the massage group (n = 187) than the control group (n = 190) were free of perineal pain (93.6% vs. 85.8%); however the frequencies of dyspareunia and incontinence of urine, gas or stool were similar between the 2 groups.
Conclusions: Perineal massage during pregnancy neither impairs nor substantially protects perineal function at 3 months post partum.
Lbrecque M et al. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. American Journal of Obstetrics and Gynecology 182(1 Pt 1): 76-80. Jan 2000.

ALLAIRE and colleagues, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill USA allaire@med.unc.edu conducted a survey to determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina.
Methods: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information regarding their recommendations for the use of complementary and alternative medicine for their pregnant or postpartum patients.
Results: Of the 82 responses received (68.3%), 77 (93.9%) reported recommending complementary and alternative medicine to their pregnant patients during the past year. 47 (57.3%) reported recommending complementary and alternative medicine to more than 10% of their patients. The percentage of nurse-midwives recommending each type of complementary and alternative medicine was as follows: herbal medicine (73.2%); massage therapy (67.1%); chiropractic (57.3%); acupressure (52.4%); mid-body therapies (48.8%); aromatherapy (32.9%); homoeopathy (30.5%); spiritual healing (23.2%); acupuncture (19.5%) and bioelectric or magnet therapy (14.6%). The indications for which the 60 respondents prescribed herbal therapies were: nausea and vomiting, labour stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labour, postpartum haemorrhage, labour analgesia and malpresentation.
Conclusions: Complementary and alternative medicine, particularly herbal medicine, is frequently prescribed to pregnant women by nurse-midwives in North Carolina.
Allaire AD et al. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives Obstetrics and Gynecology 95(1): 19-23. Jan 2000.

KEENAN, Potomac Massage Training Institute USA, reviews (40 references) the most recent literature regarding touch support and one-to-one support during labour and childbirth. The author presents the positive and negative aspects of the traditional birth attendant, examine research about one-to-one care and touch support during labour with respect to husband/partner, nurses, nurse-midwives and doulas (trained labour attendants).
Results: According to recent studies, women supported by doulas or midwives benefit by experiencing shorter labours and lower rates of epidural anaesthesia and caesarean section deliveries. Additionally, a smaller percentage of their newborns experience foetal distress and/or are admitted to neonatal intensive care units. Women whose husbands or partners massage them during labour experience shorter labours. Nursing one-to-one support resulted in no significant obstetric outcomes. Antenatal perineal massage reduced the rate of tears, caesarean section and instrumental deliveries; however, perineal massage during labour has not shown any benefit.
Keenan P. Benefits of massage therapy and use of a doula during labor and childbirth. Alternative Therapies in Health and Medicine 6(1): 66-74. Jan 2000.

Issue 44

FIELD and colleagues, Touch Research Institute, University of Miami School of Medicine, Florida USA compared massage and relaxation therapy for pregnant women.
Methods: 26 pregnant women were assigned either to a massage therapy or relaxation therapy group for 5 weeks. Therapy consisted of 20-minute sessions twice weekly.
Results: Both groups reported feeling less anxious following the first session and less leg pain following the first and last sessions. Only the massage therapy group, however, reported reduced anxiety, improved mood, better sleep and less back pain at the last day of the study. Also, urinary stress hormone levels (norepinephrine) decreased in the massage therapy group, those women had fewer complications during labour and their infants had fewer postnatal complications (i.e., less prematurity).
Field T et al. Pregnant women benefit from massage therapy. Journal of Psychosomatic Obstetrics and Gynaecology. 20(1): 31-8. Mar 1999.

Issue 43

HOCHSTRASSER and MATTMANN, (No affiliation provided) investigated 2 fundamental questions, the first regarding the usefulness and adequacy of the questionnaires and case report forms available in mainstream clinical research when attempting to evaluate 2 dissimilar therapeutic systems such as mainstream medicine and homoeopathy. The second question concerned the comparability of the 2 populations of patients in terms of individual personality characteristics, as well as regarding the progress of the pregnancies and the course of the deliveries under the 2 systems of care and control.
Results: A study of this kind is feasible in principle, but is very demanding and time consuming. In addition the study clearly showed that the instruments presently available in mainstream medicine do not cover essential aspects of homoeopathy and therefore, impede a comparison of the 2 therapeutic systems. In the homoeopathic group, the frequency of situations requiring a Caesarean was remarkably low; however, the number of cases was too small to draw qualifying conclusions.
Hochstrasser B and Mattmann P. Mainstream medicine versus complementary medicine (homeopathic) intervention: a critical methodology study of care in pregnancy. Forschende Komplementarmedizin 6(1): 20-2 Feb 1999.

HOCHSTRASSER (No affiliation provided) conducted a study which investigated pregnant women cared for and treated by physicians specialised in homoeopathy with pregnant women cared for and treated by mainstream gynaecologists.
Methods: 120 pregnant women treated by homoeopathic physicians and 85 pregnant women treated by mainstream gynaecological physicians participated in this study. Quality of life was assessed twice during pregnancy and once shortly following delivery, using SEIQoL (Schedule for the Evaluation of Individualised Quality of Life). This study also registered individual personality characteristics, the psychological situation, attitude towards the forthcoming delivery and functional state prior to and following delivery.
Results: Women from the homoeopathic group judged their quality of life lower than the women from the mainstream group, although their criteria for medical decisions and for the assessment of their own personal situation differed as well. There was some correlation between quality of life and age, number of deliveries, partnership and certain personality characteristics.
Conclusions: This study demonstrated the importance of paying more attention to the subjective world of the pregnant woman. This applies particularly in an analysis of 2 dissimilar therapeutic systems. SEIQoL was a useful instrument for such a study. The 2 populations investigated turned out to be different.
Hochstrasser B. Quality of life of pregnant women in homeopathic or mainstream medical type of care and the course of the pregnancy. Forschende Komplementarmedizin. 6(1): 23-5 Feb 1999.

MURPHY and colleagues, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322 USA review (81 References) the mechanisms of endometriosis.
Background: The authors write that oxidatively damaged red blood cells (RBCs), apoptotic endometrial cells or undigested endometrial tissue may signal the recruitment and activation of mononuclear phagocytes. Women with endometriosis may respond to this stimulus with an inadequate macrophage scavenger receptor response, although the secretory response is not impaired. Activated macrophages in the peritoneal cavity generate an oxidative stress, consisting of lipid peroxides, their degradation products and products formed from interaction with low-density lipoprotein (LDL) apoprotein and other proteins. Lipoproteins of the peritoneal fluid (interstitial fluid) have been shown to have lower vitamin E levels and to be more readily oxidised than plasma. Hence, peritoneal fluid may contribute to the disease process actively rather than passively as a carrier of mediators of inflammation and growth. In response to such stress, a sterile, inflammatory reaction with the secretion of growth factors, cytokines and chemokines is generated, which is detrimental, particularly to successful reproduction.
Hypothesis: The authors propose that a pro-oxidant environment (peritoneal fluid and activated macrophages) promotes growth of ectopic endometrium.
Results: The authors note that the data presented in this review merely begin to explore the role of oxidative stress in mediating the pathophysiology of endometriosis. They note that only by understanding the mechanisms involved in the pathogenesis of endometriosis can the basis for new diagnostic and therapeutic approaches be developed.
Murpy AA et al. Endometriosis: a disease of oxidative stress? Seminars in Reproductive Endocrinology. 16(4): 263-73. 1998.

Issue 42

BEAL, Yale University School of Nursing, New Haven, CT 06536-0740 USA reviews (57 references) the use of complementary and alternative therapies by women health care consumers, particularly regarding women’s reproductive health in the United States.
Results: Women use conventional health care services more frequently than men and account for about two thirds of health care appointments for complementary and alternative therapies.
Conclusions: The author presents the traditional conceptual frameworks of herbal medicine, homoeopathy, acupuncture and acupressure and discusses common clinical applications in women’s reproductive healthcare.
Beal MW Women’s use of complementary and alternative therapies in reproductive health care. J Nurse Midwifery 43(3): 224-34 May-Jun 1998.

Issue 40

DE-LEO and colleagues, Istituto di Ginecologic e Ostetricia, Universita degli Studi-Siena tested a plant herbal product for the treatment of menopausal symptoms.
Methods: Symptoms of the menopause include hot flushes, insomnia, nocturnal sweating, dizziness, headaches and palpitations, which reflect the body’s adaptation to oestrogen fluctuations which affects various central neurotransmitters. The plant product was based upon extracts of Salvia officinalis (sage) and Medicago sativa (alfalfa) leaves. The authors tested the efficacy in the treatment of hot flushes in 30 menopausal women with symptoms.
Results: In 20 women, hot flushes and night sweats completely disappeared, 4 women showed good improvement, the remaining 6 showed a reduction in symptoms. Gonadotropin releasing hormone (GnRH) and thyrotropin releasing hormone (TRH) tests were performed in 8 women in order to evaluate thyroid stimulating hormone (TSH) and prolactin (PRL) responses prior to and following 3 months of therapy. There was a significant increase in PRL and TSH response to TRH; basal levels of oestradiol, luteinising hormone (LH), follicle stimulating hormone (FSH), PRL and TSH were unchanged.
Conclusions: This plant product appears to exert a central slight antidopaminergic action without side effects and is an effective agent in the treatment of menopausal symptoms.
De-Leo V et al. Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent. Minerva Ginecol 50(5): 207-11. May 1998.

SEIDL and STEWART, Toronto Hospital, Canada review the scientific literature (115 references) regarding common alternative remedies for the treatment of menopausal symptoms.
Methods: The authors searched MEDLINE, CINAHL and HEALTH databases from 1966-mid-’97 for English language published articles. More than 200 references were reviewed and 85 were selected for citation based upon specific references to alternative medicine for menopausal symptoms, such as hot flushes, effects of changing oestrogen levels, such as irregular menses, vaginal dryness and to reported side effects of the treatments.
Results: The scientific literature was classified under the headings of nutritional supplements, herbal remedies, homoeopathic remedies and physical approaches. The authors discovered scientific evidence regarding the safety and efficacy of alternative treatments for the menopause. The strongest evidence emerged in favour of phytoestrogens, which are in high concentrations as isoflavones in soy products.
Conclusions: In the available controlled studies, the strongest data support phytoestrogens for their role in diminishing menopausal symptoms related to oestrogen deficiency and for their possible protective effects upon bones and the cardiovascular system. Required are randomised controlled trials, dosage standardisation and accurate safety and efficacy labelling, which will help to ensure proper use of alternative remedies.
Seidl MM and Stewart DE Alternative treatments for menopausal symptoms. Systematic review of scientific and lay literature. Can Fam Physician 44: 1299-309 June 1998.

Comments: Let’s hope that phytoestrogens, rather than HRT, becomes the future treatment of choice for menopausal symptoms. Somehow I suspect that soy will lose out in the battle with the pharmaceutical industry.

Issue 39

ROBERTSON and colleagues, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Medical Center USA investigated whether water baths during labour are associated with development of chorioamnionitis or endometritis.
Methods: 110 women with chorioamnionitis or endometritis and 97 controls were identified from the University of California at San Francisco perinatal database. The authors reviewed the medical records and interviewed patients regarding membrane rupture, history of bathing during labour and relaxation and pain relief for patients who experienced water bathing during labour.
Results: There was no statistically significant association between water baths during labour and occurrence of chorioamnionitis or endometritis (odds ratio (OR) = 0.93).
Conclusions: Water baths during labour are not associated with chorioamnionitis or endometritis.
Robertson PA et al. Is there an association between water baths during labor and the development of chorioamnionitis or endometritis? Am J Obstet Gynecol 178(6): 1215-21 June 1998.

CUMMINGS, Homoeopathic Midwifery Service, Stillorgan, Co. Dublin, Republic of Ireland has published a brief introduction to the principles of homoeopathy and to how homoeopathy can be prescribed safely and effectively for women during pregnancy and birth.
Conclusions: Women may choose to self-prescribe for minor ailments or to seek a practitioner's advice while remaining in control of their health-care decisions. The author provides case studies illustrating women achieving empowerment via homoeopathy and birth through having greater choice and using self-corrective abilities and through relieving distress. Furthermore, midwives learn from mothers; in fact, the increased interest in homoeopathy amongst midwives is due to mothers preferring to avoid chemical or mechanical intervention in birth. Midwives realise that to realistically support the empowerment of women to give birth naturally, mothers require a non-toxic therapeutic approach to relief of distress.
Cummings B. Empowering women: homoeopathy in midwifery practice. Complement Ther Nurs Midwifery 4(1): 13-6 Feb 1998.

MATHIAS and colleagues, Woman's Hospital of Texas, Houston 77054 USA investigated the neuromuscular activity of the gastrointestinal tract in women with endometriosis to assess the effects of diet and drug therapy upon symptoms and to assess the bacterial overgrowth commonly associated with these nerve diseases.
Methods: 50 women with endometriosis documented by laparoscopy and gastrointestinal (GI) tract symptoms characterised by chronic abdominal pain, nausea, vomiting, early satiety, bloating and distension and altered bowel habits participated in this prospective study, which took place in a clinical centre for women's health. Motility of the GI tract was recorded and bacterial overgrowth assessed. Treatment included dietary changes, such as reduction of glycaemic carbohydrates, balancing with omega 9 oils, the elimination of caffeine and tyramine-containing foods, the addition of omega-3 fatty acids and drug therapy with clonazepam (0.25 mg 3 times per day).
Results: All 50 women demonstrated a characteristic motility change. 40 of the women showed bacterial overgrowth. There was a significant reduction in the total symptoms score following 8 weeks of treatment.
Conclusions: The results of the study suggest that endometriosis and GI tract symptoms are a result of the dysfunction of hollow organs. The correction of the biochemical imbalance of the eicosanoid system and the hypersecretion of insulin resulting from excessive intake of glycaemic carbohydrates and lack of essential fatty acids significantly decreased symptoms in patients with endometriosis and associated neuromuscular disease of the GI tract.
Mathias JR et al. Relation of endometriosis and neuromuscular disease of the gastrointestinal tract: new insights. Fertil Steril 70(1|): 81-8 Jul 1998.

VEAL reviews (20 references) a variety of complementary treatments for infertility. The author writes that complementary therapists operate under a more holistic view of infertility treatment than their allopathic health professional colleagues.
Results: Lifestyle and nutritional factors need to be considered and potentially changed, and psychological and emotional problems, including stress, treated. Hormonal imbalances in both sexes may be treated with Chinese herbal mixtures such as Hachimijiogan, herbs including Vitex agnus-castus, or blends of essential oils for the treatment of amenorrhoea or irregular or scanty periods.
Conclusions: Herbalists, traditional Chinese medicine practitioners, aromatherapists, homoeopaths and Ayurvedic practitioners all have a range of treatments for people suffering from infertility.
Veal L. Complementary therapy and infertility: an Icelandic perspective. Complement Ther Nurs Midwifery 4(1): 3-6 Feb 1998.

Issue 38

FLYNN and colleagues, University of British Columbia's (UBC) Department of Family Practice, Canada conducted a review of the literature in order to learn which factors influencing perineal integrity could be modified by physicians and pregnant women.
Methods:The medical, nursing and midwifery literature were searched primarily for randomised controlled trials. Articles selected included perineal trauma pattern, sexual dysfunction or satisfaction, urinary incontinence and pelvic floor function. 80 papers were identified and 16 were analysed in detail.
Results: The 5 factors which affected perineal integrity were: episiotomy; third-trimester perineal massage; mother's position in second-stage labour, method of pushing; and administration of epidural analgesia. Episiotomy did not improve perineal outcomes when used routinely. Third-trimester perineal massage was discussed only in inadequate studies and studies comparing position in birth chairs and recumbent versus upright positions were inadequate for making firm recommendations. Studies of methods of pushing and the use of epidural analgesia were limited and uncontrolled, therefore no recommendations were possible.
Conclusions: From this review, only limiting episiotomy can be strongly recommended, and in the absence of strong data to the contrary, women ought to be encouraged to engage in perineal massage if they wish to and to adopt the birth position of their choice. Caretakers need to be aware of the possibility of interfering with placental function when women hold their breath for a long time when pushing.
Flynn P et al. How can second-stage management prevent perineal trauma? Critical review. Can Fam Physician. 43(1): 73-84 Jan 1997.

SINGH and colleagues, Complementary Medicine Program, University of Maryland School of Medicine, Baltimore USA write that 30%-80% of women are believed to be affected by premenstrual syndrome (PMS). The authors studied to provide information regarding the incidence of PMS and therapies used by American women.
Methods: Conducted in 1996, a national probability sample (n = 1052) of US women aged 21-64 years was surveyed by telephone using random digit dial methodology. The survey included demographic data, respondent knowledge of PMS, the incidence rates of common symptoms and remedies being used to control symptoms.
Results: 41% of the women indicated that they suffered from PMS, and an additional 17% indicated that they experienced symptoms prior to their menstrual cycle commonly associated with PMS, including pain, bloating, feeling more emotional, weight gain, food cravings, although they didn't associate these symptoms explicitly with PMS. The most frequently cited severe symptom was that of "feeling more emotional". Of those women reporting PMS symptoms, about 42% took either prescription or over-the counter medications for relief of their symptoms. 80% of women taking any kind of medication relied upon over-the-counter medications. Prescription drugs used for PMS symptoms were mainly medications for pain relief, with hormone supplements the second most frequently prescribed drugs. Less than 3% of respondents used prescription medications. Of complementary therapies used for relief of symptoms, exercise was the most frequently used (18%) and acupuncture the least used. A small percentage of women used complementary therapies and for most of these therapies there was a near-perfect concordance found between usage and belief in efficacy.
Conclusions: Women were more frequently aware of symptoms related to PMS rather than a recognition of a formalised medical syndrome. Less than half the women reporting symptoms had taken either over-the-counter or prescription drugs. Women who tried complementary therapies generally found them to be effective.
Singh BB et al. Incidence of premenstrual syndrome and remedy usage: a national probability sample study. Altern Ther Health Med 4(3): 75-9 May 1998.

Comments: It is indeed sad that women have to resort to pain killers for PMS, when a substantial body of clinical literature exists detailing the therapeutic value of using dietary modification and herbal products for symptom relief. Readers are initially referred to Valerie Marriott's excellent article Oestrogens and Phytoestogens, published in Issue 34 (October '98) of Positive Health.