Efficacy of Tokishakuyakusan add‐on therapy with low‐dose oral contraceptive pills on endometriosis patients with dysmenorrhea

Aim Tokishakuyakusan (TSS) is representative of popular Kampo medicines for Japanese women to treat dysmenorrhea, irregular menstruation and menopause. Current hormonal treatments and low‐dose oral contraceptives (OCs) used as a first‐choice drug for primary symptoms, however, have a high incidence of adverse events without improving patients' satisfaction. We evaluated the efficacy of TSS as additional treatment on the quality of life (QOL) of patients taking OCs with reduced therapeutic satisfaction. Methods Twelve patients treated with OCs for endometriosis were enrolled. TSS (7.5 g/day) in combination with OCs were given for three menstrual cycles. The main outcome was the degree of QOL assessed using the Endometriosis Health Profile‐30 (EHP‐30). Secondary outcomes were the Menstrual Distress Questionnaire (MDQ), patient's satisfaction using a Likert scale and cold feeling‐visual analogue scale (VAS). Results In EHP‐30, significant changes by TSS with OCs in each menstrual cycle were not found, although the scores for pain and emotional well‐being tended to decrease. In MDQ, water retention in the premenstrual phase was improved. With regard to cold feeling‐VAS, 61.6 mm at pretreatment decreased to 31.3 mm at the endpoint. Average Likert scale values after TSS treatment declined from 4.3 to 2.6. Cold feeling and patient's satisfaction have improved. Conclusion Although the influence of TSS add‐on therapy on QOL was moderate, possible improvement of cold feeling and menstruation‐related symptoms was suggested.