Full Length Research Paper
ABSTRACT
A survey was conducted in the central region of Burkina Faso to find out about women's menopause-related disorders and their treatment in traditional medicine. Fifty-six (56) species have been identified to treat different symptoms such as hot flashes, insomnia, nausea, joint and muscle pain, itching, lower abdominal pain, edema, mood disorders, vertigo. Leaves and stem bark were the most recommended in the preparation of recipes, at 43 and 39% respectively. The majority of the species (60.72%) was local food plants with a high use value (UVs ≥ 0.50). Many chemical groups including alkaloids, polyphenols, flavonoids, saponins, tannins, sterols, triterpenes, anthraquinones, carotenoids, anthracenosides, phenolic acids, coumarins, capable of reducing or eliminating these different symptoms exist in these plants. Also, the presence of several mineral elements such as Calcium (Ca), Magnesium (Mg), Phosphorus (P), Sodium (Na), Aluminum (Al), Iron (Fe), Potassium (K), Iodine (I), Vitamins A, B, C, F, K, P, E, proteins, lipids, carbohydrates, fibers, resins and gum show the importance of these plants in human nutrition. These local plants are therefore potential sources for the development of new natural nutraceuticals in the management of menopausal period in women.
Key words: Menopause, medicinal plants, nutrients, phytoestrogens.
INTRODUCTION
Menopause or stopping menstruation, refers to the period that occurs when the ovaries stop producing reproductive hormones. It is a natural phenomenon that usually starts around age of 50 in women (Lopes and Tremollieres, 2004). It is preceded by a period of pre-menopause which causes disturbances related to imbalances in the reproduction of natural hormones. Indeed, at first, the woman's body faces a fall of progesterone and hyper impregnation in estrogen, which can create a kind of permanent premenstrual syndrome with water retention (edema), weight gain, tense breasts, headaches, and mood disorders (irritability, aggressiveness), then in a second time, a few months or a few years later, it is estrogen deficiency that prevails with hot flashes, tiredness, genitourinary disorders, joint pain, vaginal dryness before the definitive installation of menopause (Sidibe, 2005; Löwy and Gaudillière, 2006). Menopause affects an increasing number of women around the world and is a public health problem. A follow-up of woman is necessary during this period in order to avoid complications and the occurrence of other diseases such as cardiovascular diseases, diabetes, joint and metabolic diseases (Tillier, 2005). Modern medical care is based on hormonal menopause treatments (THM) that eliminate certain symptoms (Ribot and Tremollieres, 2007). However, the use of these hormones to replace those naturally secreted by the ovaries often causes potentially serious side effects such as breast cancer, osteoporosis, heart disease including heart attacks and strokes, which are currently the leading cause of death in the world (Fournier et al., 2003; Azoulay, 2004). While the effects of menopause on women's bodies are well known in developed countries, the situation is opposite in Africa, especially in sub-Saharan Africa where management of the menopause period is almost non-existent (Cisse et al., 2008). Thus, very few African women can benefit from hormonal menopause treatments due to the unavailability and cost of these modern products. This would partly explain women's low attendance in health centers for menopause-related issues (Lombrail, 2000). Also, cultural attachment to the effectiveness of plant-based recipes means that at least 80% of rural populations living in developing countries depend on traditional medicine for their health care needs (OMS, 2013). Previous scientific works have shown that isoflavones present in some plants and recognized as phytoestrogens, are able to reduce the frequency of hot flashes and bone resorption (Lecerf, 2007). Also, some estrogens in plants are nervous sedatives against anxiety, insomnia and menopausal disorders (Nogaret, 2011). In addition, as a result of WHO's policy of promoting traditional medicine, plant medicines now occupy a considerable place in the international pharmaceutical trade (OMS, 2013). The current trend is thus converging towards health food. Indeed, many studies have proved the efficiency of nutraceuticals which are defined as foods whose specific properties go beyond the simple nutritive effect associated with the nutrients they contain (Bouyahya, 2016; Tchatchambe et al., 2017). For example, studies have shown that women with traditional soy-based diet, suffer less from the effects of menopause (Vergne and Sauvant, 2006). There are several other medicinal and nutritional plants containing many active ingredients and which have complementary or synergistic therapeutic activities capable of relieving the menopausal disorders. However, this category of plants is very little known. It is therefore urgent to explore local plants in order to develop improved traditional medicines, nutraceuticals or isolate new bioactive molecules with fewer side effects for the management of menopausal period in women.
The objective of this study was to provide scientific documentation on the plants used by women in Burkina Faso to treat menopausal disorders.
MATERIALS AND METHODS
Data collection on the treatment of menopausal disorders in traditional medicine
The survey was conducted from February to March 2018 among women in households, at the level of their women's groups or associations in Ouagadougou, Pabre and surrounding villages as well as among some traditional healers identified through networks of traditional healers and on the basis of information provided by local population. Midwives working in maternal and child health centers were also interviewed. The interviews were based on a pre-tested questionnaire (Martin, 1995)which included specific questions about the informant, his age, his level of knowledge about menopause, the treatment of symptoms in modern and/or traditional medicine, the local name of the plant used, the parts used, the right period of collecting the used parts, the mode of use, the approximate duration of treatment before the treated symptom disappears. The interviews were recorded using a dictaphone. A total of 161 people including 54 traditional healers (9 men and 45 women) were interviewed. The age of women was between 41 and 65 years old. Investigators equipped with GPS (GPS map 62 Garmin) with an accuracy of less than 2 m visited and geo-referenced the practice sites of some traditional healers. Photos of plants of interest were taken in Pabre and surrounding villages. Samples of these plants were collected and identified by the Botany team of Ouaga 1 Professor Joseph Ki-Zerbo University. The APG III (2009) classification system was used (Group, 2009)and a herbarium has been made.
Chemical composition of the listed plants
A bibliographic research made it possible to know chemical groups and phytonutrients present in the identified plants.
Data analysis
The importance of each species was determined by calculation of its use value (UVs) according to the simplified formula of Cotton and Wilkie (1996).
U indicate the number of uses where the plant is mentioned and N is the number of informants who mentioned the plant. Data were treated and analyzed with SPSS software version 15. The average utilization values of the main parts of plant were compared using one-way analysis of variance (One Way ANOVA) and the differences are considered statistically significant for a value of "p less than 0.05".
RESULTS
Fifty-six (56) local species used in the treatment of various menopausal symptoms have been identified. The information received concerns the local name of the plant, the disorders treated, the used parts in traditional recipes, the period of availability of the used parts, the method of preparation and the route of administration of recipes in traditional medicine, the edible parts and the mode of preparation of food parts. The mineral elements, vitamins and chemical groups found in each plant by literature are also shown in Table 1.
Results showed that the most common symptoms experienced by women were hot flashes, insomnia, nausea, joint and muscle pain, irregular menstruation, itching, lower abdominal pain, edema, mood disorders, vertigo. Leaves and stem bark were the most commonly used in recipes preparation, at 43% and 39% respectively. Other parts such as roots, fruits, seeds and flowers were rarely used for care. Decoction as method of preparing recipes and oral route as mode of administration were the most recommended. Maceration was indicated when the stem bark is the used part. The majority of the plants (60.72%) used in the treatment of menopause disorders was also local food plants well known including Acacia macrostachya, Adansonia digitata, Balanites aegyptiaca, Bombax costatum, Cassia tora, Cleome gynandra, Corchorus olitorius, Diospyros mespiliformis, Ficus sycomorus, Glycine max, Hibiscus sabdariffa , Manguifera indica, Moringa oleifera, Ocimum gratissimum, Parkia biglobosa, Petroselinum crispum, Psidium guajava, Sclerocarya birrea, Tamarindus indica, Vitellaria paradoxa, Zingiber officinale, Ziziphus mauritiana (Table 1) . They had a high use value (UVs ≥ 0.50). Fruits and leaves were the most consumed parts (41%) by populations. The leaves used in food are usually boiled and filtered and eaten or mixed with flour in the form of couscous. Certain leaves can be eaten as salad. For some recipes, they are dissolved in water and the filtrate is recovered as vinegar for the preparation of certain dishes. The fruits are consumed in their natural state for the most part but can be boiled at certain times. They can also be used as vinegar. The consumption of other parts such as calyx, seeds and rhizomes was specifically recommended for certain plants. Bibliographic data showed the presence of many chemical groups and phytonutrients in these plants including alkaloids, polyphenols, flavonoids, saponins, tannins, steroids, triterpenoids, anthraquinones, carotenoids, anthracenosides, phenolic acids, coumarins as well as numerous mineral elements such as calcium (Ca), magnesium (Mg), phosphorus (P), sodium (Na), aluminum (Al), iron (Fe), potassium (K), vanadium (V), copper (Cu), lead (Pb), manganese (Mn), selenium (Se), chromium (Cr), iodine (I). Vitamins A, B1, B2, B3, C, F, K1, P, E and proteins, lipids, carbohydrates, gum, resin, fibers were also present in these plants.
Figure 1 (1a to 1e.) show some plants used to treat the most common menopausal symptoms encountered by women.
DISCUSSION
Most of the population of Burkina Faso, a landlocked country in West Africa with an area of 274 000 km2, lives in rural communities and relies heavily on local plant products for their daily lives. Fifty-six (56) local plants were identified in the treatment of menopausal disorders with a predominance of woody species (84%) on herbaceous forms (16%). Previous work had also reported the therapeutic importance of woody plants over herbaceous forms (Betti, 2002; Zerbo et al., 2012). The results showed that leaves and stem bark were the most recommended parts at 43% and 39% respectively in traditional recipes to treat several symptoms. Using leaves is to be encouraged because it has a double advantage, firstly because being the site of synthesis of secondary metabolites, leaves contain many chemical groups, but also because the use of leaves prevents the destruction of the plant and preserves its durability (Lumbu et al., 2005; Bi et al., 2008). However, the leaves and fruits of some plants are only available during the rainy season, which explains why traditional healers dry them so they can be used all year long. The disadvantage of this method is that, exposure of leaves and fruits to sun or their decoction causes the loss of certain active ingredients they contain. It is therefore necessary to sensitize traditional healers as well as women to practice the right harvesting methods of drying and preserving some parts of plants or in cooking the traditional vegetables in order to preserve as many phytonutrients as possible.
Previous studies have shown that gynecological and obstetric disorders are among the first three health problems in Burkina Faso (Besancenot et al., 2004; Ramde-Tiendrebeogo et al., 2019). The plants in this study would contribute to the management of certain pathologies in women. Indeed, phytoestrogens and phytosterols present in some plants are recognized for their effectiveness in reducing the frequency of hot flashes which are the most common symptom encountered in women (Vergne and Sauvant, 2006). Plants such as A. macrostachya, A. digitata, Afzelia Africana, Annona senegalensis, B. aegyptiaca, Boswellia papyrifera, C. gynandra, Combretum glutinosum, F. sycomorus, Gueira senegalensis, M. oleifera, O. gratissimum, P. crispum indicated in the treatment of hot flashes (Table 1) constitute a source for new phytoestrogens research. Previous studies have shownthat tannins, flavonoids and flavonols are able to inhibit lipoxygenase L-1 and cyclooxygenase-1, two enzymes involved in the production of inflammation mediators (Allcarz and Jimenez, 1988; Ayo et al., 2013). This could justify the use of certain plants listed which contain them in the treatment of edema, fever or pelvic pain. Also, the astringent and healing properties of tannins (Derbré and Lamassiaude-Peyramaure, 2010)would justify the use of some plants that contain them in the treatment of many skin diseases during menopause. Alkaloids are compounds known for their action on the central nervous system and their calming effect. This could justify the use of certain plants that contain them such as Daniella olivieri, Feretia apodanthera, Leptadenia hastata, P. biglobosa, Sarcocephalus latifoluis, Vitex doniana in the treatment of sleep disorders and anxiety during the menopause period (Table 1) . Many species listed (60.72%) were food plants well known by population with high use values (UVs ≥ 0.50). Indeed, various mineral elements, vitamins, proteins, lipids, carbohydrates, gum, resin, fibers are present in these plants as showedby previous work (Table 1). Women must therefore be made aware of the menopause period in order to encourage them to choose foods – health whose effectiveness has been proven by previous studies. It is also urgent to develop and increase the range of natural nutraceuticals from the local plants of this study for the management of menopausal symptoms in women
CONCLUSION
The objective of this study was to make known the plants used in the treatment of the different symptoms of menopause by women in Burkina Faso. Results showed that local food plants are the most used. This constitutes a scientific database that could help women better manage the menopause period through a healthy and varied diet. These results also constitute a scientific support for the development of new natural nutraceuticals or improved traditional medicines for the treatment of menopausal disorders in women.
CONFLICT OF INTERESTS
The authors have not declared any conflict of interests.
ACKNOWLEDGMENTS
The Ministry of Health is highly appreciated for supporting the project.
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