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Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review.

  • 2020-07
  • Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia 42(07)
    • Ana Luiza Cabrera Martimbianco
    • Rafael Leite Pacheco
    • Rafael Leite Pacheco
    • Fábia Lima Vilarino
    • Carolina de Oliveira Cruz Latorraca
    • Maria Regina Torloni
    • Rachel Riera

Study Design

Type
Systematic Review
Sample size
n = 279
Population
5 RCTs (n = 279 participants) with FSD (premenopausal and postmenopausal women)
Methods
Systematic review of RCTs comparing T. terrestris versus inactive/active interventions; data extraction by two reviewers; risk of bias assessed by Cochrane RoB tool; certainty of evidence assessed with GRADE

Objective

 We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD).

Data sources

 We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov and OpenGrey databases.

Selection of studies

 We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included.

Data collection

 Data extraction was performed by two reviewers with a preestablished data collection formulary.

Data synthesis

 Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results

 After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, which means that we have very little confidence in the effect estimates, and future studies are likely to change these estimates.

Conclusion

 More RCTs are needed to support or refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process.Number of Protocol registration in PROSPERO database: CRD42019121130.

Research Insights

  • Tribulus→Improved Sexual Function

    After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores.

    Effect
    Beneficial
    Effect size
    Small
  • Tribulus→Increased Testosterone Level

    Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women.

    Effect
    Beneficial
    Effect size
    Small

Adverse Events Reported

  • Tribulus→Overall tolerability

    There was no report of serious adverse events

    Finding
    Reported
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