Exploring the therapeutic role of Chinses herbal medicine in the recurrence rate of uterine fibroids after conservative surgery: a systematic review and meta-analysis.

ETHNOPHARMACOLOGICAL RELEVANCE: Since surgery can only remove lesions of a larger size visible to the naked eye, the recurrence rate of uterine fibroids after surgery is high. In recent years, numerous scholars have found that traditional Chinese medicine (TCM) treatment is effective in reducing the recurrence rate of postoperative fibroids, as well as improving the clinical treatment rate, regulating serum hormone levels, reducing plasma viscosity, and promoting the restoration of uterine volume following surgery. Several randomized controlled trials have been undertaken on the prevention and treatment of postoperative recurrence of uterine fibroids using patented Chinese medicines and self-proposed formulations, such as Guizhi Fuling Pill, Xiaozheng decoction, Xiangleng pill, Zhengjia decoction, Xiaoliu decoction, Guizhi Jiliu pill, Huoxue Huayu formula, Huoxue Xiaozheng decoction, Shugan Sanjie decoction, Gongliuxiao capsule, Hongjin Xiaojie concentrated pill, and Jiawei Guizhi Fuling decoction. However, no study has systematically evaluated Chinese herbal medicine (CHM) in reducing the recurrence rate of uterine fibroids after surgery. AIM OF THE STUDY: This study aimed to conduct a meta-analysis of randomized controlled trials of CHM for the prevention of postoperative recurrence of uterine fibroids, evaluating its efficacy and safety. MATERIALS AND METHODS: A comprehensive search was conducted on PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP Information Database (VIP), WanFang Database, and China Biomedical Database (CBM) to identify randomized controlled clinical studies conducted up to March 2025 that examined the efficacy of CHM in treating patients with postoperative uterine fibroids. Two institutes were independently under-selected, and data were extracted and quality assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were performed using Review Manager software 5.4, and forest plots were generated. The quality of evidence was assessed using GRADEpro 3.2.2. This study was registered in PROSPERO (CRD420251000288). RESULTS: 16 trials were included in this study, and the postoperative recurrence rate after treatment was mainly analyzed. CHM treatment reduces postoperative recurrence rates in patients with uterine fibroids compared to the blank (6 trials, n = 588; OR (odds ratio) = 0.22; 95% CI (95% confidence intervals) = 0.14-0.34; I2 = 0%, p < 0.00001), conventional western medicine (CWM) (1 trial, n = 80; OR = 0.30; 95% CI = 0.09-0.93, p = 0.04), and combined CHM with CWM (9 trials, n = 959; OR = 0.29; 95% CI = 0.19-0.46; I2 = 0%, p < 0.00001). In addition, CHM is also effective in improving clinical efficiency, restoring serum sex hormone levels, lowering plasma viscosity, and reducing uterine volume. CHM is generally considered safe, with a low incidence of adverse reactions. CONCLUSION: CHM is effective in avoiding recurrence of uterine fibroids after surgery, excelling in terms of overall effectiveness, restoring female hormone levels, improving hemorheological indices, and promoting uterine recovery and safety. However, these findings are preliminary and still need to be validated by higher-quality studies.