Prescription profile of Chinese herbal products containing coumestrol, genestein, and/or daidzein among female users: an analysis of national health insurance data in Taiwan between 1997 and 2007

The study analyzed women who had been prescribed phytoestrogenic herbs including coumestrol, genistein and/or daidzein between 1997 and 2007 in a fixed cohort taken from all female beneficiaries from the National Health Insurance Research Database of Taiwan. The prescription frequencies, cumulated dosages, and primary indications were listed.A total of 462,861 women were included in the study, of whom ~47.0% had used phytoestrogenic herbs at least once during the study period. A total of 6,270,813 prescriptions were recorded, and more than 20% of these contained phytoestrogens. The most commonly prescribed herb and formula were Puerariae Radix and Ge gen tang (Pueraria Decoction), respectively. Most of the prescriptions were issued for diseases of the respiratory system, followed by symptoms, signs, and ill-defined conditions and diseases of the musculoskeletal system and connective tissue.This study shows that women who sought medical treatment from Chinese medicine doctors for relief of respiratory discomfort had a high possibility of exposure to phytoestrogenic herbs. Safety issues related to the female endocrine system should be a priority for future research.Phytoestrogens may interact with the estrogen receptors that mediate endocrine homeostasis, causing damage to reproductive health, especially at developing life stages [1-3]. Although the phytoestrogenic activities are weaker than those of human endogenous estrogens, the consumption of phytoestrogens may have clinically significant consequences [4]. Coumestrol, genistein and daidzein are strong phytoestrogens that are found in many foods and Chinese medicine (CM) product [5-7]. There is a concern among CM doctors and CM users about inconclusive safety results from various in vitro and in vivo models in estrogenic studies, especially for patients taking Chinese herbal products (CHPs) containing coumestrol, genistein, and/or daidzein (CGD-CHPs).CM has been an important part of healthcare in Taiwan for hundred