Milk Thistle

Sedighe Esmaeilzadeh et al. (2025) · Reproductive biology and endocrinology : RB&E

This systematic review and meta-analysis combined 17 randomized controlled trials (15 pooled, 996 women) to ask whether antioxidant supplements ease the pain of endometriosis, a chronic inflammatory condition in which tissue like the uterine lining grows outside the uterus. Oxidative stress (damage from unstable oxygen molecules called free radicals) is thought to feed the inflammation and pain, so antioxidants such as melatonin, vitamins C, D, and E, curcumin (from turmeric), garlic, silymarin (from milk thistle), and resveratrol have been tested. Results across individual trials have been inconsistent, and earlier reviews were narrower, so this one searched seven sources through January 2025 and graded the certainty of the evidence. Included trials enrolled women aged 18 to 49 with confirmed endometriosis, mostly in Iran, plus Egypt, Brazil, the United States, China, and Sweden. Women took an oral antioxidant or a comparator (placebo, standard care, or nothing) for 8 to 24 weeks. The review pooled three pain outcomes using standardized mean differences (a way to combine different pain scales into one measure): painful periods (dysmenorrhea), painful intercourse (dyspareunia), and chronic pelvic pain. Study quality was graded with Cochrane RoB 2, and evidence certainty with GRADE. For painful periods, 12 trials (706 women) showed lower pain with antioxidants (SMD -1.26; 95% CI -2.19 to -0.32, equal to about 3 points on a 0 to 10 scale), but results varied enormously between trials (I² = 90.1%), so the evidence was rated low certainty. Melatonin stood out (SMD -1.89; 95% CI -2.48 to -1.31), while vitamin D, vitamins C plus E, omega-3, resveratrol, and curcumin did not reach significance. Painful intercourse showed no significant effect (SMD -1.01; 95% CI -2.27 to 0.24). Chronic pelvic pain fell in the pooled analysis (SMD -1.07; 95% CI -1.71 to -0.42), but the evidence was very low certainty and the effect vanished when trials with conflicts of interest were removed. Single trials of garlic powder and silymarin reported lower pain, whereas curcumin did not. Only 7 of 17 trials had low risk of bias. The authors say the findings do not support routine antioxidant use for endometriosis pain, and describe melatonin as the most promising candidate for painful periods, pending confirmation. Limitations include very high heterogeneity, small trials, different antioxidants and doses, bigger effects in weaker studies, and little control of baseline vitamin levels or diet. The paper did not report adverse events. The garlic and silymarin findings come from single trials, and publication-bias testing found no small-study effects for chronic pelvic pain. The authors call for larger, standardized trials.

Monira Alwhaibi et al. (2017) · Evidence-based complementary and alternative medicine : eCAM

This cross-sectional survey of 178 mothers of young children in the Central Appalachian Region of the United States explored how many use herbal remedies and which factors are linked to that use. Herbal remedies are plant-based products taken for health purposes, and they are the most common form of complementary and alternative medicine (CAM, health approaches used alongside or instead of conventional care) among American adults. The authors framed the work with the Comprehensive Model of Information Seeking, which holds that a person's background, past experiences, mood and beliefs shape where information is sought and, in turn, whether action follows, here the use of herbal remedies. The participants were women aged 18 or older with at least one child under three years of age, living in Central Appalachia and mostly in West Virginia, with a mean age of 31.3 years. They were recruited through social media groups, listserv emails, daycares and physician's offices, and completed an online survey. One item asked whether any herbal remedy had been used in the past six months, with follow-ups on which remedy and which condition. Two new five-point scales captured how often six information sources were used and how strongly herbal remedies were believed to be safe and effective. One-third of the women (33.5%) reported using herbal remedies in the past six months. Fenugreek was the most widely used remedy (35.1%), followed by honey (8.8%), chamomile (5.3%) and ginger (5.3%). The main reasons were stimulating or increasing breast milk production (38.6%) and treating cold or flu symptoms (26.3%). Women with the highest information seeking scores had 3.61 times the odds of using herbal remedies compared with those with the lowest (95% CI 1.433-9.77), meaning that more active information seeking went with more use. Women with the highest belief in herbal safety and efficacy had 4.02 times the odds (95% CI 1.468-9.57). Part-time or unemployed women had 2.98 times the odds of full-time employed women (95% CI 1.05-8.47), while education, income and Appalachian identity showed no association. The internet was the most frequently used information source (mean 3.2 out of 5). The authors conclude that herbal remedy use is common in this region and propose that public health efforts and communication from health care providers could raise awareness of the safety and efficacy of herbal remedies. The survey recorded use and beliefs only; it did not test whether any remedy worked, and safety was not assessed. Limitations include a sample drawn mostly from West Virginia, self-selection in an internet-based survey, self-reported answers open to recall bias, and no data on whether use was regular or occasional. The authors call for further research, including qualitative work, on what health information women seek.

Chote Luangchosiri et al. (2015) · BMC complementary and alternative medicine

This double-blind, placebo-controlled trial with 55 tuberculosis patients in Bangkok, Thailand explored whether silymarin, an extract of milk thistle (Silybum marianum) seeds long sold as a liver-support supplement, could protect the liver during standard four-drug tuberculosis treatment. Anti-tuberculosis drugs commonly injure the liver, a complication called drug-induced liver injury (governing whether treatment must be paused or adjusted), with past studies reporting it in up to nearly 28% of patients. Silymarin's traditional reputation rests on antioxidant activity, meaning it governs the body's ability to neutralize cell-damaging molecules called free radicals that these drugs generate in liver tissue. Over four weeks, participants took either a 140 mg silymarin tablet or an identical placebo three times daily alongside their standard tuberculosis medications (27 people got silymarin, 28 got placebo). Researchers tracked liver enzymes and antioxidant markers in blood tests at the study's start, two weeks, and four weeks in, and recorded any liver injury meeting a pre-set clinical definition. The trial planned to enroll 70 to 80 patients but stopped at 55 due to slow recruitment during the one-year study window. Liver injury developed in just 3.7% of the silymarin group (1 of 27 patients) compared to 32.1% of the placebo group (9 of 28), a statistically significant difference (p=.012) meaning silymarin lowered the risk by about 28 percentage points; put another way, treating about four patients with silymarin prevented one case of liver injury. Interestingly, the single peak liver-enzyme reading (ALT) at four weeks was not significantly different between groups (p=.455), so silymarin's benefit shows up in how many people develop liver injury, not necessarily in the single highest enzyme reading. An antioxidant enzyme called superoxide dismutase held up better in the silymarin group (p=.027), supporting the idea that silymarin works by boosting the body's own antioxidant defenses. Mild side effects like nausea and dizziness were equally uncommon in both groups, and no one had a serious reaction. These results suggest a low-cost silymarin tablet taken alongside standard tuberculosis treatment can meaningfully cut the chance of drug-induced liver injury, likely by protecting the liver's antioxidant capacity. The main limitation is that the study fell short of its planned enrollment (55 of 70-80 patients) at a single hospital, so despite properly randomized, double-blind design, the finding needs confirmation in larger, multi-center trials before silymarin becomes a routine addition to tuberculosis care.