Evening Primrose Oil

• How It Works

  Evidence for whether evening primrose oil can relieve some types of pain or skin conditions is mixed, and it has not been adequately studied for its effects on cancer.

  Evening primrose oil has been used for a variety of conditions including rheumatoid arthritis, premenstrual syndrome (PMS), menopause symptoms, and eczema. It has also been used for several types of pain, including breast and diabetic nerve pain. Human studies are mixed on whether it can help relieve breast pain, PMS, nerve pain, or skin inflammation. Other studies suggest possible benefits in conditions such as rheumatoid arthritis and multiple sclerosis. More studies are needed to confirm these effects. There are few studies with respect to its effects on cancer.

  Interestingly, although evening primrose oil may decrease hot flash intensity in menopausal women, other data suggest that behavioral or lifestyle changes such as increased exercise provide better relief.

  Evening primrose oil does not have hormonal properties, but some products that contain it may also contain phytoestrogens, which are plant-derived sources of estrogen. Therefore, patients with hormone-sensitive cancers should use evening primrose oil products with caution.

• Purported Uses
  • To treat cancer
    Evening primrose oil has not been studied extensively for cancer. In an older study, evening primrose oil had no effect on tumor size or survival in patients with liver cancer. In breast cancer patients, those who received gamma-linolenic acid (GLA), which is a component of evening primrose oil, in addition to tamoxifen, had faster response to treatment than those who received tamoxifen alone.
  • To treat diabetic neuropathy
    Results from older studies to improve symptoms of diabetic nerve pain were mixed.
  • To treat eczema
    Clinical trials show conflicting results, but some trials show benefit in skin conditions caused by specific drugs to treat acne and myelodysplastic syndrome. However, other large analyses have concluded both evening primrose oil and borage oil are not effective for eczema.
  • To treat gastrointestinal disorders such as colitis or irritable bowel syndrome
    One clinical trial studied the effects of evening primrose oil on ulcerative colitis, showing weak effects. In general, there is little support for this use.
  • To relieve breast pain
    A handful of clinical trials support this use, especially for breast pain associated with the menstrual cycle.
  • To relieve menopausal symptoms
    One study found that evening primrose oil was no better than placebo at relieving menopausal hot flashes. Another suggests it may improve quality of life and decrease hot flash intensity. Other data suggest that behavioral or lifestyle changes such as increased exercise provide better relief.
  • To prevent premenstrual syndrome (PMS)
    Results of clinical trials are inconsistent.
  • To reduce inflammation of rheumatoid arthritis (RA)
    Clinical studies show that evening primrose rose oil may be useful in reducing symptoms of RA.
• Do Not Take If
  • You are pregnant: Side effects have included complications, and skin conditions and bruising in a newborn.
  • You are taking anticoagulants or antiplatelet agents: Evening primrose oil may increase bleeding risk or the effects of these drugs.
  • You are taking blood pressure medications: Even though no interactions have been reported, a large population-based study showed that evening primrose oil can increase blood pressure.
  • You are taking Antiretrovirals: When used concurrently, evening primrose oil significantly increases the levels of antiretroviral drugs, and can increase the risk of adverse effects.
• Side Effects
  • Minor: Abdominal pain, indigestion, nausea, softening of stools, headaches
  • Labor abnormalities: Serious labor problems occurred among women who used evening primrose oil to shorten gestation and labor times.

  Case reports

  Red dots and large bruises on a newborn: The mother used raspberry leaf tea and evening primrose oil 1 week before childbirth.

  Lipoid pneumonia: In a 50-year-old woman following chronic use of evening primrose oil, caused by breathing in fat particles from this supplement into the lungs.

• Special Point

  Evening primrose oil does not have hormonal properties, but some products that contain it may also contain phytoestrogens, which are plant-derived sources of estrogen. Therefore, patients with hormone-sensitive cancers should use evening primrose oil products with caution.

• Scientific Name

  Oenothera biennis

• Clinical Summary

  Derived from the plant Oenothera biennis, evening primrose oil is used for rheumatoid arthritis, premenstrual syndrome, eczema, fatigue, diabetic neuropathy, and mastalgia. The mucilaginous stem and leaf juices have been used as a poultice to treat minor bruises and wounds, and to soothe skin inflammation ⁽²⁵⁾. Evening primrose oil is thought to improve skin moisture and to reduce transepidermal water loss ⁽²⁶⁾. It is also among the popular natural products used to relieve menopausal symptoms ^(27) (28). In vitro, evening primrose oil demonstrates anti-inflammatory activity ⁽²⁹⁾ and inhibits platelet aggregation ^(6) (7). In animal models, it exerts anti-angiogenic, anti-inflammatory, and anti-arthritic effects ⁽³⁰⁾ and improved cardiac recovery after myocardial infarction ⁽³¹⁾.

  Small clinical studies suggest its effectiveness against atopic dermatitis ^{(18) (25) (32)}, but other analyses have concluded that neither evening primrose oil nor borage oil are effective for eczema ^(23) (33). A small study in acne patients treated with oral isotretinoin suggests that evening primrose oil can improve xerotic cheilitis ⁽³⁴⁾, and may be effective against 5-azacitidine-induced skin reactions in patients with myelodysplastic syndrome (MDS) ⁽¹⁹⁾. It was also found useful in preventing weight regain following extensive weight loss ⁽⁵⁾. A meta-analysis suggests it may relieve rheumatoid arthritis symptoms ⁽²¹⁾. Other studies show modest benefit in patients with ulcerative colitis ^(35) (36) or in ocular surface diseases such as dry eye ^(37) (38). Results from previous studies that evaluated possible benefits for diabetic neuropathy patients were equivocal ⁽³⁹⁾. But several studies suggest that co-supplementation with hemp seed and evening primrose oils along with a diet high in total antioxidant capacity may improve clinical and immunological parameters in patients with multiple sclerosis ^{(40) (41) (42)}.

  Additional data indicate that supplementation with vitamin E and evening primrose oil reduced cyclical mastalgia ⁽²⁰⁾, but other analyses did not find improvements in breast pain ^(1) (43) or premenstrual syndrome ⁽²²⁾. Evening primrose oil may improve quality of life and decrease hot flash intensity in menopausal women ⁽⁴⁴⁾, although other data suggest that behavioral/lifestyle approaches such as exercise provide better relief ⁽²⁸⁾. It has not been studied extensively for cancer, but a study involving liver cancer patients showed no effect on tumor size or survival ⁽⁴⁵⁾. Another small study suggested that gamma-linolenic acid (GLA) may be an effective adjunctive therapy for breast cancer ⁽⁴⁾.

  Although evening primrose oil does not have intrinsic estrogenic properties, some commercial products combine evening primrose oil with phytoestrogens. Therefore, patients with hormone-sensitive cancers should use evening primrose oil products with caution.

• Purported Uses
  • Cancer treatment
  • Diabetic neuropathy
  • Eczema
  • Gastrointestinal disorders
  • Mastalgia
  • Menopausal symptoms
  • Premenstrual syndrome
  • Rheumatoid arthritis
• Mechanism of Action

  Evening primrose oil is rich in omega-6 gamma-linolenic acid (GLA), which can be converted directly to the prostaglandin precursor dihomo-GLA (DGLA) ^(2) (3). Administration of the oil may benefit individuals unable to metabolize cis-linolenic acid to GLA, producing subsequent intermediates of metabolic significance including prostaglandins ^(2) (3).

  In vitro, long-chain fatty alcohols such as hexacosanol, tetracosanol, docosanol, and octocosanol demontrate anti-inflammatory activity ⁽²⁹⁾. In animal models, benefits on cardiac recovery after myocardial infarction are attributed to its hypocholesterolemic effect and indirect influence on prostaglandins and cytokine synthesis ⁽³¹⁾. In arthiritis models, evening primrose oil normalized body weight, angiopoietin-1, and tumor necrosis factor-alpha levels, and reduced malondialdehyde levels, synovial hyperplasia, and inflammatory cell invasion in joint tissues ⁽³⁰⁾.

  In patients with multiple sclerosis, evening primrose oil accelerates anti-inflammatory responses and prevents pro-inflammatory cytokine production while helping to maintain fatty acid membranes and optimizing balance between saturated and unsaturated fatty acids ⁽⁴⁰⁾. Increases in plasma GLA and its metabolite DGLA seen with evening primrose oil supplementation has correlated with clinical improvements in atopic dermatitis ⁽³²⁾ and produced dose-dependent effects on serum fatty acid levels and eczema severity scores ⁽²⁵⁾. Inhibition of cheilitis is attributed to GLA’s effects on stratum corneum maturation, differentiation, and preservation of its permeability barrier ⁽³⁴⁾. Antiplatelet and anticoagulant effects are likely related to decreased thromboxane B2 synthesis induced by evening primrose oil ^(46) (47).

• Contraindications
  • Pregnant women should not take evening primrose oil due to increased risk of pregnancy complications ^(8) (48).
  • Patients with hormone-sensitive cancers should use evening primrose oil products with caution, because even though it does not possess estrogenic properties on its own, some commercial evening primrose oil products may contain other phytoestrogen ingredients.
• Adverse Reactions

  Minor: abdominal pain, indigestion, nausea, softening of stools, and headaches ⁽²⁵⁾.
  Labor abnormalities: When used to shorten gestation and length of labor, increased incidences of prolonged membrane rupture, oxytocin augmentation, arrest of descent, and vacuum extraction ^(8) (48).

  Case reports
  Petechiae and ecchymoses: Observed in a newborn whose mother used raspberry leaf tea and evening primrose oil vaginally and orally 1 week before childbirth ⁽¹²⁾.
  Lipoid pneumonia: In a 50-year-old woman following chronic use of evening primrose oil, caused by aspiration of lipid particles into the lungs ⁽²⁴⁾.

• Herb-Drug Interactions

  Anticoagulants/Antiplatelets: May have additive effects and increase bleeding risk ^(46) (49). In a small study of humans on several months of supplementation with y-linoleic acid from evening primrose oil, a significant increase in bleeding time was observed in 9 of 12 patients  ⁽⁴⁷⁾. Evening primrose oil is about 10% GLA ⁽⁵²⁾.

  Blood pressure medications: Although there are no interactions reported with blood pressure medications, evening primrose oil was identified as being among supplements that may increase both systolic and diastolic blood pressures, with a clinically meaningful difference for systolic blood pressure in a large population-based study ⁽⁵⁰⁾.

  Antiretrovirals: When used concurrently, evening primrose oil significantly increases the levels of antiretroviral drugs, and can increase the risk of adverse effects ⁽⁵¹⁾.

• References

  1. Srivastava A, Mansel RE, Arvind N, et al. Evidence-based management of Mastalgia: a meta-analysis of randomised trials. Breast. Oct 2007;16(5):503-512.

  2. Belch JJ, Hill A. Evening primrose oil and borage oil in rheumatologic conditions. Am J Clin Nutr 2000;71:352S-6S.

  3. Tyler, V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton: Pharmaceutical Press; 1994.

  4. Kenny FS, et al. Gamma linolenic acid with Tamoxifen as primary therapy in breast cancer. Int J Cancer 2000; 85:643-8.

  5. Schirmer MA, Phinney SD. Gamma-linolenate reduces weight regain in formerly obese humans. J Nutr. Jun 2007;137(6):1430-1435.

  6. De La Cruz JP, Martin-Romero M, Carmona JA, et al. Effect of evening primrose oil on platelet aggregation in rabbits fed an atherogenic diet. Thromb Res. Jul 1 1997;87(1):141-149.

  7. Guivernau M, Meza N, Barja P, Roman O. Clinical and experimental study on the long-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacyclin production. Prostaglandins Leukot Essent Fatty Acids. Nov 1994;51(5):311-316.

  8. Dove D, Johnson P. Oral evening primrose oil: its effect on length of pregnancy and selected intrapartum outcomes in low-risk nulliparous women. J Nurse Midwifery. 1999 May-Jun;44(3):320-4.

  9. Holman CP, et al. A trial of evening primrose oil in the treatment of chronic schizophrenia. J Orthomolecular Psychiatry 1983;12:302-4.

  10. Newall C. Herbal Medicines, A Guide for Health Care Professionals. London: Pharmaceutical Press; 1997.

  11. Martens-Lobenhoffer J, Meyer FP. Pharmacokinetic data of gamma-linoleic acid in healthy volunteers after the administration of evening primrose oil (Epogam). Int J Clin Pharmacology Therapeutics 1998;36:363-6.

  12. Wedig KE, Whitsett JA. Down the primrose path: petechiae in a neonate exposed to herbal remedy for parturition. J Pediatr. Jan 2008;152(1):140, 140 e141.

  13. Zurier RB, et al. Gamma-linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum 1996;39:1808-17.

  14. Budeiri D, et al. Is evening primrose oil of value in the treatment of premenstrual syndrome? Control Clin Trials 1996;17:60-8.

  15. Keen H, et al. Treatment of diabetic neuropathy with gamma-linolenic acid. Diabetes Care 1993;16:8-15.

  16. Pye JK, et al. Clinical experience of drug treatment for mastalgia. Lancet 1985;2:373-7.

  17. Blommers J, et al. Evening primrose oil and fish oil for severe chronic astalgia: a randomized, double-blind, controlled trial. Am J Obstet Gynecol. 2002 Nov;187(5):1389-94.

  18. Senapati S, Banerjee S, Gangopadhyay DN. Evening primrose oil is effective in atopic dermatitis: a randomized placebo-controlled trial. Indian J Dermatol Venereol Leprol. 2008 Sep-Oct;74(5):447-52.

  19. Platzbecker U, Aul C, Ehninger G, Giagounidis A. Reduction of 5-azacitidine induced skin reactions in MDS patients with evening primrose oil. Ann Hematol. 2010 Apr;89(4):427-8.

  20. Pruthi S, Wahner-Roedler DL, Torkelson CJ, et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010 Apr;15(1):59-67.

  21. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD002948.

  22. Dante G, Facchinetti F. Herbal treatments for alleviating premenstrual symptoms: a systematic review. J Psychosom Obstet Gynaecol. 2011 Mar;32(1):42-51.

  23. Bamford JT, Ray S, Musekiwa A, et al. Oral evening primrose oil and borage oil for eczema. Cochrane Database Syst Rev. 2013 Apr 30;4:CD004416. doi: 10.1002/14651858.CD004416.pub2.

  24. Rabahi MF, Ferreira AA, Madeira JG, Galvao PM, Pinto SA. Lipoid pneumonia secondary to long-term use of evening primrose oil. J Bras Pneumol. 2010 Oct;36(5):657-61.

  25. Chung BY, Kim JH, Cho SI, et al. Dose-dependent effects of evening primrose oil in children and adolescents with atopic dermatitis. Ann Dermatol. Aug 2013;25(3):285-291.

  26. Muggli R. Systemic evening primrose oil improves the biophysical skin parameters of healthy adults. Int J Cosmet Sci. Aug 2005;27(4):243-249.

  27. Ohn Mar S, Malhi F, Syed Rahim SH, et al. Use of Alternative Medications for Menopause-Related Symptoms in Three Major Ethnic Groups of Ipoh, Perak, Malaysia. Asia Pac J Public Health. Nov 2015;27(8 Suppl):19s-25s.

  28. Gentry-Maharaj A, Karpinskyj C, Glazer C, et al. Use and perceived efficacy of complementary and alternative medicines after discontinuation of hormone therapy: a nested United Kingdom Collaborative Trial of Ovarian Cancer Screening cohort study. Menopause. Apr 2015;22(4):384-390.

  29. Montserrat-de la Paz S, Garcia-Gimenez MD, Angel-Martin M, et al. Long-chain fatty alcohols from evening primrose oil inhibit the inflammatory response in murine peritoneal macrophages. J Ethnopharmacol. 2014;151(1):131-136.

  30. El-Sayed RM, Moustafa YM, El-Azab MF. Evening primrose oil and celecoxib inhibited pathological angiogenesis, inflammation, and oxidative stress in adjuvant-induced arthritis: novel role of angiopoietin-1. Inflammopharmacology. Oct 2014;22(5):305-317.

  31. Abo-Gresha NM, Abel-Aziz EZ, Greish SM. Evening primrose oil ameliorates platelet aggregation and improves cardiac recovery in myocardial-infarct hypercholesterolemic rats. Int J Physiol Pathophysiol Pharmacol. 2014;6(1):23-36.

  32. Simon D, Eng PA, Borelli S, et al. Gamma-linolenic acid levels correlate with clinical efficacy of evening primrose oil in patients with atopic dermatitis. Adv Ther. Feb 2014;31(2):180-188.

  33. Madhok V, Futamura M, Thomas KS, et al. What’s new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 2. Treatment and prevention. Clin Exp Dermatol. Jun 2015;40(4):349-354; quiz 354-345.

  34. Park KY, Ko EJ, Kim IS, et al. The effect of evening primrose oil for the prevention of xerotic cheilitis in acne patients being treated with isotretinoin: a pilot study. Ann Dermatol. Dec 2014;26(6):706-712.

  35. Greenfield SM, Green AT, Teare JP, et al. A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis. Aliment Pharmacol Ther. Apr 1993;7(2):159-166.

  36. Ng SC, Lam YT, Tsoi KK, et al. Systematic review: the efficacy of herbal therapy in inflammatory bowel disease. Aliment Pharmacol Ther. Oct 2013;38(8):854-863.

  37. Jalbert I. Diet, nutraceuticals and the tear film. Exp Eye Res. Dec 2013;117:138-146.

  38. Kokke KH, Morris JA, Lawrenson JG. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Cont Lens Anterior Eye. Jun 2008;31(3):141-146; quiz 170.

  39. Rock E, DeMichele A. Nutritional approaches to late toxicities of adjuvant chemotherapy in breast cancer survivors. J Nutr. Nov 2003;133(11 Suppl 1):3785s-3793s.

  40. Rezapour-Firouzi S, Arefhosseini SR, Ebrahimi-Mamaghani M, et al. Erythrocyte membrane fatty acids in multiple sclerosis patients and hot-nature dietary intervention with co-supplemented hemp-seed and evening-primrose oils. Afr J Tradit Complement Altern Med. 2013;10(6):519-527.

  41. Rezapour-Firouzi S, Arefhosseini SR, Mehdi F, et al. Immunomodulatory and therapeutic effects of Hot-nature diet and co-supplemented hemp seed, evening primrose oils intervention in multiple sclerosis patients. Complement Ther Med. Oct 2013;21(5):473-480.

  42. Rezapour-Firouzi S, Arefhosseini SR, Ebrahimi-Mamaghani M, et al. Activity of liver enzymes in multiple sclerosis patients with Hot-nature diet and co-supplemented hemp seed, evening primrose oils intervention. Complement Ther Med. Dec 2014;22(6):986-993.

  43. Kataria K, Dhar A, Srivastava A, et al. A systematic review of current understanding and management of mastalgia. Indian J Surg. Jun 2014;76(3):217-222.

  44. Farzaneh F, Fatehi S, Sohrabi MR, et al. The effect of oral evening primrose oil on menopausal hot flashes: a randomized clinical trial. Arch Gynecol Obstet. Nov 2013;288(5):1075-1079.

  45. van der Merwe CF, Booyens J, Joubert HF, et al. The effect of gamma-linolenic acid, an in vitro cytostatic substance contained in evening primrose oil, on primary liver cancer. A double-blind placebo controlled trial. Prostaglandins Leukot Essent Fatty Acids. Jul 1990;40(3):199-202.

  46. Norred CL, Brinker F. Potential coagulation effects of preoperative complementary and alternative medicines. Altern Ther Health Med. Nov-Dec 2001;7(6):58-67.

  47. Guivernau M, Meza N, Barja P, et al. Clinical and experimental study on the long-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacyclin production. Prostaglandins Leukot Essent Fatty Acids. Nov 1994;51(5):311-316.

  48. Dante G, Bellei G, Neri I, et al. Herbal therapies in pregnancy: what works? Curr Opin Obstet Gynecol. Apr 2014;26(2):83-91.

  49. Riaz A, Khan RA, Ahmed SP. Assessment of anticoagulant effect of evening primrose oil. Pak J Pharm Sci. Oct 2009;22(4):355-359.

  50. McCarty CA, Berg RL, Rottscheit CM, et al. The use of dietary supplements and their association with blood pressure in a large Midwestern cohort. BMC Complement Altern Med. 2013;13:339.

  51. Jalloh MA, Gregory PJ, Hein D, Risoldi Cochrane Z, Rodriguez A. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15.

  52. Chung S, Kong S, Seong K, et al. Gamma-linolenic acid in borage oil reverses epidermal hyperproliferation in guinea pigs. J Nutr. Oct 2002;132(10):3090-3097.