J. Pharm. Pharmacogn. Res., vol. 13, no. 5, pp. 1338-1344, Sep-Oct 2025.
DOI: https://doi.org/10.56499/jppres24.2192_13.5.1338
Original Article
Effect of Clitoria ternatea L. on vaginal health, inflammation, and reproductive hormones: A pilot study
[Efecto de Clitoria ternatea L. sobre la salud vaginal, la inflamación y las hormonas reproductivas: Un estudio piloto]
Revi Gama Hatta Novika1,2*, Ahmad Yunus3,4, Nurul J. Wahidah1, Lanjar Sumarno5, Muhana F. Ilyas6
1Midwifery Study Program, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
2Master Program in Public Health, Graduate School, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
3Department of Agrotechnology, Faculty of Agriculture, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
4Center for Research and Development of Biotechnology and Biodiversity, LPPM Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
5Research Center for Agroindustry, National Research and Innovation Agency, Bogor, West Java, Indonesia.
6Medical Doctor Profession Program, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
*E-mail: revi.gama@staff.uns.ac.id
Abstract
Context: Clitoria ternatea, commonly known for its potential health benefits, is believed to possess anti-inflammatory properties and has been traditionally utilized for a variety of health applications. However, its effects on vaginal health and reproductive hormones remain underexplored.
Aims: To assess the effects of C. ternatea on vaginal health by evaluating bacterial vaginosis occurrence, vaginal pH, Nugent scores, and inflammatory markers (TGF-β, IL-6) and to investigate its impact on reproductive hormones by measuring progesterone and estradiol levels.
Methods: Thirty female participants were enrolled in a single-group pre- and post-test design study. Subject participants were given administration of C. ternatea 460 mg twice daily for 28 days. Demographic data and clinical evaluations were documented. Before and after the intervention, samples were collected for microscopic examination and ELISA-based assessment of TGF-β, IL-6, progesterone, and estradiol levels.
Results: This study indicated that C. ternatea supplementation significantly reduced bacterial vaginosis occurrence from 93.1% to 51.7% (p<0.001), decreased vaginal pH from 5.04 ± 0.518 to 4.67 ± 0.679 (p=0.004), and improved Nugent scores from 6.96 ± 1.480 to 5.00 ± 1.840 (p<0.001). Additionally, there were significant reductions in TGF-β (116.86 ± 52.518 ng/mL to 46.16 ± 49.246 ng/mL, p<0.001) and IL-6 (320.96 ± 139.189 ng/L to 128.31 ± 181.669 ng/L, p<0.001). However, there were no significant changes in progesterone or estradiol levels.
Conclusions: C. ternatea may significantly improve vaginal health by reducing the occurrence of bacterial vaginosis, lowering vaginal pH, and decreasing inflammatory markers. However, it does not appear to affect reproductive hormone levels. This study provides preliminary evidence supporting the use of C. ternatea for vaginal health, warranting further investigation in larger, controlled trials.
Keywords: bacterial vaginosis; Clitoria ternatea; inflammation; reproductive hormones; vaginal health.
Resumen
Contexto: Se cree que Clitoria ternatea, conocida por sus posibles beneficios para la salud, posee propiedades antiinflamatorias y se ha utilizado tradicionalmente para diversas aplicaciones. Sin embargo, sus efectos sobre la salud vaginal y las hormonas reproductivas siguen siendo poco explorados.
Objetivos: Evaluar los efectos de C. ternatea en la salud vaginal mediante la evaluación de la incidencia de vaginosis bacteriana, el pH vaginal, las puntuaciones de Nugent y los marcadores inflamatorios (TGF-β, IL-6), e investigar su impacto en las hormonas reproductivas mediante la medición de los niveles de progesterona y estradiol.
Métodos: Treinta mujeres participantes participaron en un estudio de un solo grupo con diseño pre y postest. Se administró a las participantes 460 mg de C. ternatea dos veces al día durante 28 días. Se documentaron los datos demográficos y las evaluaciones clínicas. Antes y después de la intervención, se recolectaron muestras para su examen microscópico y la evaluación mediante ELISA de los niveles de TGF-β, IL-6, progesterona y estradiol.
Resultados: Este estudio indicó que la suplementación con C. ternatea redujo significativamente la aparición de vaginosis bacteriana del 93,1% al 51,7% (p<0,001), disminuyó el pH vaginal de 5,04 ± 0,518 a 4,67 ± 0,679 (p=0,004) y mejoró las puntuaciones de Nugent de 6,96 ± 1,480 a 5,00 ± 1,840 (p<0,001). Además, se observaron reducciones significativas en TGF-β (de 116,86 ± 52,518 ng/mL a 46,16 ± 49,246 ng/mL, p<0,001) e IL-6 (de 320,96 ± 139,189 ng/L a 128,31 ± 181,669 ng/L, p<0,001). Sin embargo, no se observaron cambios significativos en los niveles de progesterona ni de estradiol.
Conclusiones: C. ternatea puede mejorar significativamente la salud vaginal al reducir la incidencia de vaginosis bacteriana, disminuir el pH vaginal y disminuir los marcadores inflamatorios. Sin embargo, no parece afectar los niveles de hormonas reproductivas. Este estudio proporciona evidencia preliminar que respalda el uso de C. ternatea para la salud vaginal, lo que justifica una mayor investigación en ensayos controlados de mayor tamaño.
Palabras Clave: Clitoria ternatea; hormonas reproductivas; inflamación; salud vaginal; vaginosis bacteriana.
Citation Format: Novika RGH, Yunus A, Wahidah NJ, Sumarno L, Ilyas MF (2025) Effect of Clitoria ternatea L. on vaginal health, inflammation, and reproductive hormones: A pilot study. J Pharm Pharmacogn Res 13(5): 1338–1344. https://doi.org/10.56499/jppres24.2192_13.5.1338
References
Abou Chacra L, Ly C, Hammoud A, Iwaza R, Mediannikov O, Bretelle F, Fenollar F (2023) Relationship between bacterial vaginosis and sexually transmitted infections: Coincidence, consequence or co-transmission? Microorganisms 11(10): 2470. https://doi.org/10.3390/microorganisms11102470
Al-Snafi AE (2016) Pharmacological importance of Clitoria ternatea–A review. IOSR J Pharm 6(3): 68–83.
Ashraf K, Adlin NF, Basri AN, Ahmad W, Sultan S (2023) The traditional uses, phytochemistry, and pharmacological effects of Clitoria ternatea: A review. Indian J Pharm Educ Res 58(1): 1–14. https://doi.org/10.5530/ijper.58.1.1
Coudray MS, Madhivanan P (2020) Bacterial vaginosis—A brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol 245: 143–148. https://doi.org/10.1016/j.ejogrb.2019.12.035
Darmadi AAK, Suriani NL, Ginantra IK, Sudirga SK (2022) Short Communication: Effectiveness of cinnamon leaf extract to control anthracnose disease on large chilies in Bali, Indonesia. Biodiversitas 23(6): 2859–2864. https://doi.org/10.13057/biodiv/d230611
Devi BP, Boominathan R, Mandal SC (2003) Anti-inflammatory, analgesic and antipyretic properties of Clitoria ternatea root. Fitoterapia 74(4): 345–349. https://doi.org/10.1016/S0367-326X(03)00057-1
Eddouks M, Chattopadhyay D, De Feo V, Cho WC (2012) Medicinal plants in the prevention and treatment of chronic diseases. Evid Based Complement Alternat Med 2012: 458274. https://doi.org/10.1155/2012/458274
Fatimah I, Hidayat H, Nugroho BH, Husein S (2020) Ultrasound-assisted biosynthesis of silver and gold nanoparticles using Clitoria ternatea flower. S Afr J Chem Eng 34: 97–106. https://doi.org/10.1016/j.sajce.2020.06.007
Faught BM, Reyes S (2019) Characterization and treatment of recurrent bacterial vaginosis. J Women’s Health 28(9): 1218–1226. https://doi.org/10.1089/jwh.2018.7383
Ghozali DA, Doewes M, Soetrisno S, Indarto D, Ilyas MF (2023) Dose-response effect of L-citrulline on skeletal muscle damage after acute eccentric exercise: an in vivo study in mice. PeerJ 11: e16684. https://doi.org/10.7717/peerj.16684
Hutapea CM, Subchan P, Putra A (2023) Clitoria ternatea flower extract-based gel elevates TGF-β1 gene expression and collagen density in UVB-induced collagen loss rat skin. J Kedokt Brawijaya 32(3): 2148–153. https://doi.org/10.21776/ub.jkb.2022.032.03.2
Islam MdA, Mondal SK, Islam S, Akther Shorna Most N, Biswas S, Uddin MdS, Zaman S, Saleh MdA (2023) Antioxidant, cytotoxicity, antimicrobial activity, and in silico analysis of the methanolic leaf and flower extracts of Clitoria ternatea. Biochem Res Int 2023: 8847876. https://doi.org/10.1155/2023/8847876
Javed A, Parvaiz F, Manzoor S (2019) Bacterial vaginosis: An insight into the prevalence, alternative treatments regimen and it’s associated resistance patterns. Microb Pathog 127: 21–30. https://doi.org/10.1016/j.micpath.2018.11.046
Jeyaraj EJ, Lim YY, Choo WS (2022a) Antioxidant, cytotoxic, and antibacterial activities of Clitoria ternatea flower extracts and anthocyanin-rich fraction. Sci Rep 12(1): 14890. https://doi.org/10.1038/s41598-022-19146-z
Jeyaraj EJ, Nathan S, Lim YY, Choo WS (2022b) Antibiofilm properties of Clitoria ternatea flower anthocyanin-rich fraction towards Pseudomonas aeruginosa. Access Microbiology 4(4): 000343. https://doi.org/10.1099/acmi.0.000343
Kaur M, Rana A, Kumar S (2020) Estrogenic activity of hydroalcoholic extract of Clitoria ternatea Linn. leaves on rats. Asian Pac J Reprod 9(1): 31–36. https://doi.org/10.4103/2305-0500.275526
Kenyon C, Colebunders R, Crucitti T (2013) The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 209(6): 505–523. https://doi.org/10.1016/j.ajog.2013.05.006
Kosai P, Sirisidthi K, Jiraungkoorskul K, Jiraungkoorskul W (2015) Review on ethnomedicinal uses of memory boosting herb, butterfly pea, Clitoria ternatea. J Nat Remedies 15(2): 71–76. https://doi.org/10.18311/jnr/2015/480
Lakshan SAT, Jayanath NY, Mendis Abeysekera WPK, Abeysekera WKSM (2019) A commercial potential blue pea (Clitoria ternatea L.) flower extract incorporated beverage having functional properties. Evid Based Complement Alternat Med 2019: 2916914. https://doi.org/10.1155/2019/2916914
Multisona RR, Shirodkar S, Arnold M, Gramza-Michalowska A (2023) Clitoria ternatea flower and its bioactive compounds: Potential use as microencapsulated ingredient for functional foods. Appl Sci 13(4): 2134. https://doi.org/10.3390/app13042134
Muzny CA and Sobel JD (2022) The role of antimicrobial resistance in refractory and recurrent bacterial vaginosis and current recommendations for treatment. Antibiotics 11(4): 500. https://doi.org/10.3390/antibiotics11040500
Ng BK, Chuah JN, Cheah FC, Mohamed Ismail NA, Tan GC, Wong KK, Lim PS (2023) Maternal and fetal outcomes of pregnant women with bacterial vaginosis. Front Surg 10: 1084867. https://doi.org/10.3389/fsurg.2023.1084867
Novika RGH, Wahidah NJ, Yunus A, Sumarno L, Ilyas, MF (2024) Clinical effect of Echinacea purpurea as an antiviral and its effect on reproductive hormones. J Pharm Pharmacogn Res 12(2): 255–263. https://doi.org/10.56499/jppres23.1784_12.2.255
Nugraha AP, Rahmadhani D, Puspitaningrum MS, Rizqianti Y, Kharisma VD, Ernawati DS (2021) Molecular docking of anthocyanins and ternatin in Clitoria ternatea as coronavirus disease oral manifestation therapy. J Adv Pharm Technol Res 12(4): 362–367. https://doi.org/10.4103/japtr.japtr_126_21
Pagar R, Deshkar S, Mahore J, Patole V, Deshpande H, Gandham N, Mirza S, Junnarkar M, Nawani N (2024) The microbial revolution: Unveiling the benefits of vaginal probiotics and prebiotics. Microbiol Res 286: 127787. https://doi.org/10.1016/j.micres.2024.127787
Pendharkar S, Skafte-Holm A, Simsek G, Haahr T (2023) Lactobacilli and their probiotic effects in the vagina of reproductive age women. Microorganisms 11(3): 636. https://doi.org/10.3390/microorganisms11030636
Sadeghpour Heravi F (2024) Host-vaginal microbiota interaction: shaping the vaginal microenvironment and bacterial vaginosis. Curr Clin Micro Rpt 11(3): 177–191. https://doi.org/10.1007/s40588-024-00227-8
Sharma U, Dwivedi S (2021) Development and characterization of herbal formulation containing aqueous extract of Clitoria ternatea Linn. (flowers) for the treatment of vaginal infection. LOJ Pharm Clin Res 2(4): 235–240. https://doi.org/10.32474/lojpcr.2021.02.000143
Swathi KP, Jayaram S, Sugumar D, Rymbai E (2021) Evaluation of anti-inflammatory and anti-arthritic property of ethanolic extract of Clitoria ternatea. Chin Herb Med 13(2): 243–249. https://doi.org/10.1016/j.chmed.2020.11.004
Vodstrcil LA, Muzny CA, Plummer EL, Sobel JD, Bradshaw CS (2021) Bacterial vaginosis: Drivers of recurrence and challenges and opportunities in partner treatment. BMC Med 19(1): 194. https://doi.org/10.1186/s12916-021-02077-3
World Medical Association (2013) World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. JAMA 310(20): 2191–2194. https://doi.org/10.1001/jama.2013.281053
Yanti Y, Setiawan T, Lay BW (2018) Antibacterial, antibiofilm and quorum sensing inhibitory activities of Clitoria ternatea anthocyanin against Streptococcus mutans. Int J Infectious Dis 73(suppl): 143–144. https://doi.org/10.1016/j.ijid.2018.04.3739
© 2025 Journal of Pharmacy & Pharmacognosy Research