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Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal Disorders

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Abstract

For a woman, menopause represents a transitional phase from a fertile to a non-fertile age, in which there is a gradual reduction in ovarian function accompanied by a gradual cessation of oestrogen production. The clinical presentation can involve a series of disorders, including hot flushes with episodes of sweating, particularly at night, palpitations, changes in sleep-wake rhythm, irritability, anxiety and mood changes, vaginal dryness due to a process of progressive atrophy with thinning of the outer and inner labia, reduction of vascularisation and elastic fibres, and decreased sexual desire; subsequently, Many women use alternative therapies to treat hot flushes and other menopausal symptoms. The purpose of this review is to summarize current information on the efficacy and safety of phytoestrogens and the herbal medicine. Given the importance that these symptoms assume for the woman, not only for the perceived quality of life, but also for the increased risk of developing all the diseases, all the treatments adopted for menopausal women are directed primarily to resolving vasomotor disorder.
Women’s Health Care
Leo et al., J Women’s Health Care 2014, 3:5
http://dx.doi.org/10.4172/2167-0420.1000182
Volume 3 • Issue 5 • 1000182
J Women’s Health Care
ISSN: 2167-0420 JWHC, an open access journal
Open Access
Research Article
Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment
of Menopausal Disorders
Vincenzo De Leo*, Valentina Cappelli, Alessandra Di Sabatino and Giuseppe Morgante
Molecular Medicine and Development Department, Obstetrics and Gynecology Clinic, University of Siena, Italy
Abstract
For a woman, menopause represents a transitional phase from a fertile to a non-fertile age, in which there is a
gradual reduction in ovarian function accompanied by a gradual cessation of oestrogen production.
The clinical presentation can involve a series of disorders, including hot ushes with episodes of sweating,
particularly at night, palpitations, changes in sleep-wake rhythm, irritability, anxiety and mood changes, vaginal dryness
due to a process of progressive atrophy with thinning of the outer and inner labia, reduction of vascularisation and
elastic bres, and decreased sexual desire; subsequently, Many women use alternative therapies to treat hot ushes
and other menopausal symptoms. The purpose of this review is to summarize current information on the efcacy and
safety of phytoestrogens and the herbal medicine. Given the importance that these symptoms assume for the woman,
not only for the perceived quality of life, but also for the increased risk of developing all the diseases, all the treatments
adopted for menopausal women are directed primarily to resolving vasomotor disorder
*Corresponding author: Prof Vincenzo De Leo, Molecular Medicine and
Development Department, University of Siena, Italy, Tel: +390577233465; Fax:
+390577233454; E-mail: vincenzo.deleo@unisi.it
Received February 26, 2014; Accepted August 14, 2014; Published August 18,
2014
Citation: Leo VD, Cappelli V, Sabatino AD, Morgante G (2014) Phyto-Oestrogens
and Chaste Tree Berry: A New Option in the Treatment of Menopausal Disorders. J
Women’s Health Care 3: 182. doi:10.4172/2167-0420.1000182
Copyright: © 2014 Leo VD, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Menopause; Vasomotor symptoms; Hot ushes; Phyto-
oestrogens; Magnolia; Chaste tree berry
Introduction
For a woman, menopause represents a transitional phase from
a fertile to a non-fertile age, in which there is a gradual reduction in
ovarian function accompanied by a gradual cessation of oestrogen
production [1]. During this period, women are faced with irregular
ovulatory or anovulatory cycles without a systematic progression from
one to the other.
e mean age of onset of this phase is 40 to 50 years and it is certainly
the most vulnerable period in a womans life in that hormone deciency
causes neuroendocrine changes that constitute the pathophysiological
basis of neurovegetative disorders (Figure 1).
e clinical presentation can involve a series of disorders, including
hot ushes with episodes of sweating, particularly at night, palpitations,
changes in sleep-wake rhythm, irritability, anxiety and mood changes,
vaginal dryness due to a process of progressive atrophy with thinning
of the outer and inner labia, reduction of vascularisation and elastic
bres, and decreased sexual desire; subsequently, the process of atrophy
also aects the epidermis with thin, pale skin that is easily susceptible
to bacterial and viral infections. A similar condition is observed in the
vagina with a reduction in thickness of the mucosa, which becomes
atrophic with reduced vascularisation and results in dyspareunia (Table
1) [2].
Among the most important long-term complications, attention
should be drawn to the loss of minerals and consequent reduction in
bone mass, which is associated with osteopenia and osteoporosis of
varying degrees and dysfunction and atrophy of the genitourinary tract.
With the passage of time, oestrogen deciency in fact accelerates the
process of bone demineralisation, as oestrogens promote the absorption
of calcium in the intestine and the mineralisation process in bone [3].
e most common symptoms of menopause, even when taking
into account all the dierent populations studied, are hot ushes, which
aect between 65% and 86.8% of the menopausal female population,
whereas night sweats aect between 65% and 82.1%, insomnia between
61% and 67.8% and mood changes between 57% and 47.5% [4,5].
e symptom for which postmenopausal women most frequently
visit their doctor for relief is the occurrence of hot ushes [6]. is
symptom is present in more than 80% of women entering into
physiological menopause, while it aects more than 90% of women who
have undergone surgical removal of the ovaries. Menopausal symptoms
must not be regarded simply as disorders associated with deterioration
in the quality of the life, but also as a risk factor for the development of
osteoporosis, as well as cardiovascular diseases and brain deterioration
[7,8].
Figure 1: Main changes in the neuroendocrine axis in menopause.
Citation: Leo VD, Cappelli V, Sabatino AD, Morgante G (2014) Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal
Disorders. J Women’s Health Care 3: 182. doi:10.4172/2167-0420.1000182
Page 2 of 6
Volume 3 • Issue 5 • 1000182
J Women’s Health Care
ISSN: 2167-0420 JWHC, an open access journal
A review from 2009 on this subject shows that more severe hot
ushes can be correlated with rapid bone loss and the subsequent
development of osteoporosis within a short period of time [9]; they
are also related to a weaker verbal memory [10] and reduced levels
of plasma antioxidants, but also to an increased cardiovascular stress
response and to changes in blood pressure.
e vasomotor symptoms are also correlated with a signicant
increase in the risk of coronary heart disease, which does not appear
to be entirely explicable by other risk factors for coronary heart disease
[11].
Given the importance that these symptoms assume for the woman,
not only for the perceived quality of life, but also for the increased risk
of developing all the diseases listed above, all the treatments adopted
for menopausal women are directed primarily to resolving vasomotor
disorders.
Changes in ermoregulation During Menopause
e hypothalamus is the CNS structure that, as well as various other
functions, is specically devoted to maintaining body temperature and
the sleep-wake rhythm, as well as to maintaining water and salt balance
and regulating food intake.
In the hypothalamus, the anterior and preoptic nuclei are
responsible for cooling, whereas the posterior nucleus is devoted to
heating; these centres possess cells that are able to respond to variations
in body temperature, which is recorded from the temperature of the
blood that reaches the encephalon. When the temperature is higher
than physiological levels, the posterior nucleus releases noradrenaline,
which in turn stimulates the nuclei in the anterior hypothalamus,
culminating in a response that causes an increase in sweating and
peripheral vasodilatation and thus returning the system to a state of
equilibrium. It is specically the increase in noradrenaline which
results in sweating and hot ushes in menopausal women with the aim
of reducing raised body temperature [12].
Dopamine also plays an important role in thermoregulation in
that it too is devoted to maintaining a state of euthermia via the D2
receptors. As has long been known, bromocriptine, a dopamine
agonist, is able to increase the activity of the hypothalamic endogenous
opioid system (β-endorphins) on the mechanisms regulating body
temperature in menopause [13]. In fact, β-endorphins are also involved
in thermoregulatory homeostasis and inhibit the noradrenergic
neurons below the threshold at which heat loss is activated.
During fertile life, oestrogens play an important role in modifying
the synthesis, release and metabolism of many neurotransmitters,
including dopamine and melatonin, which are responsible for
modulating the hypothalamic and limbic systems.
It is therefore clear that the decrease in oestrogen levels from the
perimenopausal period until overt menopause is accompanied by
changes in function of these systems, which is of particular relevance to
thermoregulation and vasomotor stability.
e resultant outcome is connected with menopausal symptoms.
e menopausal changes therefore induce a temporary imbalance of
thermoregulation in the hypothalamus, modulating the homeostasis of
the body temperature to values below physiological levels, which are
then achieved by the dispersal of heat by means of vasodilatation and
profuse sweating.
Postmenopausally, the decrease in oestrogens reduces the
inhibitory activity of β-endorphins on noradrenaline and causes an
increase in activity of the noradrenergic system but also a reduction
of the dopaminergic system, which is signicantly less active than in
premenopausal women (Figures 2 and 3) [7,8].
All these mechanisms explain the positive eect of hormone
therapy, resulting in stimulation of the D2 dopaminergic receptors and
the subsequent attenuation of the menopausal symptoms associated
with hot ushes and sweating, with a consequent improvement also
in the psychological correlations and a decrease in the risk factors for
osteoporotic and cardiovascular diseases.
Melatonin levels and the time during which these levels remain
high during the night also dier during the various phases of life, with a
signicant decrease with advancing age; this explains why sleep is oen
disturbed and is of poorer quality in the elderly [14].
Perimenopausally, it has been shown that the reduction in
melatonin secretion precedes the increase in FSH in menopause.
Moreover, the instability of the ovarian hormones and their
uctuation during the perimenopausal period destabilises the
physiological circadian rhythm and the decrease in oestrogens can also
contribute signicantly to changes in mood and physiological well-
being.
A genuine problem that frequently occurs when a woman asks for
relief of the vasomotor disorders that aict her is represented by the
fact that, as is now well known, the traditional Hormone Replacement
erapy (HRT) is accepted and used by only a small percentage of
women (about 8%), as the literature reports that there is a state of fear
of an increased risk of breast cancer that in fact causes doctors not to
prescribe such drugs, although very oen it is the women themselves
who refuse to use them.
Short-term
symptoms
Medium-term
symptoms
Long-term
symptoms
−Menstrual irregularity
−Hot ushes
−Sweating
(including at night)
−Insomnia
−Anxiety
−Depression
−Asthenia
−Irritability
−Urogenital disorders
oVaginal dryness
oDyspareunia
oUrinary incontinence
−Cutaneous and mucosal atrophy
oCutaneous hypoelasticity
(increased wrinkles)
oAtrophy of the oral mucosa
oEye symptoms
−Obesity
−Osteoporosis
−Cardiovascolar
disorders
−Atherosclerosis
−Alzheimer’s
disease
Table 1: Schematic representation of the main short-term, medium-term and long-
term symptoms of menopausal women.
Figure 2: Heat control system during fertile life and changes in the
menopausal woman.
Figure 3: Mechanism of development of hot ushes in menopause.
Citation: Leo VD, Cappelli V, Sabatino AD, Morgante G (2014) Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal
Disorders. J Women’s Health Care 3: 182. doi:10.4172/2167-0420.1000182
Page 3 of 6
Volume 3 • Issue 5 • 1000182
J Women’s Health Care
ISSN: 2167-0420 JWHC, an open access journal
Hormone Replacement erapy (HRT)
A reasoned choice of the therapeutic protocol in terms of
preparation type, dosage, therapeutic regimen and route of
administration is essential for the rational use of HRT. As conrmed
by the results of the WHI study, dierent therapeutic strategies must be
chosen with an individualised risk-benet assessment. In recent years,
following a few clinical studies that had aroused considerable fear, the
therapeutic approaches to postmenopausal women have been reviewed
[15]. Additionally, new treatment protocols have been identied with
low oestrogen doses that are eective in controlling postmenopausal
symptoms and reducing the incidence of side eects and potential risks
associated with the duration of treatment (Table 2).
e reduction in the dose of oestrogens to be administered does
not preclude the fact that all women must undergo tests before starting
treatment. Women who take hormone therapy should undergo a clinical
follow-up at least once a year, including a gynaecological visit, updating
of the medical history, laboratory and instrumental tests and a lifestyle
assessment. Mammography must be performed, preferably within 12
months of the start of treatment [16]; increased breast density can be
attributed predominantly to the eects of the progestin component of
HRT [17,18].
e woman must be examined from an endocrine and metabolic
standpoint, the type of oestrogen and possibly the most suitable type
of progestin must be chosen, as well as the best route of administration
and the combination modality best suited to the individual [15].
e main aim of hormone replacement therapy is to improve the
quality of life of patients in spontaneous or surgical postmenopause who
are experiencing menopausal symptoms [2]: hot ushes [6], nocturnal
sweating, vaginal atrophy, dyspareunia, neurovegetative problems,
osteoporosis [3] or a familial history of osteoporosis, with high levels
of total cholesterol and low levels of HDL-cholesterol, and with a family
history of cardiovascular diseases [19-21]. HRT should be considered in
the absence of contraindications and aer discussing the potential risks
and benets with the woman [22]. HRT is contraindicated in women
with a positive history of breast cancer [23,24] or endometrial cancer
[25], in women with thromboembolic episodes [26] during pregnancy
or in those taking oral contraceptives, with any current liver diseases or,
at all events, with impaired liver function.
Phyto-oestrogens
In recent times, the pharmaceutical market has been enriched by
numerous products known as food supplements based predominantly
on phyto-oestrogens, or plant oestrogens, derived from soya and
combined with vitamins and other plant substances, which have made
them greatly appreciated by women, both for the relief of disorders
of the perimenopausal and overt menopausal period, and during the
fertile life. It is the gynaecologist’s task to identify the right products to
recommend to women based on the quantities and quality of substances
present.
Phyto-oestrogens are compounds that are present in many plants
with a very similar action to mammalian oestrogens.
However, some clarications are needed about phyto-oestrogens,
since they do not all have the same therapeutic ecacy.
ese products exert a gentle and balanced oestrogenic action
due to the active ingredients they contain; more precisely, by virtue of
their particular chemical structure, they are able to bind to oestrogen
receptors and thus exert biological activity of an oestrogenic or
antioestrogenic nature. e diversication of this eect depends on
their concentration, that of the oestrogens produced by the body and
on certain individual characteristics (tissue concentration of receptors
and enzymes involved in the metabolism of these hormones).
Phyto-oestrogens are commonly divided into three main classes:
isoavones, coumestans and lignans (a fourth category that of lactones
is of little therapeutic value) (Table 3). ey are ubiquitous in the
plant world (present in at least 300 varieties of plants, few of which
are edible). In terms of food sources, mention may be made of soya,
legumes and, albeit in small quantities, many types of fruits, vegetables
and wholegrain.
Soya, its derivatives (our, soya milk and tofu) and red clover
represent the main commercial sources of phyto-oestrogens.
Soya isoavones in particular have a higher oestrogenic activity
than other phyto-oestrogens. ey bind to the oestrogen receptor,
albeit with lesser anity, forming a receptor complex that functions in
a similar way. Many of the health-giving properties of isoavones are
attributable to the weak oestrogenic action of genistein and daidzein,
the two most important isoavones, and their interaction with the
oestrogen receptors that are distributed throughout the body. Genistein
has a seven-fold greater oestrogenic activity than daidzein.
As well as the biological signicance, the indications for phyto-
oestrogens are also now well known; these substances have a known
antioxidant and oestrogenic activity (they reduce disorders due to both
a deciency and an excess of oestrogens).
Recent studies have shown the progressive reduction in hot ushes
and sweating following treatment with phyto-oestrogens. Doses of 45-
90 mg of soya isoavones, equal to about 2-3 soya-based meals a day,
should be used to provide protection against hot ushes.
It has emerged from these studies that soya isoavones do not
stimulate endometrial growth and therefore they do not increase the
risk of endometrial or uterine tumours [27]. Other studies have shown
that the continuous administration of phyto-oestrogens derived from
soya isoavones exerts a protective action against cardiovascular
diseases and postmenopausal osteoporosis.
It has been shown that phyto-oestrogens exert a protective action
on blood vessels and against heart diseases. Following constant and
HORMONE REPLACEMENT THERAPY
Positive effects Risks
Reduction of menopausal symptoms Venous thromboembolism
Prevention of osteoporosis Cardiovascular risk
Increased trophism of the urogenital tract Risk of breast Ca
Table 2: Schematic representation of the main positive effects and possible risk
factors of the use of hormone replacement therapy (HRT).
ISOFLAVONES COUMESTANS LIGNANS
Genistein
− Soya and derivatives
Daidzein
− Legumes
Glycitein
− Clover
Biochanin A
− Whole grains
Formononetin
Coumestrol
− Beans, soya sprouts
4-Methoxycoumestrol
− Cloves, soya sprouts,
red clover, sunower
seeds
Enterodiol
− Linseed and sesame
seeds
Enterolactone
− Soya, hops, fruit and
vegetables, cereals
Table 3: Subdivision of classes and subclasses of phyto-oestrogens and principal
dietary sources.
Citation: Leo VD, Cappelli V, Sabatino AD, Morgante G (2014) Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal
Disorders. J Women’s Health Care 3: 182. doi:10.4172/2167-0420.1000182
Page 4 of 6
Volume 3 • Issue 5 • 1000182
J Women’s Health Care
ISSN: 2167-0420 JWHC, an open access journal
sustained intake, they can in fact reduce levels of triglycerides and low-
density lipoproteins (LDL or bad cholesterol) and increase levels of
high density cholesterol (HDL or good cholesterol) [28].
Isoavone supplements allow a better knowledge of the dosage
than the consumption of soya-rich foods, which is reected in greater
ecacy. e results can be appreciated more clearly aer the second
week of intake. In addition, these products do not cause any side eects.
e commercially available soya isoavone-based supplements
are not all equal. As well as high-quality products, unregulated
products and/or those of a low technological level can be found. Many
commercialised products refer to generic extracts of soya or isoavones
without specifying the type of isoavones they contain and exhibit a
dierent genistein/daidzein ratio from that found in nature; in addition,
some contain less active isoavones, such as glycitein.
Following the example of oral therapy, some soya isoavone-based
topical formulations have been marketed with the aim of treating and
preventing postmenopausal vulvovaginal symptoms. e availability of
products containing an adequate dose of soya isoavones has shown
to be eective, not only in curing vulvovaginal symptoms by more
continuous administration, but also in preventing their development
by periodic administration, in alternate 3-month cycles, which is met
with greater approval by the women.
Among other eects, oestrogens also possess an antioxidant activity,
thus inhibiting the formation of free radicals. Phytoestrogens have
also been shown to exert marked antioxidant, anti-inammatory and
antihypertensive activity. erefore, food supplements, in particular
multivitamins, represent a valid alternative to hormone replacement
therapy in menopausal woman.
Supplements that contain vitamin D and calcium as well as phyto-
oestrogens are indicated in the prevention of osteoporosis as a result
of their joint action of increasing intestinal absorption of calcium and
increasing its availability in bone, thus making the latter less fragile.
Combinations of phyto-oestrogens and other substances produce
an improvement in menopausal symptoms.
Over the years, there have been numerous combinations of phyto-
oestrogens and various other vitamin or benecial substances, but
recently pharmaceutical companies have particularly focussed on
some substances that can help relieve the disorders suered by women
in the peri- and postmenopausal period as much as possible. Various
substances have been studied and, of these, some deserve particular
mention, such as magnolia, lactobacilli, vitamin D and calcium, which
act specically on the disorders that women complain of most oen [4].
Vitamin D and calcium are very well known for their activity on bone
and therefore in the prevention of osteopenia and, in time, osteoporosis,
and their benecial properties are now conrmed.
In terms of the benecial activity of the combination of phyto-
oestrogens and probiotic lactic ferments, mention may be made of
Lactobacillus sporogenes (Bacillus coagulans), which reaches the distal
part of the small and large intestine in live form, where it germinates and
produces enzymes, vitamins and lactic acid, thus creating favourable
conditions for the absorption of calcium, magnesium, phosphorus,
iron and copper, but also trace elements and vitamins. In combination
with phyto-oestrogens, it is useful by virtue of its capacity for producing
glycosidase, an enzyme that releases the main active ingredients of
soya isoavones by cleaving their glycoside bond; lactobacilli therefore
improve the activity of phyto-oestrogens by stabilising the intestinal
bacterial ora and allowing the constant absorption of the active
ingredients.
A 2011 study shows that bioavailability varies with single doses
of two oral formulations of isoavones (genistein) with and without
lactobacilli, with a signicant increase in the peak plasma concentration
compared with the same dose of isoavones without lactobacilli.
A symptom that is oen associated with hot ushes in a large
number of women is a poorly tolerated state of anxiety that oen causes
a profound state of psychological prostration; this condition is also
oen correlated with a sense of constant tiredness and asthenia, with a
deterioration in the quality of rest and with a decrease in actual hours
of sleep.
In terms of this important symptom, the marked anti-anxiogenic
properties of magnolia extract are well known [29]. Magnolia extract
exerts a calming and comforting eect, without however causing
daytime drowsiness, and does not have the side eects that characterised
prescription anxiolytics. e main active ingredients are magnolol and
honokiol, which have modulating capacities on the GABAA receptors of
the cerebral limbic system, which is the centre devoted to emotions and
feelings. is explains how this substance can have benecial eects on
changes in the sleep-wake rhythm through a calming, muscle-relaxing
and balance-restoring action.
Magnolia extract also reduces blood cortisol levels, which are
increased in stress states; therefore, this substance also exhibits adaptive
activity in situations of severe psychological and physical stress [30].
Recent studies comparing magnolia extract with diazepam in
women who have stress-related anxiety and are overweight have shown
its equivalent ecacy to that of the drug [31,32].
Because postmenopause is a condition in which weight gain
represents a clinical condition that aects many women and in most
cases is associated with anxiety, this mechanism is converted into a
greater sensation of hunger with a preference for carbohydrates and
simple sugars, causing a sort of vicious cycle.
ere have been no reports of relevant side eects for any of these
ingredients and there is optimal compliance on the part of the women
mainly because they know they are taking natural products that do not
negatively interfere with their own genital tract and with the risk of
developing breast cancer.
Chaste tree berry
Particular mention should be made of chaste tree berry, which is
characterised by a few specic benecial properties for postmenopausal
women.
Chaste tree berry (Vitex Agnus-castus) is a phytocomplex
containing glycosides, avonoids, terpenes and alkaloids, and its main
active ingredient is agnuside; it has always been known as a product
that can resolve premenstrual syndrome problems in women of fertile
age and recently its usefulness has also been observed in menopause,
particularly in respect of vasomotor symptoms [5]. ese data have
suggested that there may be an analogy between this syndrome and
menopausal symptoms. e mechanism of action of chaste tree berry
involves an increase in hypothalamic dopaminergic tone; it expresses
a binding anity with oestrogen α (ERα) and β (ERβ) receptors and
stimulates m-RNA expression by the progesterone receptor (PR
expression) and that of pS2 (presenelin-2), another oestrogen-inducible
gene (Figure 4) [5,33]. Dopamine is the main neurotransmitter that
Citation: Leo VD, Cappelli V, Sabatino AD, Morgante G (2014) Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal
Disorders. J Women’s Health Care 3: 182. doi:10.4172/2167-0420.1000182
Page 5 of 6
Volume 3 • Issue 5 • 1000182
J Women’s Health Care
ISSN: 2167-0420 JWHC, an open access journal
controls the secretion of prolactin (Prl) by way of inhibition. ere
are clear data to show how it corrects the deciency of progesterone
in the corpus luteum during fertile life, by its action as a dopamine
agonist, and how it causes an improvement in menopausal symptoms
by reducing Prl levels.
in recent years, it has also emerged that, through its dopaminergic
action, chaste tree berry is also capable of engendering benecial eects
by improving the emotional symptoms typical of the menopause,
because a decrease in dopaminergic tone is correlated with psychological
symptoms [34].
A 2011 study has shown how the daily incidence of hot ushes
aer 8 weeks of treatment is signicantly decreased in women taking
chaste tree berry compared with a group taking placebo (Figure 5)
[35]; in addition, Kupperman’s index in the group treated with chaste
tree berry showed a statistically signicant dierence in terms of
the severity of hot ushes, night-time sweating, insomnia, anxiety,
depression, asthenia and headache compared with the control group.
However, there are few studies to date that focus on the possible activity
of chaste tree berry on sexual desire in menopausal women, although
data available to us regarding the dopaminergic and opioid action also
suggest the possibility of a topical formulation for treating dyspareunia
in these women [36].
is evidence suggests that the combination of phyto-oestrogens
and chaste tree berry can convincingly resolve the vasomotor and
psychological symptoms typical of peri- and postmenopausal women.
On the basis of these considerations, the potential availability of
a complete product consisting of phyto-oestrogens, chaste tree berry
and magnolia extract can be particularly useful, not only in resolving
vasomotor symptoms, but also in acting on the neuroendocrine
component that is the main cause of anxiety and certain neurovegetative
symptoms, such as sweating and night-time awakenings
Correlations Between Premenstrual Syndrome and
Vasomotor Symptoms in Menopause
ere is a correlation between premenstrual syndrome and
vasomotor symptoms, i.e. women who have suered from premenstrual
syndrome during their fertile life show more severe vasomotor
symptoms in the postmenopausal period.
One of the factors predominantly involved in the aetiopathogenesis
of both conditions is certainly the change in the dopaminergic and
serotoninergic systems, so that the administration of dopaminergic
drugs, such as bromocriptine and/or cabergoline, can improve both
sets of symptoms by normalising the dopaminergic and serotoninergic
systems.
e success of administration of chaste tree berry in women
with premenstrual syndrome is due to the restoration of a normal
dopaminergic tone. Postmenopausally, the combination of phyto-
oestrogens and chaste tree berry produces a more benecial eect on
dopaminergic tone with a more signicant reduction in the incidence
of vasomotor symptoms and, particularly, hot ushes.
e simultaneous presence of magnolia also encourages more
physiological sleep with fewer night-time awakenings.
Conclusions
For all of the above reasons, soya isoavones, which, in the light
of numerous clinical studies and according to reports from women,
appear to act by improving vasomotor symptoms, represent a valid
alternative to HRT. e properties of isoavones are not limited to
vasomotor symptoms alone, but they also have positive eects on bone
mass in that oestrogen β receptors, with which soya phyto-oestrogens
have a greater anity, are strongly expressed in bone.
In addition, isoavones exert an antioxidant action, reducing free
radicals, and have an inhibitory eect on the enzyme aromatase that
converts androgens to oestrogens in adipose tissue and increases the
risk of endometrial and breast cancer. Products used postmenopausally
not only contain phyto-oestrogens, but are oen combined with
calcium, vitamin D and other components, as is the case with the latest
preparation in which magnolia and in particular chaste tree berry
contribute signicantly to improving vasomotor and neurovegetative
symptoms.
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Citation: Leo VD, Cappelli V, Sabatino AD, Morgante G (2014) Phyto-Oestrogens and Chaste Tree Berry: A New Option in the Treatment of Menopausal
Disorders. J Women’s Health Care 3: 182. doi:10.4172/2167-0420.1000182
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0420.1000182
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Article
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To assess the effects of an oral soy isoflavone extract (Phytosoya) on endometrium and breast in postmenopausal women treated for 3 years. A total of 395 postmenopausal women were included in this international prospective, open-label study. The number of patients who completed the 3-year study was 197. The women were treated for 3 years with a specific, standardized soy isoflavone extract (total 70 mg/day). Endometrial biopsy, transvaginal ultrasonography and mammography were performed before and after 3 years of treatment. No case of hyperplasia/cancer was diagnosed among the 192 interpretable biopsies at 3 years. Only one case of simple hyperplasia was diagnosed among 197 post-baseline interpretable biopsies. The endometrial safety of this extract has been demonstrated (point estimate 0.5%). There was no statistically significant change in endometrial thickness after 3 years (98.4% inactive or atrophic and 0.3% proliferative endometrium at 1 year). Mammography results showed no notable change from baseline. No patient in any set developed an ACR classification of 4 or 5 after 3 years of treatment. The global safety was rated as either 'excellent' or 'good' by 99.1% of investigators and 99.0% of patients after 3 years of treatment. The adverse events were as follows: eight patients had metrorrhagia and seven patients had at least one breast adverse event: three patients had 'breast pain', two patients reported 'breast tenderness' and two patients had 'hypertrophic breast' (most of them were possibly treatment-related). As no case of hyperplasia was diagnosed among the 301 interpretable biopsies at 1 year and there was only one case of simple hyperplasia in the 197 post-baseline biopsies at 3 years, the endometrial safety of this extract has been demonstrated. Furthermore, as demonstrated by the lack of change in endometrial thickness associated with the histologic results, we suggest that this extract does not exert a mitogenic effect on the endometrium. These results suggest that daily administration of 70 mg of a specific, standardized isoflavone extract for 3 years could be a safe treatment for both endometrium and breast.