omens H f W ea o l l th a Leo et al., J Women’s Health Care 2014, 3:5 n C r a u r e o DOI: 10.4172/2167-0420.1000182 J Journal of Women's Health Care ISSN: 2167-0420 Research Article Open Access 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 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 Keywords: Menopause; Vasomotor symptoms; Hot flushes; Phyto- fibres, and decreased sexual desire; subsequently, the process of atrophy oestrogens; Magnolia; Chaste tree berry also affects the epidermis with thin, pale skin that is easily susceptible to bacterial and viral infections. A similar condition is observed in the Introduction vagina with a reduction in thickness of the mucosa, which becomes atrophic with reduced vascularisation and results in dyspareunia (Table For a woman, menopause represents a transitional phase from 1) [2]. a fertile to a non-fertile age, in which there is a gradual reduction in ovarian function accompanied by a gradual cessation of oestrogen Among the most important long-term complications, attention production [1]. During this period, women are faced with irregular should be drawn to the loss of minerals and consequent reduction in ovulatory or anovulatory cycles without a systematic progression from bone mass, which is associated with osteopenia and osteoporosis of one to the other. varying degrees and dysfunction and atrophy of the genitourinary tract. With the passage of time, oestrogen deficiency in fact accelerates the The mean age of onset of this phase is 40 to 50 years and it is certainly process of bone demineralisation, as oestrogens promote the absorption the most vulnerable period in a woman’s life in that hormone deficiency of calcium in the intestine and the mineralisation process in bone [3]. causes neuroendocrine changes that constitute the pathophysiological basis of neurovegetative disorders (Figure 1). The most common symptoms of menopause, even when taking into account all the different populations studied, are hot flushes, which The clinical presentation can involve a series of disorders, including affect between 65% and 86.8% of the menopausal female population, hot flushes with episodes of sweating, particularly at night, palpitations, whereas night sweats affect between 65% and 82.1%, insomnia between changes in sleep-wake rhythm, irritability, anxiety and mood changes, 61% and 67.8% and mood changes between 57% and 47.5% [4,5]. vaginal dryness due to a process of progressive atrophy with thinning of the outer and inner labia, reduction of vascularisation and elastic The symptom for which postmenopausal women most frequently visit their doctor for relief is the occurrence of hot flushes [6]. This symptom is present in more than 80% of women entering into physiological menopause, while it affects 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]. *Corresponding author: Prof Vincenzo De Leo, Molecular Medicine and Development Department, University of Siena, Italy, Tel: +390577233465; Fax: +390577233454; E-mail: [email protected] 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 Figure 1: Main changes in the neuroendocrine axis in menopause. use, distribution, and reproduction in any medium, provided the original author and source are credited. J Women’s Health Care Volume 3 • Issue 5 • 1000182 ISSN: 2167-0420 JWHC, an open access journal 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 Short-term Medium-term Long-term peripheral vasodilatation and thus returning the system to a state of symptoms symptoms symptoms equilibrium. It is specifically the increase in noradrenaline which − Urogenital disorders − Menstrual irregularity results in sweating and hot flushes in menopausal women with the aim o Vaginal dryness − Hot flushes o Dyspareunia − Osteoporosis of reducing raised body temperature [12]. − Sweating o Urinary incontinence − Cardiovascolar (including at night) − Cutaneous and mucosal atrophy disorders Dopamine also plays an important role in thermoregulation in − Insomnia o Cutaneous hypoelasticity − Atherosclerosis − Anxiety that it too is devoted to maintaining a state of euthermia via the D2 (increased wrinkles) − Alzheimer’s − Depression o Atrophy of the oral mucosa disease receptors. As has long been known, bromocriptine, a dopamine − Asthenia o Eye symptoms agonist, is able to increase the activity of the hypothalamic endogenous − Irritability − Obesity opioid system (β-endorphins) on the mechanisms regulating body Table 1: Schematic representation of the main short-term, medium-term and long- temperature in menopause [13]. In fact, β-endorphins are also involved term symptoms of menopausal women. 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 Figure 2: Heat control system during fertile life and changes in the menopausal woman. thermoregulation and vasomotor stability. The resultant outcome is connected with menopausal symptoms. The 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. Figure 3: Mechanism of development of hot flushes in menopause. Postmenopausally, the decrease in oestrogens reduces the inhibitory activity of β-endorphins on noradrenaline and causes an A review from 2009 on this subject shows that more severe hot increase in activity of the noradrenergic system but also a reduction flushes can be correlated with rapid bone loss and the subsequent of the dopaminergic system, which is significantly less active than in development of osteoporosis within a short period of time [9]; they premenopausal women (Figures 2 and 3) [7,8]. are also related to a weaker verbal memory [10] and reduced levels of plasma antioxidants, but also to an increased cardiovascular stress All these mechanisms explain the positive effect of hormone response and to changes in blood pressure. therapy, resulting in stimulation of the D2 dopaminergic receptors and the subsequent attenuation of the menopausal symptoms associated The vasomotor symptoms are also correlated with a significant with hot flushes and sweating, with a consequent improvement also increase in the risk of coronary heart disease, which does not appear in the psychological correlations and a decrease in the risk factors for to be entirely explicable by other risk factors for coronary heart disease osteoporotic and cardiovascular diseases. [11]. Melatonin levels and the time during which these levels remain Given the importance that these symptoms assume for the woman, high during the night also differ during the various phases of life, with a not only for the perceived quality of life, but also for the increased risk significant decrease with advancing age; this explains why sleep is often of developing all the diseases listed above,