The menopause indicates the period in which the woman completely ceases the reproductive cycle: after about 40 years of menstrual cycles, the cycle initially becomes irregular, until it stops completely.
The average age at which a woman goes through menopause is around 51 years.
In menopause the absence of estrogen causes symptoms of varying severity: hot flushes, atrophy of the genitals and breasts, sweating, vaginal dryness, irritability, depression and osteoporosis due to the loss of calcium from the bone.
Classic drug therapy is based on estrogen-based and progesterone-based hormone replacement therapy, with the aim of reducing symptoms and preventing osteoporosis; while on the one hand the benefits are considerable, on the other this therapy is not without side effects: nausea, predisposition to thrombotic phenomena, hypertension, but above all an increase in the incidence of uterine and breast cancer.
Alongside the classic menopausal therapy it is useful to think of a phytotherapeutic aid able to alleviate the annoying associated symptoms: in this sense, the Cimicifuga ( Cimicifuga Racemosa) and the Agnocasto ( Vitex agnus-castus ) are very important.
Cimicifuga
Cimicifuga, commonly called "women's grass", is a perennial herbaceous plant cultivated throughout Europe, belonging to the Ranuncolaceae family; the drug consists of rhizomes and dried or fresh roots, and contains triterpene glycosides (actein and cimifugoside) - important for premenstrual and dysmenorrheic neurovegetative dysfunctions - phenolic acids, quinolizidine alkaloids, flavonoids and resins (cimicifugina).
Today, Cimicifuga is found on the market in the form of a standardized extract of 2.5% in triterpenes (acteina).
Cimicifuga does not have a known mechanism of action, although its activity is assumed to be central, due to the intervention of actein in particular on hypothalamic dopaminergic receptors.
Cimicifuga is able to reduce blood levels of LH (luteinizing hormone) but not those of FSH (follicle stimulating hormone) and prolactin; it also tends to antagonize mineral bone loss.
Many clinical studies have confirmed the ability of this plant to reduce the symptoms of menopause:
- 86.6% improvements in hot flushes;
- 88.5% improvement in excessive sweating;
- 91.9% improvement in headache;
- 86.5% improvement in irritability;
- 82.5% improvement in sleep disorders;
- 90.4% improvement in heart palpitations.
If used correctly, Cimicifuga appears to be a safe drug, although it can cause mild gastric disturbances. Furthermore, no interactions with other medicines are reported.
The plant contains salicylates, so it should not be taken by anyone with an allergy to acetylsalicylic acid.
Agnocasto and menopause
The other plant of interest is the Agnocasto: the drug is given by the ripe fruit of the plant, which appears as a black berry containing four seeds.
The Agnocasto drug contains iridoid glycosides (aucubin, agnoside), flavonoids (caticina, vitexin, isovitexina), terpenes (vitexilattone) and alkaloids (vaticina).
The Agnocasto extract acts directly at the level of the anterior pituitary gland: with a dopaminergic mechanism (stimulation on the D2 receptors of hypothalamus and anterior pituitary gland) it is able to inhibit prolactin secretion, both at basal level and stimulated by TRH; moreover, it modifies the blood levels of the luteinizing hormone and of the stimulating follicle hormone going to stimulate its secretion.
Also in this case it is not yet clear what the substance can cause the pharmacological effect, therefore it is believed that the iridoid glycosides, flavonoids and diterpenes can contribute to the pharmacological action.
The Agnocasto is a safe drug, which has no interactions with other drugs, although allergic reactions have been described however regressed with the interruption of treatment; side effects are mild and reversible and include nausea, headache, gastrointestinal and menstrual disorders, acne, itching and erythema.
Particular care should be taken in the case of use in conjunction with other hormonal therapies, given the endocrine properties just described.
Some pharmacological tests on the Agnocasto have confirmed its actions as antispasmodic and sedative for intestinal and abdominal pains: the administration of the extract showed beneficial effects in women between 20 and 40 years with recovery of progesterone and other blood levels endocrine values.
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In addition to Cimicifuga and Agnocasto, in the phytotherapeutic practice we also have other plants available with remedial substances for the most common menopausal disorders.
A class of very important compounds in this sense is that of isoflavones (improperly called phytoestrogens), which are found in many legumes, particularly in the Soja ( Soja hispida ) and in the Red clover ( Trifolium pratense ).
In Soja the active ingredients useful during menopause are located in the seeds, where we find isoflavones (genistein 70-85%, daidzein 10-30%, glycitein), lipids rich in unsaturated fatty acids (linoleic, linolenic and oleic), proteins and saponins with cholesterol-lowering effect.
The main effects of soya are to reduce hot flashes, sleep disorders, irritability and depression; due to the presence of cholesterol-lowering components it also reduces the incidence of vasomotor manifestations and total cholesterol levels; it is free of side effects, but the possible preventive action against breast and uterine tumors is very important.
As for the red clover, the leaves and flowers of this plant are used, where we find mainly isoflavones (biocanin A, which is the precursor of genistein, formononetin, genistein, daidzein).
Trefoil isoflavones are present in higher concentrations than those of soya, and this is why the posology of clover-based products is reduced.
The therapeutic properties of the clover are the same as the soja and include reduction of flushing and irritability, and prevention of bone loss.
One of the important factors during menopause is the drastic reduction of progesterone levels following a decline in its production: a very important plant in this sense is Dioscorea ( Dioscorea villosa) .
Dioscorea is rich in diosgenin, a sapogenin that is structurally very similar to progesterone; the use of this plant is able to normalize the estrogen-progesterone ratio; in fact, the intake of dioscorea dry extract titrated to 20% diosgenin, at a dose of one 400mg tablet per day, is the ideal supplement to the natural hormone replacement therapy in menopause.
The use of dioscorea extracts, through various clinical studies, has proved useful in promoting the maintenance of bone density but also in the treatment of vaginitis, endometriosis and uterine fibroids.
