The terms ‘PMS’ and ‘menopause’ are often met with raised eyebrows. Both are mediated by changes in women’s hormonal levels; may result in mood swings, irritability, dysphoria (unhappiness), tension and anxiety; and have scourged relationships between wives and their husbands, mothers and their children, sisters and their siblings, the world over. While these conditions are exclusive to women, brave individuals have often commented that it’s not just women that suffer. It’s everyone!
Menstrual Cycle Conditions
The menstrual cycle is a monthly process that women of child-bearing age go through which leads to the development of an egg in preparation of a potential pregnancy. This cycle is strongly governed by the levels of four hormones; Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) from the pituitary and oestrogen and progesterone from the ovaries. However despite its importance, the menstrual cycle can cause many distressing symptoms and problems in women. Disruption of the menstrual cycle itself can lead to a variety of ailments, such as luteal phase defects, amenorrhea (no menstruation), oligomenorrhea (infrequent menstruation), polymenorrhea (overly frequent menstruation) menorrhagia (long, heavy menstruation), and dysmenorrhea (painful menstruation which include: back spasms, abdominal pain, migraines, nausea, vomiting and diarrhoea). The causes of these conditions can be the result of a number of different factors; stress, diet, changes in weight, exercise regime or abnormalities involving the ovaries, pituitary gland or hypothalamus. The most common problem associated with the menstrual cycle however, is Pre-Menstrual Syndrome (PMS), a collection of symptoms felt in the lead up to menstruation.
Pre-Menstrual Syndrome (PMS)
PMS is characterised by a collection of physical and psychological symptoms occurring prior to menstruation. Ninety-five % of women experience some form of PMS, while 40% of women have symptoms severe enough to disrupt their lifestyle, and 5% are incapacitated by their symptoms (this condition is termed Premenstrual Dysphoric Disorder; PMDD).1
While symptoms vary widely between individuals, common physical symptoms include abdominal pain, bloating, headaches or migraines, back pain, swelling and breast tenderness. , Psychological symptoms may include irritability, tension, depression, aggression, dysphoria, fatigue, insomnia, food cravings and reduced libido.2,3,4
The exact causes and mechanisms of PMS remain elusive, although its relationship to the luteal phase of the menstrual cycle strongly suggests the fluctuating levels oestrogen and progesterone are at play. These hormones are responsible for regulating the production and release of a number of neurotransmitters in the central nervous system. Thus when hormone levels are altered, so too are the levels of neurotransmitters. In particular, serotonin, which has been shown to fluctuate during the occurrence of PMS.
Menopause
Sadly, the pain, anguish and discomfort associated with the menstrual cycle can persist throughout life, even increasing as women reach menopause. Menopause denotes the complete cessation of a woman’s menstrual cycles and fertility, usually around 45-55 years of age. With age, as the number of follicles in the ovaries diminishes, it causes a gradual decline in the level of hormones. The ovaries start to function erratically and the monthly cycle becomes less predictable and quite often, menstruation is skipped. The erratic behaviour of the ovaries can cause hormone levels to fluctuate significantly. This period of transition can vary considerably in duration from months to years. The transition, menopause itself and up to a year post-menopause is commonly referred to as peri-menopause. The fluctuating levels of hormones, in particular oestrogen can result in a variety of symptoms which vary substantially in severity and duration amongst individuals.
During peri-menopause, around two-thirds of women will experience vasomotor symptoms such as hot flashes and night sweats. Other common symptoms include vaginal dryness, breast tenderness, urinary tract infections, incontinence, depression, irritability, sleep and mood disturbances, sexual dysfunction, decreased libido and loss of skin elasticity.14, 15 It is also associated with decreasing cardiovascular health, accelerated bone loss and urogenital atrophy. In particular, mood and sleep disturbances can have a significant negative impact on the overall quality of life for a large proportion of women.15
Postmenopausal women are at increased risk of osteoporosis because of the association between oestrogen deficiency and accelerated bone loss. During the first five years of menopause, women can experience bone loss of 2-5% a year, leading to an increased risk of bone fractures, and result discomfort and loss on independence. Oestrogenic and phytoestrogenic replacement has been shown to help guard against the rapid onset of this condition.
Available Treatments/Therapies
Hormone Replacement Therapy (HRT)
Many symptoms associated with menopause are attributed to the decline in oestrogen as well as progesterone, thus one method is to simply replace them via hormone replacement therapy (HRT). This treatment is currently used by many women all over the world. HRT is effective at elevating oestrogen and progesterone levels thus can relieve symptoms associated with deficient levels of hormones such as hot flashes, night sweats and vaginal pain. But in cases where peri-menopausal symptoms are caused by excess hormone levels (breast tenderness, nausea, migraines, psychological) HRT can add fuel to the fire and the symptoms can be exacerbated or new unwanted symptoms can emerge.
Long-term treatment with HRT may be limited due to its potentially negative health effects: it has also been associated with an increased risk of breast cancer, endometrial adenocarcinoma and endometrial hyperplasia. Accordingly, current treatment guidelines indicate that HRT should be used only in the short term for moderate-to-severe symptoms, with the lowest effective dose for treatment. As a result, a number of complementary and alternative therapies for menopause (and PMS) have found favour among millions of women around the world.
Alternative HRT
Recent focus has centred around phytoestrogen compounds; naturally occurring plant derivatives that structurally resemble endogenous oestrogen (and progesterone). These compounds can bind directly to oestrogen receptors and act as selective oestrogen receptor modulators (SERMs), mediating oestrogenic activity throughout the body. Once bound to an oestrogen receptor they initiate the same response as endogenous oestrogen, but it is not as strong. This means phytoestrogens can increase oestrogenic activity when oestrogen levels are low and decrease oestrogenic activity when oestrogen levels are high (by competitively inhibiting endogenous oestrogen. Thus a distinct advantage of phytoestrogens over HRT is that they aim to regulate the hormone levels back to normal rather than simply increasing them. This means phytoestrogens can relieve the symptoms of hormone excess as well as deficiency. Importantly, the use of phytooestrogens does not exacerbate or result in any unwanted symptoms nor increase the risk of ovarian and breast cancer.
In light of the risks of HRT, the time to switch to an effective, minimum-risk medication for the management of menopause, PMS and general female health could not be better. Phytooestrogens in the form of soy isoflavones as well as chasteberry have been the focus of recent research for a natural solution for PMS and Menopausal conditions.
Soy Isoflavones
The health benefits of soy foods generally have been known to Chinese medicine for thousands of years. Now that soy isoflavones are available in a concentrated extract form, women are able to make the most of the health benefits of these compounds by increasing their intake to levels never before possible. Soy isoflavones (such as daidzin, genistin and glycitin) are types of phytoestrogens which can control fluctuating hormone levels back to normal, an important property to alleviate the symptoms of PMS and menopause. Recent findings show that soy isoflavones can reduce the severity and occurrence of menopausal symptoms such as hot flashes, increased perspiration and night sweats. In addition, their use is not associated with any adverse effects or an increased risk of cancer as in HRT. Soy isoflavones are a safer, attractive therapeutic choice for the management of menopause and general female health.
Isoflavones also have antioxidant properties which prevent oxidative damage to cells and tissues caused by free radical accumulation. This is important for skin protection and repair and the maintenance of a healthy cardiovascular system.
The gradual decline in oestrogen levels associated with menopause, is accompanied by a decreased ability to absorb calcium. As a consequence, women tend to undergo rapid bone loss (increased risk of osteoporosis) during menopause. Clinical evidence has emerged that chronic supplementation with soy isoflavones can significantly lessen the effects of peri- and post-menopausal bone degeneration.
But how much of soy isoflavones should women be taking per day? Studies have shown that these compounds exert a dose dependent behavior.
In doses less than 60mg/day of isoflavones, mild but significant improvements in menopausal symptoms have been observed in comparison to placebo controls. However some studies have shown the long-term effect of doses under 60mg/day have no beneficial effects. At 70mg/day, the improvement in symptoms was very effective and significant . Interestingly, 80mg/day of isoflavones has shown to also attenuate bone loss from the lumbar spine in oestrogen-deficient peri-menopausal women. From these studies, 80mg/day of isoflavones appears to be the ideal dose to effectively relieve symptoms of menopause and provide protection from bone loss.
However, in addition to the overall amount of isoflavones, a recent review has revealed that the amount of the different isoflavones is also critical. The review highlighted that all studies with more than 15mg/day of genistein were able to significantly decrease hot flashes in women. When only 15mg/day of genistein was given, just one of the six studies reported any significant improvements in symptoms. Thus in order to obtain the benefits of isoflavones on peri-menopause symptoms, it is important that genistein levels are greater than 15mg/day.
Vitex Agnus-Castus (Chasteberry)
Attracting considerable interest from pharmaceutical companies in recent years is chasteberry, a shrub native to the Mediterranean, Central Asia and America. It has been recognised in folk medicine for its beneficial properties since times dating back to Homer’s Iliad (6th Century BC).
The effects of chasteberry are thought to be mediated via two key pathways. Firstly, the inhibitory effects of chasteberry on prolactin production strongly suggest that it functions as a dopamine D2 receptor agonist. While controlling prolactin release, the dopaminergic system is also a key player in the regulation of motor function and emotional/behavioural control. Chasteberry’s action as a D2 receptor agonist is reinforced by the latter of these functions, given its beneficial effects on the PMS and menopause-related symptoms of mood, emotion and headache.
Clinical trials have shown chasteberry provides relief for women suffering from PMS and menopause-related distress. In double-blind, randomised, placebo-controlled studies, chasteberry has mediated significant improvements in irritability, mood alteration, anger and headache in women relative to placebo controls. Studies have also shown chasteberry provides relief from the common female symptoms of bloating, general oedema and mastalgia (breast tenderness), providing evidence for its beneficial regulatory effect on hormonal levels prior to, during and post menopause. It has also shown to improve irregularities of the menstrual cycle. A dose of 20mg/day of chasteberry extract is proven to be effective in relieving these unwanted symptoms of PMS and menopause .
Additional studies have also shown chasteberry to activate μ-opioid receptors. When activated, opioid receptors are considered the most proficient of all receptor types at providing pain relief. μ-opioid receptor activation is associated with the analgesic effects of drugs such as morphine and codeine. The activation of μ-opioid receptors by chasteberry therefore provides compelling evidence for its ability to provide effective pain relief during PMS and menopause.
Final Words
Herbal medicines such as chasteberry and soy isoflavones provide an effective alternative for the ongoing management of female health, PMS and peri-menopause. Soy isoflavones reduce peri-menopausal symptoms such as hot flashes, night sweats. In addition they provide bone support and promote healthy cardiovascular function. Chasteberry helps provide relief from menstrual cycle problems, PMS symptoms, and menopausal distress such as irritability, mood alteration, emotion, headache, pain relief, headache, bloating, general oedema and mastalgia.
References
Dickerson LM, Mazyck PJ, Hunter MH (2003) Premenstrual Syndrome, American Family Physician: 2003.
Mortola, J. L (1992) Premenstrual syndrome. The Western Journal of Medicine. 156(6): 651.
Previously spelled as “estrogen.” Some outdated acronyms still exist based on the old-fashioned spelling, such as “S.E.R.M.s” – “Selective Oestrogen Receptor Modulators.”
Clayton AH (2008) Symptoms related to the menstrual cycle: diagnosis, prevalence, and treatment, Journal of Psychiatric Practice, 14(1):13-21.
Yonkers KA, O’Brien PM, Eriksson E (2008) Pre-menstrual Syndrome, Lancet, 371(9619):1200-10.
Cheung, A. M, Chaudhry, R., Kapral, M., Jackevicius, C. and Robinson, G. (2004) Perimenopausal and Postmenopausal Health. BMC Women’s Health. 4(Suppl 1): S23.
Riggs BL, Khosla S, Melton LJ, III (2002) Sex steroids and the construction and conservation of the adult skeleton. Endocrine Reviews 23(3):279-302; Chapurlat RD, Gamero P, Sornay-Rendu E, Arlot ME, Claustrat B, Delmas PD (2000) Longitudinal study of bone loss in pre- and perimenopausal women: evidence for bone loss in perimenopausal women. Osteoporosis International 11(6):493-8.
Ma DF, Qin LQ, Wang PY, Katoh R. (2008) Soy isoflavone intake increases bone mineral density in the spine of menopausal women: meta-analysis of randomized controlled trials, Clinical Nutrition 27(1):57-64.
LaCroix, A. Z., Newton, K. M., Leveille, S. G., Wallance, J. (1997) Healthy Aging, A women’s issue. Successful Aging. West J Med. 167:220-232.
Bakken, K., Alsaker, E., Eggen, A.E. & Lund, E. (2005). [Estrogen replacement therapy and breast cancer]. Tidsskr Nor Laegeforen, 125: 282-5; Colditz, G.A. (2005). Estrogen, estrogen plus progestin therapy, and risk of breast cancer. Clin Cancer Res, 11: 909s-17s; Ewertz, M., Mellemkjaer, L., Poulsen, A.H., Friis, S., Sorensen, H.T., Pedersen, L., McLaughlin, J.K. & Olsen, J.H. (2005). Hormone use for menopausal symptoms and risk of breast cancer. A Danish cohort study. Br J Cancer, 92: 1293-7.
Rueda, B.R. & Zukerberg, L.R. (2005). Loss of cables is associated with development of endometrial hyperplasia and cancer. Int J Gynecol Cancer, 15: 400.
U.S. Preventive Services Task Force. (2005) Hormone therapy for the prevention of chronic conditions in postmenopausal women: recommendations from the U.S. Preventive Services Task Force. Anals of Internal Medicine. 142(10): 855-860.
Mueller, S.O., Simon, S., Chae, K., Metzler, M. & Korach, K.S. (2004). Phytoestrogens and their human metabolites show distinct agonistic and antagonistic properties on estrogen receptor alpha (ERalpha) and ERbeta in human cells. Toxicol Sci, 80: 14-25.
Finking Beate Hess, H.H.G. (1999). The value of phytoestrogens as a possible therapeutic option in postmenopausal women with coronary heart disease. J Obstet Gynaecol, 19, 455-9; Phipps, W.R., Duncan, A.M. & Kurzer, M.S. (2002). Isoflavones and postmenopausal women: a critical review. Treat Endocrinol, 1, 293-311.
Nahas EA, Nahas-Neto J, Orsatti FL, Carvalho EP, Oliveira ML, Dias R (2007) Efficacy and safety of a soy isoflavone extract in postmenopausal women: a randomized, double-blind, and placebo-controlled study, Maturitas 58(3):249-58; Faure ED, Chantre P, Mares P (2002) Effects of a standardized soy extract on hot flushes: a multicenter, double-blind, randomized, placebo-controlled study, Menopause 9(5):329-34; Upmalis DH, Lobo R, Bradley L, Warren M, Cone FL, Lamia CA (2000) Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study, Menopause 7(4):236-42; Khaodhiar L, Ricciotti HA, Li L, Pan W, Schickel M, Zhou J, Blackburn GL (2008) Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women, Menopause 15(1):125-32.
Finking Beate Hess, H.H.G. (1999). The value of phytestrogens as a possible therapeutic option in postmenopausal women with coronary heart disease. Journal of Obstetrics and Gynaecology, 19, 455-9; Phipps, W.R., Duncan, A.M. & Kurzer, M.S. (2002). Isoflavones and postmenopausal women: a critical review. Treatment Endocrinology, 1, 293-311.
Anthony, M.S., Clarkson, T.B., Hughes, C.L., Jr., Morgan, T.M. & Burke, G.L. (1996). Soybean isoflavones improve cardiovascular risk factors without affecting the reproductive system of peripubertal rhesus monkeys. The Journal of Nutrition, 126, 43-50; Kapiotis, S., Hermann, M., Held, I., Seelos, C., Ehringer, H. & Gmeiner, B.M. (1997). Genistein, the dietary-derived angiogenesis inhibitor, prevents LDL oxidation and protects endothelial cells from damage by atherogenic LDL. Arteriosclerosis, Thrombosis, and Vascular Biology, 17, 2868-74; Kirk, E.A., Sutherland, P., Wang, S.A., Chait, A. & LeBoeuf, R.C. (1998). Dietary isoflavones reduce plasma cholesterol and atherosclerosis in C57BL/6 mice but not LDL receptor-deficient mice. The Journal of Nutrition 128, 954-9.
Riggs BL, Khosla S, Melton LJ, III (2002) Sex steroids and the construction and conservation of the adult skeleton. Endocrine Reviews 23(3):279-302; Chapurlat RD, Gamero P, Sornay-Rendu E, Arlot ME, Claustrat B, Delmas PD (2000) Longitudinal study of bone loss in pre- and perimenopausal women: evidence for bone loss in perimenopausal women. Osteoporosis International 11(6):493-8.
Ma DF, Qin LQ, Wang PY, Katoh R. (2008) Soy isoflavone intake increases bone mineral density in the spine of menopausal women: meta-analysis of randomized controlled trials, Clinical Nutrition 27(1):57-64.
Khaodhiar, L., et al., Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women. Menopause, 2008. 15(1): p. 125-32.
Upmalis, D.H., et al., Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause, 2000. 7(4): p. 236-42.
Faure, E.D., P. Chantre, and P. Mares, Effects of a standardized soy extract on hot flushes: a multicenter, double-blind, randomized, placebo-controlled study. Menopause, 2002. 9(5): p. 329-34.
Alekel, D.L., et al., Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. Am J Clin Nutr, 2000. 72(3): p. 844-52.
Williamson-Hughes, P.S., et al., Isoflavone supplements containing predominantly genistein reduce hot flash symptoms: a critical review of published studies. Menopause, 2006. 13(5): p. 831-9.
Merz PG, Gorkow C, Schrödter A, Rietbrock S, Sieder C, Loew D, Dericks-Tan JS, Taubert HD (1996) The effects of a special agnus castus extract (BP1095E1) on prolactin secretion in healthy male subjects, Experimental and Clinical Endocrinology & Diabetes, 104:447-453.
Schellenberg R (2001) Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ, 322(7279):134-7; Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A (2008) Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch Gynecol Obstet, 264:150-3; Loch EG, Selle H, Boblitz N (2000) Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus, Journal of women's health & gender-based medicine. 9(3):315-20.
Ibid; Huddleston M, Jackson EA (2001) Is an extract of the fruit of agnus castus (chaste tree or chasteberry) effective for prevention of symptoms of premenstrual syndrome (PMS)? The Journal of Family Practice 50(4): 298.
German E Monograph, Chaste tree Fruit.
Loch, E.G., H. Selle, and N. Boblitz, Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health Gend Based Med, 2000. 9(3): p. 315-20
Schellenberg, R., Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ, 2001. 322(7279): p. 134-7
Webster DE, Lu J, Chen SN, Farnsworth NR, Wang ZJ (2006) Activation of the mu-opiate receptor by Vitex agnus-castus methanol extracts: implication for its use in PMS, Journal of Ethnopharmacology, 106(2):216-21.
