Climacteric Syndrome during Peri-menopause: Pycnogenol
Climacteric Syndrome during Peri-menopause: Pycnogenol
Abstract & Commentary
By Dónal P. O'Mathúna, PhD. Dr. O'Mathuna is a lecturer in Health Care Ethics, School of Nursing, Dublin City University, Ireland; he reports no financial relationships relevant to this field of study.
Source: Yang HM, et al. A randomized, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in peri-menopausal women. Acta Obstet Gynecol Scand. 2007;86:978-985.
The objective of this trial was to conduct a clinical investigation of the effect of Pycnogenol, French maritime pine bark extract, on climacteric syndrome. French maritime pine bark extract (Pycnogenol) was found to alleviate menstrual pain and reduce hyperactivity in clinical studies. These results suggest the possibility to observe positive effects in treating climacteric syndrome. Some 200 peri-menopausal women were enrolled in a double-blind, placebo-controlled study and treated with Pycnogenol (200 mg) daily. Climacteric symptoms were evaluated by the Women's Health Questionnaire (WHQ). Patients were checked for antioxidative status and routine chemistry. A total of 155 women completed the study. All climacteric symptoms improved, antioxidative status increased, and LDL/HDL ratio was favorably altered by Pycnogenol. No side effects were reported. Pycnogenol may offer an alternative method to reducing climacteric symptoms without unwanted effects.
Menopause is brought on by the drop in estrogen levels that occurs naturally with age or after surgery or disease. About three-quarters of women report a wide variety of troublesome symptoms, most commonly hot flashes and vaginal dryness and irritation. The severity and frequency of these symptoms vary widely. Peri-menopause is the period immediately prior to menopause and the first year after menopause (defined as when a woman has had no menstrual periods for 12 consecutive months).
Hormone replacement therapy (HRT) was widely used to relieve peri-menopausal symptoms until a number of studies in 2002 reported that HRT had more adverse effects than had previously been considered.1 Almost immediately, more conservative approaches to treating menopausal symptoms were sought, including complementary therapies. Even before this, however, menopausal symptoms were one of the most common reasons why women used herbal remedies.2 Much interest has focused on black cohosh, especially a specific commercial preparation called Remifemin®. This has been shown to modestly reduce symptoms like hot flashes with few adverse effects.3
The study by Yang and colleagues reports on another propriety product, Pycnogenol®. This standardized extract is made from the bark of the French maritime pine (Pinus pinaster). The extract contains a complex mixture of compounds called polyphenols and bioflavonoids. The term pycnogenol is also used for extracts of other natural products containing similar compounds, in particular some grape seed extracts.
Pycnogenol® has been recommended for a wide variety of conditions, including allergies, asthma, hypertension, muscle soreness, attention deficit-hyperactivity disorder, endometriosis, dysmenorrhea, erectile dysfunction, and to prevent vascular conditions such as heart disease and varicose veins, to slow aging, and maintain skin health. It is added to a number of "anti-aging" creams.
The Yang et al study measured menopausal symptoms and general discomfort using the Women's Health Questionnaire (WHQ). They also screened blood pressure, cholesterol and triglyceride levels, and total antioxidant status (TAS) at enrollment and again after 1, 3, 4, and 6 months.
Over the course of the study, no significant differences in blood pressure were found between the pycnogenol and placebo groups. HDL-cholesterol levels did not differ, but LDL-cholesterol levels were significantly lower in the pycnogenol group than placebo. This led to a more beneficial LDL/HDL ratio overall. The TAS also was significantly better in the group taking pycnogenol due to its antioxidants. Taken together, these results show that pycnogenol contributes to lowering important risk factors for cardiovascular disease in peri-menopausal women. However, the incidence of cardiovascular disease was not measured in this study.
Regarding the peri-menopausal symptoms themselves, all symptoms measured by the WHQ were significantly better with pycnogenol compared to placebo. The improvements were significant after 1 month of treatment, and they continued to improve throughout the 6 months of the study. Both the frequency and severity of the symptoms improved, leading to better overall quality of life. No adverse effects were reported by participants.
Other studies have suggested that pycnogenol does not act as a phytoestrogen. Instead, animal experiments have shown that pycnogenol stimulates the production of nitric oxide (NO). NO is a naturally occurring messenger molecule that leads to relaxation of vascular tissue, including blood vessels. The molecule can also lead to the release of neurotransmitters, which may explain the improved mood and memory found with pycnogenol.
The Yang et al study also found ethnic differences in the most commonly reported menopausal symptoms. The participants in the study were from Taiwan, and the most common symptoms were somatic (tiredness, headache), followed by anxiety and menstrual problems. When the WHQ was used with European women, the most common symptoms were vasomotor (hot flashes), loss of memory, attractiveness, and sleep problems. It would, therefore, be important to repeat this study with groups of women from other ethnic groups to ensure pycnogenol relieves the symptoms held to be most disturbing by those groups.
This well-conducted study gives evidence to support the use of Pycnogenol® for the relief of peri-menopausal symptoms in Taiwanese women. The lack of adverse effects is also encouraging. Pycnogenol® is available as a standardized product, giving greater confidence of consistent, high quality products compared to those which are unstandardized.
1. Rossouw JE, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321-333.
2. Pinn G. Herbs used in obstetrics and gynaecology. Aust Fam Physician. 2001;30:351-354, 356.
3. Bai W, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibolone. Maturitas. 2007;58:31-41.O’Mathuna DP. Climacteric Syndrome during Peri-menopause: Pycnogenol. 2008;10:22-23.
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