Management of the menopausal disturbances and oxidative stress

Women frequently seek gynaecologic medical advice at menopause and require pharmacologic interventions to control subjective vasomotor complaints and to prevent late severe organic complications, which may effect the genitourinary tract, the skeletal, the cardiovascular and the nervous system. Depending on the severity of the presentation and the involvement of additional systems beyond the reproductive tract, physicians have several distinct therapies available, which should be carefully evaluated and administered in a "patient-personalised" fashion: they include organ-oriented drugs, available for selective treatment in patients which do not display major direct endocrine symptoms, as well as endocrine therapies (administration of native estrogens; or synthetic selective hormonal drugs, i.e. SERMs and SEEMs). Much interest is now focusing on new kinds of plant estrogen-like compounds, mostly isoflavones, which by one hand display estrogen-like (or antagonistic) effects, by the other are powerful antioxidising agents. In our survey, we discuss extensively the enormous amount of data available in the literature, underlining by one side that most of the formulations currently in use for the overall therapy of menopausal complaints have structure features also characteristic of antioxidising agents, by the other that there are wide evidences of increased oxidative damage occurs in women during the postmenopausal life. These observations suggest the possibility of a contribution of antioxidising activity of the administered drugs to the beneficial clinical effects on the patients, in agreement with the demonstrated estrogen intrinsic antioxidising activity in vitro. This stresses the requirement of further basic and clinical studies on the relevance of oxidative damage during postmenopausal female life.