Current controversies in the treatment of gynecological disorders with plant derived extracts

Hormone therapy of gynecological disorders include in many cases treatment with estrogens. The endogenous estrogen is estradiol 17β (E2) which addresses both cloned estrogen receptors (ERs) equipotently. So called selective estrogen receptors modulators (SERMs) are currently in the focus of many academic and industrial scientists which have exclusively beneficial but no undesired effects in the female organism, i.e. they should reduce climacteric complaints, have antiosteoporotic effects and reduce VLDLs and LDLs but increase HDLs thereby reducing the “bad” cholesterol stores and possibly also atherosclerotic events. Clinically useful SERMs should have no effect in the endometrium, the uterus and if possible also not on blood clotting factors. Treatment with substances addressing the estrogen receptors have been used in the past as oral contraceptives, for the treatment of premenstrual symptoms and for the treatment of climacteric and postmenopausal complaints and diseases. Particularly this latter aspect is issue of many controversial publications. The HERS, the WHI and the Million Women Studies have raised more questions than given answers to the question as to whether classical of hormone replacement therapy (HRT) bears more dangers than benefits for patients. This has led to an increased use of alternatives which include plant derived extracts. The sales of soy and red clover products which contain estrogenic isoflavones have increased and highly controversial discussions are going on whether these isoflavones have exclusively beneficial effects as claimed by industry or also the undesired effects of estrogens as warned by many scientists in academia. In view of the many placebo controlled studies in which no effects were observed by soy/red clover products their uncontrolled use appears to be problematic.