One hundred thousand American women enter menopause each month. Most of them won’t be taking estrogen pills to replace the estrogen their bodies no longer produce.
Yes, they know that estrogen curbs hot flashes, night sweats, vaginal dryness, mood swings, changes in sleep patterns and other symptoms of menopause. They also may know that, over the long term, hormone replacement therapy reduces the risk of heart disease, osteoporosis and maybe even Alzheimer’s disease.
But for many, estrogen simply isn’t an option as long as some research suggests that it raises the risk of breast cancer.
Can you smell an opportunity?
Supplement-makers can. “Dramatic benefits within 4 to 8 weeks,” Remifemin promises. A midlife change “just as nature intended,” offers Promensil.
Of course, it doesn’t hurt sales that taking anything seems to help relieve menopausal symptoms, at least for a time. “The placebo effect is giant,” concedes one manufacturer.
But beyond that, there isn’t much evidence that menopausal shakes, powders or pills work.
Heal, phyto
The active ingredients in most dietary supplements for menopause are phytoestrogens–chemicals found in plants that may act like the estrogen produced naturally in the body.
“These plant estrogens are thousands of times weaker than natural estrogen,” says nutritionist Mindy Kurzer of the University of Minnesota. “But they also circulate in the blood at levels thousands of times higher than natural estrogen.” That’s why researchers want to know if plant estrogens work like natural estrogen.
The food that is richest by far in phytoestrogens is soybeans. A typical 3-ounce serving of tofu, for example, contains about 23 milligrams of isoflavones (the major group of phytoestrogens). About a half-cup of shelled peanuts, on the other hand, has less than a 10th of a milligram. Menopausal supplements made from herbs like black cohosh, red clover and dong quai may contain soylike levels of plant estrogens.
“Researchers thought that Asian women may experience milder symptoms during menopause than Western women because the soy foods in their diets provide plant estrogens to supplement their dwindling supply of natural estrogen,” says Margo Woods of Tufts University in Boston.
But that’s not proof that soy foods–or the phytoestrogens in soy foods or menopausal supplements–ease women’s discomfort.
Soy foods and powders
So far, seven studies have compared soy protein shakes, bars, muffins and flour to look-alike (but soy-less) placebos. Two of them found that soy curbed hot flashes.
But even though both studies used similar soy powders, their results were inconsistent:
– Once a day for six weeks, Gregory Burke and colleagues at Wake Forest University in North Carolina gave a soy protein beverage containing 34 milligrams of isoflavones to 42 women who had been experiencing at least one daily hot flash or episode of night sweats. For another six weeks the women were given a placebo beverage, and for another six weeks they were given the soy beverage twice a day.
Drinking soy once a day did nothing to relieve their symptoms, the women reported, while taking it twice a day reduced the severity–but not the number–of hot flashes by 20 percent. The soy drinks had no effect on other symptoms.
– In an Italian study published in Obstetrics and Gynecology in 1998, 51 women with severe hot flashes drank a soy protein beverage twice a day (with a total of 76 milligrams of isoflavones) for 12 weeks, while 54 similar women were given a placebo.
The average number of hot flashes in the soy-drinkers declined from 11 a day to six. In the placebo group it dropped from 11 to eight. Although statistically significant, “that’s a very modest difference,” says Tufts’ Woods. “It may not be enough for some women who are looking for an alternative to estrogen.”
The Italian researchers didn’t measure the severity of the women’s hot flashes, and the soy had no effect on symptoms like anxiety, headaches or insomnia. (The beverages used in the U.S. and Italian studies were similar to Ross Laboratories’ Health Source Soy Protein Shake.)
In five other studies, soy products were no better than soy-free placebos at relieving any menopausal symptoms. They included:
– Soy-flour muffins (with 80 milligrams of isoflavones) eaten once a day by 48 women for six months, in a study by Iowa State University.
– Soy bars (with 23 milligrams of isoflavones) eaten twice a day by 76 women for three months.
– Bread baked with soy flour (with 70 milligrams of isoflavones) eaten once a day by 23 women for 12 weeks.
The bottom line
“Most studies find that soy has no effect on menopausal symptoms,” Burke says. “When a benefit is detected, it appears to be relatively mild, and much less than what women get from estrogen replacement therapy.”
No good studies have looked at foods like tofu, soy cheese or soy burgers (some burgers and other soy foods may not even have decent levels of isoflavones). As for menopausal supplement pills: “We have yet to see any good published data that suggest that these pills have a significant impact on menopausal symptoms like hot flashes or night sweats,” Burke says. What’s more, generous doses of isoflavones from powders or pills may not be safe (see story on this page).
“Soy will probably lower your cholesterol levels if they’re high, and maybe future research will show that soy can prevent osteoporosis and certain cancers,” Burke says.
But when it comes to the discomfort of menopause, don’t expect a miracle.
PRACTICING SAFE SOY
Are phytoestrogen powders and pills safe to take?
“We don’t know,” says soy researcher Gregory Burke of Wake Forest University. “We don’t have evidence suggesting they’re not safe. But I’m concerned that it’s easier for people who take pills to get larger dosages, which may put them at higher risk.”
Two recent studies also have raised red flags. British researchers last year found that eating about 2 ounces of soy powder containing 45 milligrams of isoflavones each day for just two weeks stimulated the proliferation of epithelial breast cells in premenopausal women.
An earlier U.S. study found an increase in breast cell proliferation in more than a quarter of women given a daily soy protein beverage with 38 milligrams of isoflavones.
Any time cells multiply, there’s an increased risk of cancer. “That’s very worrisome,” says Tufts University researcher Margo Woods. “If we had no data suggesting harm, I’d feel a little bit better. But this is in the opposite direction of what we expected.”
Animal evidence also raises questions. “If lab mice are fed the isoflavone genistein before they’re exposed to a cancer-causing chemical,” says Bill Helferich of the University of Illinois at Urbana-Champaign, “the development of breast cancer is suppressed. In some studies, if they get the genistein after cancer has begun to develop, the genistein stimulates the growth of tumors.” Researchers don’t know if the same is true in humans, he cautions.
But until they find out, anyone who has had breast cancer should stick to soy foods (like tofu), not supplement pills or powders.
— David Schardt
