While some women glide through menopause, more than 85 percent experience one or more unpleasant symptoms, which can affect their physical and mental health, daily activities, and quality of life.
Hot flashes and night sweats are the symptoms for which the most women seek treatment, affecting 75 percent of women. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression, and brain fog.
While many doctors consider menopause hormone therapy to be the most effective treatment for menopausal symptoms, it’s sometimes not recommended (such as following breast cancer, as there is conflicting evidence about its safety in that circumstance) or avoided in favor of nonhormonal therapies. In Australia, it’s estimated that more than one-third of women seek complementary or alternative medicines to manage menopausal symptoms.
But do they work? Or are they a waste of time and considerable amounts of money?
What’s on the Market?
The complementary or alternative interventions for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioral therapy, and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements).There is some evidence to support the use of hypnosis and cognitive behavior therapy for the treatment of hot flashes, and these therapies are even recommended in clinical treatment guidelines. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements.
The most popular nutritional supplements for hot flashes are phytoestrogens (or plant estrogens). This trend has been driven in part by supplement companies that promote such agents as a safer or more natural alternative to hormone therapy.
What Are Phytoestrogens?
Phytoestrogens are plant-derived substances that can show estrogen-like activity when ingested.There are numerous types including isoflavones, coumestans, and lignans. These can be consumed in the form of food (such as whole soybeans, soy-based foods such as tofu and soy milk, legumes, whole grains, flaxseeds, fruits, and vegetables) and commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones, and flaxseed gives us lignans.
Because declining estrogen levels drive menopausal symptoms, the theory is that consuming a substance that acts like estrogen will provide relief.
Phytoestrogens can be consumed in foods such as tofu or soy milk. somrak jendee/Shutterstock
What Does the Evidence Say?
In the case of isoflavones, initial support came from epidemiological data showing that women in Asian countries who consumed a traditional, phytoestrogen-rich diet (that is, one including tofu, miso, and fermented or boiled soybeans) experienced fewer menopausal symptoms than women in Western countries.However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing that only about 30 percent of women from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared with an estimated 50 to 60 percent of menopausal women from Japanese populations.
Circulating estrogen levels (which drop considerably during menopause) and the duration of soy intake (longer-term intake being more favorable) may also influence the effect of dietary phytoestrogens on menopausal symptoms.
Overall, evidence regarding the benefit of phytoestrogens for hot flashes is fairly mixed. A Cochrane review synthesized study results and failed to find conclusive evidence that phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flashes or night sweats in perimenopausal or postmenopausal women.
The review did note that genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flashes experienced by symptomatic postmenopausal women, though to a lesser extent than hormone therapy.
Another recent study showed marked reductions in hot flashes in women following a low-fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit.
In Australia, clinical guidelines don’t endorse the routine use of phytoestrogens. Guidelines for the United Kingdom note some support for the benefit of isoflavones but highlight that multiple preparations are available, their safety is uncertain, and interactions with other medicines have been reported. In the United States, the Office on Women’s Health notes that many women do find relief from menopause symptoms with remedies such as red clover and soy, which both contain phytoestrogens.
Can Phytoestrogens Help the Psychological Symptoms of Menopause?
Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety, and brain fog.A recent systematic review and meta-analysis found that phytoestrogens reduce depression in post- but not perimenopausal women. A more recent clinical trial found no improvement.
Some research suggests phytoestrogens reduce the risk of dementia, but there are no conclusive findings regarding their effect on menopausal brain fog.
The Bottom Line
At present, there is uncertainty about the benefit of phytoestrogens for menopause symptoms.If you do wish to see whether they might work for you, start by including more phytoestrogen-rich foods in your diet, such as tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans, and alfalfa. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms.
Try including one to two servings per day for about three months and monitor symptoms. Before you try any supplements, discuss them first with your doctor (especially if you have a history of breast cancer); if your symptoms don’t improve after three months, stop taking them.
Caroline Gurvich is associate professor and clinical neuropsychologist at Monash University in Australia, Jane Varney is senior research dietitian in the department of gastroenterology at Monash University, and Jayashri Kulkarni is professor of psychiatry at Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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