Menopause is defined as a 1-year period since the last menstrual cycle and typically occurs in females between 45 and 55 years of age. During this period, the ovaries stop producing the sex hormones estrogen and progesterone. This lack of circulating sex hormones during menopause and even after menopause is responsible for an increased risk of several diseases including cardiovascular disease, various cancers, and osteoporosis, to name a few. In an effort to lower these risks, hormone replacement therapy consisting of estrogen alone or in combination with progestin is commonly recommended for menopausal and post-menopausal women.

Hormone replacement therapy (HRT) increases the circulating levels of estrogen and progesterone to pre-menopausal levels. Hormone replacement therapy gained wide acceptance when numerous studies reported increases in bone mineral density, reductions in hip fracture risk and lowered colorectal cancer risk. However, recent studies have reported a number of negative health outcomes associated with chronic use of these hormones and many now feel that the risks of hormone replacement therapy may now outweigh the benefits.

Estrogen therapy alone results in thickening of the uterine lining and increases uterine cancer risk. Combination therapy was shown to increase breast cancer risk after 4 years of continued use. Although some studies have reported that hormone replacement therapy has a favorable effect on the cholesterol profile, estrogen and progesterone therapy increases heart attack risk after only 1 year of use and this risk remains elevated even after hormone therapy is discontinued. Combination hormone therapy also increases the risk for stroke, blood clots and even dementia. While many women do provide themselves proper care and follow a healthy diet rich in natural vitamins, plant foods, liquid vitamins and the like, Alternative Health habits are often countered by the adverse effects of HRT therapy.

Aside from these significant health risks, there are also ethical issues associated with HRT. Premarin, an estrogen replacement, and Prempro, a combination estrogen/progestin drug, are two of the most commonly prescribed hormone replacement therapy drugs. Both of these drugs are manufactured from the urine of pregnant mares. For over half of their pregnancy, these horses are kept confined to stalls that do not allow them space to turn around or move more than a single step in any direction. These horses continually wear bags for collecting urine, are on vitamin poor diets and have limited drinking water in order to concentrate the hormone levels. The foals of these horses are either used for production of estrogens or slaughtered for the sale of their meat. Because of the extensive research reporting negative health outcomes and due to the unethical practices attributed to obtaining hormones for hormone replacement therapy in postmenopausal women, natural alternatives to this drug regimen have received much attention as of late.

Most of the attention for alternative medicine has focused on phyto(plant)estrogens from soy products. Phytoestrogens alter circulating levels of sex hormones and offer the same positive benefits of hormone replacement therapy without the severe side effects. The richest source of isoflavones in the diet comes from soy products. Soy consumption exerts hormonal changes in post-menopausal women. The phytoestrogens function as estrogen agonists and benefit bone and the cardiovascular system. Furthermore, populations that consume high quantities of soy have lowered chronic disease risk and fewer and less severe menopausal symptoms.

Several studies have reported the benefits of consuming soy isoflavones in post-menopausal women. Preliminary outcomes suggest that soy may have beneficial effects on the cardiovascular system and bone with no adverse effects on the endometrium or on cancer risk. A recent study published in the American Journal of Clinical Nutrition of over 68,000 women aged 40 to 70 years reported a 33% decrease in colorectal cancer risk for those with the highest intake of soy products. Dr. Carey Gleason from the University of Wisconsin Department of Medicine recently reported that soy isoflavones also have positive cognitive effects in older adults, a result opposite that seen with hormone replacement therapy. The optimal daily intake to achieve these health benefits is reported to be 3 teaspoons of soy protein and 1 teaspoon of soy isoflavones.

The efficacy of soy products in post-menopausal women may be further enhanced by consuming the right type of soy. Soy products can be categorized as non-fermented and fermented. Non-fermented products include soybeans, nuts, flour, tofu and soymilk. Fermented soy products include miso, soy sauce, fermented tofu and natto. The main benefits of fermented soy products in post-menopausal women include greater isoflavone bioavailability and protection from menopause-related health problems. The fermentation process produces healthy bacteria that convert isoflavones into a free form, which enhances bioavailability and enhances the positive health effects of soy. Fermented soy products have also been shown to reduce cholesterol and triglycerides, lower blood pressure, inhibit progression of atherosclerosis, lower cancer risk by retarding tumor growth especially in the stomach, prevent bone mineral loss and reduce severity of hot flashes. Soy products are typically good natural sources of vitamins and minerals. Caution: Before you ingest large quantities of soy products get tested for food intolerances.

Fermented soy products also provide less obvious, yet still important, health benefits over non-fermented soy foods. Fermented soy products are easier to digest because enzymes produced during the fermentation process predigest the carbohydrates found in the soy and improve the protein digestibility. Furthermore, fermentation improves the solubility and absorption of minerals and increases the amount of available vitamin content. Finally, fermented soy products enhance gastric secretions, thereby allowing even greater digestibility. Not surprisingly, Japan consumes the most fermented soy products of any country and has the longest lifespan of any country. The Japanese also customarily consume large amounts of green tea which is also purported to help increase one's lifespan.

Overall, ingestion of soy products to treat symptoms of post-menopause yields significant health advantages and presents no known physical problems or ethical issues like hormone replacement therapy does. Furthermore, preliminary evidence in animals and humans alike suggests that fermented soy products such as miso, fermented tofu and soymilk may offer greater health benefits compared to unfermented soy in the post-menopausal woman.

by Dr. Linda Kennedy MS SLP ND