Menopause quality of life unchanged by soy supplements
David Cohen, M.D.·Published 18 December 2012·9 min read
Key points
Menopausal women who took soy supplements during a two-year trial reported no differences in quality of life compared to their counterparts taking placebo pills, U.S. researchers report.
With all that we know about the pitfalls of conventional medicine's treatment of women in menopause, it makes sense that women are turning to natural approaches to relieve menopausal discomforts.
In fact, beyond the three fundamentals embodied in our Personal Program - core nutrition, stress reduction, and botanical endocrine support - soy is our next-best-step when it comes to hot flashes in menopause.
Studies abound on both the health benefits and the detrimental effects of soy, with somewhat conflicting results.
Menopausal women who took soy supplements during a two-year trial reported no differences in quality of life compared to their counterparts taking placebo pills, U.S. researchers report.
It's possible that soy could still offer women some benefits through menopause, said the study's lead author Dr. Paula Amato, from Oregon Health and Science University in Portland, "but I think if you are similar to the subjects in the study, then probably taking supplements isn't going to make a huge impact on your quality of life."
In light of health concerns attached to taking hormones, soy has been seen as an attractive alternative for relieving menopausal symptoms. But research on the effectiveness of soy extracts for hot flashes and other bothersome symptoms has yielded conflicting results so far.
In the new report, published in the medical journal Menopause, Amato and her colleagues looked not just at specific symptoms but overall quality of life measures among healthy women, mostly in their 50s and six years or more into menopause on average.
Several hundred women were asked to take supplement pills three times a day for two years. Among them, 126 took a fake supplement that contained no soy extract, while 135 women took tablets containing a total of 80 milligrams a day of soy protein and another 123 women took 120 mg each day.
At the start of the study and again one and two years into it, the women filled out a quality of life survey that asked about mental, physical and sexual health as well as about hot flashes.
In each of the surveys, the women in all three groups scored similarly on the main measures in the questionnaire.
"From our study and the good amount of the literature to date it appears that taking soy supplements after menopause does not improve quality of life," said Amato. "We can't really recommend it to our patients."
SOY AND MENOPAUSE
With all that we know about the pitfalls of conventional medicine's treatment of women in menopause, it makes sense that women are turning to natural approaches to relieve menopausal discomforts. The beneficial effects of estrogen on these discomforts are indisputable, but as women become more informed they see that the risks – especially of breast cancer – may be too great to justify its use. Others stop using conventional HRT because of side effects, and look to natural remedies to help them control their menopause symptoms.
This growing interest in natural solutions for treating menopausal symptoms has prompted the food and supplement industries to develop alternatives to conventional pharmaceutical estrogens such as Premarin. The soy foods industry has been poised to benefit most from this search for natural remedies for menopause because of soy's high phytoestrogen content.
The lay press and the soy industry have widely promoted the message that soy phytoestrogens act, in effect, as surrogate estrogens. Such a message gives women the impression that they can use soy to naturally relieve symptoms of falling estrogen levels at menopause. While the research does show that isoflavones behave like estrogens in the body the conclusion that they are all the medicine a woman needs to help her through menopause is not borne out by recent clinical studies on soy and menopausal symptoms.
Written and revised by
David Cohen, M.D.
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Soy phytoestrogens have very little effect on vasomotor symptoms such as hot flashes, night sweats and vaginal dryness. In one comprehensive study from the Bowman Gray School of Medicine in North Carolina, researchers looked at the effects of soy phytoestrogens on women aged 45 to 55 with menopausal symptoms. This study was big news because the women who took a phytoestrogen-rich soy supplement reported a 50 percent decrease in the severity of their hot flashes. What most news stories didn't mention, however, is that the placebo group reported a 35 percent reduction. Furthermore, this study showed small reductions in the severity of hot flashes, but none on their frequency. In other words, these women were having just as many hot flashes as they did before they added soy foods or supplements, but the intensity of those hot flashes were diminished. While decreased intensity is certainly a good thing when it comes to hot flashes, soy estrogens are clearly not as potent as many forms of conventional estrogen replacement which often eliminate hot flashes quickly and completely.
A recent study of women with vasomotor symptoms at the Mayo Clinic showed no benefits from soy protein isolates, which have high levels of phytoestrogens. This has also been Dr. Zava's experience in analyzing saliva hormone level results accompanied by detailed questionnaires; soy phytoestrogens simply don't work well to control vasomotor symptoms. The isoflavones in soy are aromatase inhibitors which lower the levels of estrogens made by the body, which is counter-productive to controlling vasomotor symptoms.
Mark Messina, president Nutrition Matters and an adjunct professor at Loma Linda University in California, cautioned against concluding that the key ingredients in soy supplements, known as isoflavones, don't have any effect on hot flashes, however.
"Unfortunately, because of the severe limitations of this study, very little if anything can be learned about isoflavones and hot flashes," Messina wrote in an email to Reuters Health.
For one, he said, the levels of a particular type of isoflavone - called genistein - were lower than in other studies that have found benefits from soy extracts.
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Additionally, the researchers originally set out to look at the effects of soy extracts on bone health, and did not recruit women specifically with hot flash or quality of life concerns in mind.
"So in my opinion, no useful information about isoflavones and hot flashes is provided by this study," said Messina, who regularly consults for companies that make or sell soy foods and supplements.
Isoflavone companies market the supplements, sold for about $17 for 90 50-mg pills, as "potentially" easing the changes associated with menopause.
What can soy offer women in menopause?
Soy and soy isoflavones have been closely studied and found supportive for a wide range of perimenopause and menopause symptoms and concerns: improved insulin regulation; weight loss; bone health; improved nail, skin and hair health; heart health; and decreased frequency and severity of menopausal discomforts, particularly hot flashes and night sweats.
In fact, beyond the three fundamentals embodied in our Personal Program - core nutrition, stress reduction, and botanical endocrine support - soy is our next-best-step when it comes to hot flashes in menopause. But that doesn’t mean it works for every woman - the underlying reasons for hot flashes and night sweats can differ in menopause, and about 20% of the population report they do not tolerate the protein from soy well.
For some women, soy can also have a positive impact on symptoms of PMS. Premenstrual problems can worsen for many women as they enter perimenopause and monthly hormonal cycles take on a more erratic pattern. PMS symptoms that may increase in perimenopause include irritability and other mood changes, breast tenderness, and headaches.
Though controversial, there are also some promising benefits for the aging brain to be weighed with soy. The effects of soy isoflavones observed on mood and cognitive performance in post-menopausal women have been positive - particularly with verbal memory - and this may be of relevance to younger women experiencing memory lapses and foggy thinking in perimenopause, too. We expect more studies will help us understand these effects better, but women with hormonal imbalance report these symptoms almost universally - no matter what their age.
Women who eat foods rich in soy protein are also doing their hearts a big favor. According to a comprehensive review of the literature by the FDA in the late 1990’s, eating 25 g of soy protein daily is enough to gain soy’s heart-healthy benefits. A study on post-menopausal women released in the fall of 2006 also showed reduced markers for inflammation linked to risk of cardiovascular problems, including homocysteine and C-reactive protein. As we enter menopause, minimizing any risk factors that jeopardize our heart health - including inflammation - will support our chances for longer, healthier lives.
Not only is soy high in protein (38% of the bean) but it’s also low in carbohydrates, making it a low glycemic index (GI) food that can support us in keeping our weight at a healthy level. Choosing foods with a low GI helps your blood sugar and insulin levels remain stable over time, helping you feel fuller longer, with fewer hunger cravings and fewer calories being stored as fat.
Amato agreed that the study has some limitations, and that the findings can't be generalized to all forms of soy in all types of women.
For instance, "taking supplements just might not be the same as eating a high soy content diet your entire life," she told Reuters Health.
Side effects/safety of soy
Studies abound on both the health benefits and the detrimental effects of soy, with somewhat conflicting results. Soy remains controversial - though as much as we've read about and used it at Women to Women, we're not quite sure why soy seems to stir the passions of so many.
We've been following the soy controversy for years, and from what we see in the research and at the clinic, the preponderance of evidence falls clearly on the beneficial side - especially as a safe alternative to conventional HRT-based menopausal treatments.
When it comes to soy, we've also observed that it works extremely well for some women and moderately well for others, while there is that segment of the population that does not metabolize or tolerate it well, and a smaller subset that reacts adversely to it. This should come as no surprise to us, though, since we all know from personal experience that different body types often react differently to different foods - and after all, soy is a bean!
We will often suggest that women experiencing menopausal symptoms add whole, non-GMO soy foods to their diet to see how well they tolerate them. Most of our patients have done very well by it, some women thrive on it, and for one reason or another, a very few choose to avoid it entirely. We are excited to offer our own delicious SoySational supplement, designed to bring women relief from symptoms like hot flashes and night sweats that are associated with menopause. So whether you're pre-, peri- or post-menopausal, we recommend you give soy a try and see for yourself.
But "if you look at this specific supplement for this particular group of women for this reason, quality of life, I'm convinced by this study it's not terribly helpful," she added.
Effect of soy isoflavone supplementation on menopausal quality of life
Objective: The purpose of this study was to assess the effect of soy isoflavone supplementation on quality of life in postmenopausal women.
Methods: A multicenter, randomized, double-blind, placebo-controlled 24-month trial was conducted to assess the effect of 80 or 120 mg of daily aglycone hypocotyl soy isoflavone supplementation on quality of life in 403 postmenopausal women using a validated Menopause-Specific Quality of Life questionnaire.
Results: Menopause-Specific Quality of Life domain scores at 1 year and 2 years were similar to baseline. There were no differences in domain scores among treatment groups.
Conclusions: Soy isoflavone supplementation offers no benefit to quality of life in postmenopausal women.
Amato, Paula MD; Young, Ronald L. MD; Steinberg, Francene M. PhD; Murray, Michael J. MD; Lewis, Richard D. PhD; Cramer, Margaret A. MD; Barnes, Stephen PhD; Ellis, Kenneth J. PhD; Shypailo, Roman J. BS; Fraley, Joe Kennard MPH; Konzelmann, Karen L. MS; Fischer, Joan G. PhD; LaSalle, Colette RD; Smith, Elliot O’Brian PhD; Wong, William W. PhD
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