The Wisdom of Menopause

by Christiane Northrup

  Note: Cancer survivors should consult with their doctors before taking Amberen, as should women currently taking prescription medication designed to alter natural hormone levels.

  PUERARIA MIRIFICA (PM): Also known as Thai kudzu, PM is hands down one of the most powerful supplements a woman can take for menopausal symptoms. It has been used for seven hundred years by both men and women for its hormone-like effects. This herb has been shown to be extremely safe and effective at relieving no fewer than twenty different conditions associated with menopause and perimenopause, including vaginal dryness, hot flashes, night sweats, depression, insomnia, and irritability. In its phase I studies, every one of the menopausal symptoms evaluated was reduced from moderately severe to mild, with the most significant drop occurring in the first thirty days of use. Women typically start to feel relief in the first week of taking PM.

  But not all PM is created equal. Of the thirteen different species native to Asia, only one contains the potent plant sterol known as miroestrol, which has estrogen-like effects on bone and vaginal tissue while also protecting the breasts and endometrium from the adverse effects of excess estrogen.15 It works by interacting with estrogen receptors to balance the effects of the estrogen already in the body, not by changing the amounts of natural estrogen a woman’s body produces. In one study comparing PM with conjugated equine estrogens (Premarin), PM had an estrogenic effect that was similar to Premarin but without the side effects.16 In another study conducted in Thailand by Chatsri Deachapunya, Ph.D., PM was shown to have no effect on endometrial epithelial cells (including both normal cells and cancerous cells), underscoring its safety.17 Research further shows that PM can halt the growth of breast cancer cells in vitro (in the lab).18

  Choose a brand of PM that contains standardized miroestrol (approximately 20 mg of miroestrol per 100 g). Research suggests the maximum safe amount of miroestrol is 10 mg per day per kg of body weight, so check the level in the supplement you purchase to make sure the amount is safe. Those I recommend include H.R.T. Plus from Longevity Plus (H.R.T. stands for Herbal Remedy from Thailand), available at www.longevityplus.com, and PM PhytoGen Complex from Solgar. The usual dose of these products is one to two tablets per day.

  Any of the key menopausal herbs above, either alone or in combination, often help to relieve a wide variety of symptoms, including vaginal dryness, hot flashes, and mood swings. My advice is to try one or more for at least a month. If you are still troubled by your symptoms, add another of the key herbs, or choose from the more specific remedies listed in other chapters.

  MENOPAUSAL HEALING FOODS

  Though many common foods contain vitamins, minerals, and phytoestrogens that are healthful for the perimenopausal transition, a few stand out as particularly helpful: soy, fresh ground flaxseed, and foods containing bioflavonoids. No matter what type of perimenopausal treatment you choose, if any, I’d suggest supplementing your diet with at least one of these “superfoods.”

  Soy

  Soy, like menopausal herbs, can be used as a safe alternative to hormone replacement, offering most of the benefits of hormone therapy without any of the risks or side effects. On the other hand, if you are taking hormones and are happy with your regimen, you can still enjoy the benefits of soy. In fact, a diet rich in phytoestrogens, including soy, may allow you to decrease the total dose of hormones you are on and still maintain all the benefits.

  Although over the last several years, there’s been a lot of anti-soy information out there, mainstream medical research is indeed confirming that soy protein, as a regular component of the diet, can lessen both the frequency and the intensity of hot flashes and other perimenopausal symptoms. Soy protein appears to benefit just about every system in the body. Many perimenopausal women report that it helps their skin, hair, and nails, and after about two to three months on high doses of soy, many report a return of vaginal moisture to premenopausal levels. It also helps women with mood swings, PMS symptoms, migraine headaches, irregular periods, and weight gain, and has been shown to decrease calcium loss through the kidneys.19 Studies indicate that soy protein helps decrease fat and increase lean tissue in menopausal women.20 It has also been shown to decrease the risk of breast and endometrial cancer because of its antiproliferative effects.21

  Hundreds of studies are documenting the other benefits of soy. For example, one followed fifty postmenopausal women who consumed three servings of soy milk (7.5 oz each) or three handfuls of roasted soy nuts per day for twelve weeks, for a total daily dose of 60–70 mg of isoflavones.22 The following benefits were reported.

  HEART: Researchers measured a 5.5 percent increase in “good” HDL cholesterol and a 9 percent reduction in “bad” LDL cholesterol. Many other studies have also documented soy’s ability to lower LDL cholesterol23 as well as total cholesterol and triglycerides.24 Soy has further been shown to reduce blood levels of C-reactive protein (CRP)25 and homocysteine,26 both markers for cardiovascular problems. In fact, on October 26, 1999, the FDA approved the health claim that soy protein reduces the risk of coronary artery disease.27 It also has a beneficial effect on blood vessel reactivity28 (which may be why it helps migraine headaches) and on the function of the endothelium (the inner lining of the blood vessels) in healthy postmenopausal women.29

  BONES: The soy milk/soy nut study noted a 13 percent increase in osteocalcin, a marker of bone formation, and a 14.5 percent decrease in markers for osteoclasts, cells that cause bone loss. Soy protein revealed a bone-forming benefit that estrogen does not provide.

  These same benefits have not been found with isolated isoflavones in tablet form, including a type of artificial isoflavone known as ipriflavone.30 There are at least eight different brands of plant-based estrogen-mimicking pills on the market, but no controlled studies have been done that show the effects of the various doses. Nor are there any studies showing that the body can absorb isoflavones from the pill versions as well as from whole soy foods. This is probably because whole soy contains other known and unknown ingredients in addition to the isoflavones.

  More recent studies show that the beneficial effect soy has on bone metabolism in postmenopausal women is especially true for those who already have low bone mass.31

  COLON CANCER AND BOWEL PROBLEMS: In large population studies, soy consumption has been associated with a decreased risk of colon cancers.32 Preliminary results of another study showed that a diet enhanced with soy protein may help reduce colon cancer incidence in people who have a history of the disease or who have had precancerous polyps removed. Based on these preliminary results, Maurice Bennink, Ph.D., of Michigan State University suggests that there could be both a 50 percent reduction in risk in cancer incidence and an additional delay in onset of ten to fifteen years in patients taking soy.33 Numerous animal studies also show that soy protein (not isoflavone pills) can reverse precancerous colon conditions. Animal studies show, too, that soy has an inhibitory effect on inflammatory bowel conditions such as Crohn’s disease and ulcerative colitis. A 2009 study of 25,000 British adults failed to find any significant differences in colorectal, breast, or prostate cancer risk related to consuming phytoestrogens, including soy.34

  SERMS: Many women on tamoxifen have reported relief of symptoms such as hot flashes and depression when they increase their intake of soy.

  Is There a Soy-Thyroid Connection?

  One of my newsletter subscribers wrote to me about her recently diagnosed thyroid disease and asked a question I hear frequently: “Does soy intake interfere with thyroid function?”

  Based on a standard blood test, I have been told I am developing Hashimoto’s thyroiditis. My doctor says it is not related to perimenopause, but I am a forty-five-year-old woman and you said in your newsletter that perimenopause and thyroid problems often occur together. I’d like to increase my intake of soy to help with my perimenopause symptoms and protect my heart and bones. But I’ve read that eating a lot of soy causes hypothyroidism. I’m confused. What should I do?

  My read
er may have seen a report on some studies done on animal cells in vitro, or on infants using soy-based formulas, that have suggested the possible antithyroid effect of soy. However, a randomized, double-blind, placebo-controlled study was done at the Health Research and Studies Center in Los Altos, California, on thirty-eight menopausal women between the ages of sixty-four and eighty-three who weren’t on hormone replacement. Over the six-month period during which these women took 90 mg of soy isoflavones per day, no antithyroid effect was shown.35 This correlates with the epidemiological evidence in Japan, a country whose inhabitants show no increased risk for hypothyroidism, even though the Japanese consume an average of 100–200 mg of soy isoflavones per day.36

  Here’s the bottom line: there is no convincing evidence that soy intake increases the risk of hypothyroidism during perimenopause. However, women frequently begin increasing their intake of soy during perimenopause, a time when they often get their thyroid function checked for the first time as well. And given that fully 25 percent of perimenopausal women have a thyroid problem, many believe that soy is responsible. If you have any doubt about your thyroid function, get it tested. Make sure you test for TSH (thyroid-stimulating hormone) along with T3 and T4, the two thyroid hormones. It’s a simple blood test, and it will put your mind at ease. Your TSH level should definitely be no higher than 3.0, although many experts, including myself, are more comfortable setting the limit at 2.5 (see chapter 5 for a full discussion of TSH levels). (Note: Soy isoflavones, especially in high doses, can disrupt thyroid function in those who are iodine deficient—estimated to be 13 percent of the population. Women with iodine deficiency and hypothyroidism may also do better when they eliminate or moderate their intake of other so-called goitrogenic foods, including raw cabbage, broccoli, and turnips. However, there’s no evidence that any of these foods adversely affect the thyroid of those with adequate iodine and normal thyroid function.37)

  A NOTE ABOUT PHYTOESTROGENS, ISOFLAVONES,

  AND CANCER RISK

  There’s been much talk recently about the phytoestrogens (estrogens from plants) and isoflavones (a particular type of phytoestrogen) in foods such as soy and flax causing an increased risk of breast cancer. Many women have avoided these beneficial foods for fear that they may actually be harmful. But this is not the case. The literature shows that phytoestrogens and isoflavones do not increase your risk for breast cancer.

  In 2009, the Council for Responsible Nutrition sponsored a meeting in Milan attended by an international group of nearly twenty researchers from around the world to look at this very topic. Overall, the information presented in this conference strongly supported the idea that isoflavones are indeed safe for women with breast cancer as well as for women who are at high risk for developing breast cancer. Mark Messina, Ph.D., a well-respected soy isoflavone researcher, said this at the conclusion of the conference:

  According to the science presented at this meeting, isoflavones do not have an effect on breast cell proliferation or breast tissue density, which are two wellestablished biomarkers of breast cancer risk. In fact, epidemiologic data presented at the meeting showed that exposure to isoflavone-rich soyfoods may improve the prognosis of breast cancer patients. Further, new findings strongly indicated that certain results from some animal studies that have raised concern about the impact of isoflavones on breast cancer are not applicable to humans.38

  Margaret Ritchie, Ph.D., a world-renowned expert in phytoestrogens and associated breast cancer research at the University of St. Andrews in Scotland, explains that phytoestrogens simply cannot act the same way estradiol (the most biologically active form of estrogen) does in the body because of their chemistry and the shape of their molecules. Although research does exist indicating that rodents that are fed genistein (a single type of phytoestrogen) and then exposed to cancer-promoting chemicals did have a higher risk for cancer, Dr. Ritchie explains, “Since no person can eat only one phytooestrogen and rodents produce huge amounts of equol [a type of estrogen], these studies are of limited value. Additional studies carried out by the same researchers showed when animals were fed soy … with many other phytochemicals present, there was a reduction in tumour size and number.”39

  Soy Benefits Are Dose-Dependent

  It is not always easy to compare soy foods, gram for gram, in terms of effectiveness, because some soy foods contain more isoflavones than others. A lot depends upon where the crop is grown and how it is processed. One serving of a typical soy food contains 20 g of protein and about 30 mg of soy isoflavones (genistein, daidzein, etc.). In contrast, some supplements made from whole soy are much more concentrated.

  Most American research studies have been done with only 40–60 g of soy protein per day (two to three small servings) because that is the most American volunteers will eat! It is also the minimum amount you’ll need to eat to get any noticeable effect. At this level of consumption, it takes about four to six weeks of consistent use to notice an effect. This is consistent with research that shows that when women ate 60 g of soy protein per day in the form of a powdered drink mix, they had a 45 percent reduction in hot flashes after twelve weeks.40 Research and my clinical and personal experience suggest that most women need about 100–160 mg of soy isoflavones per day to get significant relief from other menopausal symptoms, such as vaginal dryness, as well as to protect their heart and bones. A 2009 randomized, double-blind, placebo-controlled clinical trial of ninety-three postmenopausal women conducted at the Johns Hopkins University in Baltimore showed that women consuming 160 mg of total isoflavones a day (in the form of Revival soy products) for twelve weeks reduced hot flashes and night sweats while improving quality of life.41

  Each of the following servings contains approximately 35–50 mg of soy isoflavones:

  ~ 1 cup soy milk

  ~ ½ cup tofu

  ~ ½ cup tempeh

  ~ ½ cup green soybeans (edamame), available fresh or frozen

  ~ 3 handfuls of roasted soy nuts

  Powdered soy protein can be mixed with water, milk, or juice. Various brands are available. This is a particularly convenient way to get the benefits of soy. Some brands, such as Revival, contain the equivalent of four to six servings of soy in one drink. (See Resources.)

  Add soy foods to your diet gradually; otherwise you might experience gas, since your intestinal bacteria have to adjust to this new food. You can use digestive enzymes such as Beano to help.

  SUE: Depression Lifted, Breasts Healed

  I’ve heard many inspiring stories about how soy foods have changed women’s lives. Here’s a letter from a woman named Sue.

  About a year ago my mom got me started on Revival, and I will be forever grateful. She herself had started taking Revival after she was diagnosed with breast cancer. She went through rigorous chemotherapy, radiation, and tamoxifen treatment. She is now doing well and is cancer free.

  I was on Prozac, Premarin, and Pravachol for years and had not been able to eliminate any of them. Cutting back on Prozac or Premarin left me unfit to live with. Two weeks after starting Revival, I began cutting back the prescription medications and was off all the drugs and hormones within six weeks—with no ill effects. Now for the real surprise.

  For years I have feared my regularly scheduled mammogram. I would usually get called back at least once for repeat views because I have severe fibrocystic breast disease and I’ve had two densities in my left breast that they’ve been watching closely. Yesterday I went for my regular mammogram and was absolutely shocked with the result. The left breast densities are almost totally gone—if you try really hard, you can see them. And the fibrocystic density has greatly diminished. On the old films the density could be seen throughout the breasts. Now there’s about 30 percent normal breast tissue. I was told I no longer have to go for a mammogram every six months. I’m down to just once per year.

  What to Expect When You Add Soy to Your Diet

  Depending on the amount you’re eating, you may notice a decrease in hot flashes within
a few days of adding soy to your diet. The average woman in Japan (where hot flashes are relatively rare) eats four to six servings of soy per day, or the equivalent of 100–200 mg soy isoflavones. Like all things, soy should be part of a varied diet, not the main ingredient.

  Some perimenopausal women have found that their periods returned when they began taking soy or one of any number of menopausal herbal mixtures on the market. A patient came to me for a consultation after this happened, because her regular gynecologist was very worried that the herbs were having a dangerous adverse effect. However, the phytoestrogens in soy or menopausal herbs do not cause periods in women who are completely through menopause.

  Irregular periods during the menopausal years are due to fluctuating hormonal levels. It is very common for a menopausal woman to go for months without having a period and then start menstruating regularly again for several months or even years. Soy intake won’t prevent this. And the same is true of women who’ve reported that their fibroids began to grow when they started taking high doses of soy. Soy doesn’t promote fibroid growth, though the highly fluctuating estrogen levels associated with perimenopause often cause very rapid fibroid growth. In fact, some women report a reduction in the size of their fibroids when on soy compared to when they take conventional hormones.