According to
data by North American Menopause Society (NAMS) about 6000 US women transition into
menopause every day. With ever increasing life expectancy in western world (79.7
years) it is expected that by the year 2020 number of US women older than 51
will be 50 million and the corresponding statistics worldwide is 1.1Billion. [1]
Women who
have undergone surgical menopause are more likely to use Hormone replacement
therapy as compared to women with natural menopause. About 75% of women who undergo
surgical menopause use HRT at some time, 50% of those with a hysterectomy only had
used HRT and only 30% of women with natural menopause had used HRT.[2]
About 80% of
women experience Vasomotor symptoms as they transition into menopause and according
to the Study of Women's Health Across the Nation (SWAN)[3]
these symptoms last average 7.4 years after menopause.
Many women
opt for menopausal hormone therapy (MHT) to relieve the vasomotor symptoms, especially
after the current research have shown it to be safe in women within 10 years of
menopause and no contraindication. MHT have many adverse effects in older
postmenopausal women (over age 60 years) and is not generally indicated.
Because of
the concern for safety, many women are turning towards plant based herbal
remedies often called as “Bioidentical hormones”. These are synthesized from soy and plant extract and modified
to be structurally similar to endogenous hormones. A recent Systematic Review and Meta-analysis published
in the recent edition of Journal of American Medical Association (JAMA)[4]
sought to determine the effectiveness of these therapies in relieving vasomotor
symptoms and vaginal dryness.
Two independent reviewers
extracted data from Ovid MEDLINE, EMBASE, and Cochrane Central, searching for eligible
studies that were published before March 27,2016. A total of 62 studies were
identified, including 6653 individual women. The main outcome studied were
Hot flashes, night sweats, and vaginal dryness. The time range of therapy
extended between 4 weeks to 2 years, the average being about 12 weeks.
Out of 62 studies, only 36 studies
used plant based phytoestrogens, the rest used other herbal and Chinese herbal medicines.
As compared to placebo use of phytoestrogen was seen to decrease number of hot
flashes per day (pooled mean difference of changes -1.31, 95% CI -2.02 to
-0.61) and vaginal dryness score (pooled mean difference -0.31, 95% CI -0.52 to
-0.10) but no difference was seen in daily night sweat score between the two
treatment regimen.
Dr. Oscar H.
Franco, MD, of Erasmus University Medical
Center in Rotterdam, The Netherlands, who is the lead researcher also and
colleagues also attempted to determine the individual effects of plant based treatments
like all forms of soy isoflavones, Black Cohosh and Chinese and non-Chinese
medicinal herbs.
Red leaf clover and soy isoflavones were not found much
effective in hot flashes. No definitive evidence regarding its active ingredients
and concerns over safety and side effects were also important issues regarding its
use in clinical practice.
Studies including Chinese herbal medicines and other herbal
remedies lacked sufficient power to perform meta- analysis but the results were
inconsistent and did not show any association.
The study had several limitations including the reporting of
the hot flashes being itself subjected to recall bias, methodological
deficiencies, limited generalizability, and inconsistent composition of
phytoestrogen used.
The authors cautioned that the results should be interpreted in light of the limitations and further rigorous well designed randomized, placebo-controlled, double-masked trial with large women from different racial/ethnic background and menopausal status that could be followed up for years is required before any conclusion can be drawn.
Current evidence does suggest that the composite and individual
specific phytoestrogen use was associated with moderate reduction in night
sweats and vaginal dryness but has no effect on hot flashes.
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