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November 19, 2012

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My mother was having hot flashes and seemed to benefit from taking phytoestrogens as did some people reported from this article. While it is possible for some people to receive a significant type of benefit from any therapy and others do not, I find it hard to believe that the effect was not due to the placebo effect when statistics do not show a significant benefit. If results do not show a consistent effect then I have trouble believing it. Let me use an example to try and explain my point of view: if someone is said to be lactose intolerant with no remittance of symptoms, and they consume lactose, I expect almost, if not all, experiences of lactose consumption to result in a noticeable difference. If symptoms only result 50% of the time then either a variable has not been taken into account or the person probably is not lactose intolerant. I hope that the lines for efficacy and dose of supplements become more clear in to future to facilitate their use.

I do not think that the lack of significant results from this trial should change anyone's opinion of phytoestrogens for menopausal symptoms. This trial was not randomized, double-blinded, or placebo controlled. Also, effective doses of the phytoestrogens may not have been achieved, as patients were eating foods that may contain variable amounts of phytoestrogens. Other well-designed trials that exist should be reviewed, as they better assess the effectiveness of phytoestrogens for menopausal symptoms. More RCTs with standard phytoestrogen doses should also be conducted, so stronger conclusions can be made.

It is interesting to see that such a large population in this study came out with the results that it did. However, the design certainly does not seem to be ideal. The researchers only interviewed the patients annually, which does not seem to be frequent enough to be able to draw any real conclusions on this topic. With the popularity of soy products, I feel that a much stronger study would need to be done to debunk the belief that phytoestrogens can be helpful for menopause symptoms.

I agree that the study design here is not ideal. Self-reporting may introduce biases into the study. This is because the study relied on participants to recall accurate information in terms of dietary intake of phytoestrogens and fiber and specific menopausal symptoms they had experienced. It is possible that reported information may have been inaccurate, making it difficult to interpret study results as reliable. Other than that, interesting article!

I just looked up the NS evidence grade too. Natural Standard gives phytoestrogens a grade B. I agree with the other comment, that it will be interesting if these new findings will change the grade. Other therapies that have a NS grade B are acupuncture and Ginseng.

This is clearly a subject that would benefit from a well-designed clinical trial. The study design for this trial does not seem to be ideal, and I have seen articles both supporting and not supporting the use of phytoestrogens in menopausal women. It is interesting to see that sage contains compounds that may be helpful in these women; I have not read about its benefits before. Although the results seem to be conflicting, it is great to see that research is being done to find alternatives to the standard hormone replacement therapies that are riddled with side effects.

After menopause, women often see an increase in body weight and weight gain occurs due to many reasons, including the change in hormones. Although estrogen replacement therapy potentially helps with certain menopausal symptoms, estrogen supplementation or excess estrogen can cause an increase in breast, thigh, and hip tissue, possibly resulting in an increase in overall body weight. This makes me wonder if women with higher phytoestrogen consumption had higher body fat or weight, and if that could play a role in other health conditions. For reference, there is also a fairly extensively review article on the pros and cons of phytoestrogens at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074428/ however, it is a couple years outdated so it doesn’t include more recent study results such as this one.

I second the other comments on here about how much of these foods were consumed and the concerns about the survey/questionnaire being used to determine how much participants were consuming. There is a large amount of subjectivity and a strong potential for recall bias, as well as other confounding variables, in this study. The authors do conclude that “for certainty of any effect of dietary phytoestrogens or fiber on the prevention of incident VMS, a randomized, placebo-controlled, double-masked trial with sufficient numbers of women in different racial/ethnic, menopausal status, and metabolic groups over years of follow-up is required” but they say that “…our results suggest that a clinically significant or large effect is improbable.” I think it is unfair to conclude that a clinically significant or large effect is improbable, and a bit premature based on the results of this study.

I would be interested to know the amounts of these products that were consumed. I think there are a lot of confounding variables in this study. There was another study (PMID: 16735939) looking at vasomotor symptoms in women after breast cancer that showed significant improvements in these symptoms with the use of phytoestrogens. I think more well-designed clinical trials need to be done before conclusions can be drawn.

I have read a few studies about phytoestrogens and menopausal symptoms. It is interesting that the new studies found the relationship between them to be lacking. I did not know that sage contained compounds that acted similarly to estrogen. It will be interesting to see if there is any correlation with sage and menopausal symptoms.

It’s interesting that acupuncture is mentioned as an alternative therapy to menopause. While it’s ideal to do further studies on phytoestrogens, acupuncture should seriously be considered as well. It’s used for a wide variety of ailments and has seemed to work for some people.

Menopausal symptoms present differently in every woman, and it will be difficult to determine which therapy works for whom. Many foods containing phytoestrogens such as soy products, flaxseeds, and berries, are healthy food options, so they should still be encouraged to promote healthy eating and better weight management, as weight gain is one of the common presentations of menopause.

The study did state that the consumption of the phytoestrogens were determined based on a food frequency questionnaire, and that the symptoms were self-reported. I wonder how the symptoms were evaluated. Did the designers of the study utilize a questionnaire in order to subjectively asses the symptoms? Subjective data may possibly lead to some bias interpretation of results.

Phytoestrogens currently have a Natural Standard evidence grade of B for good scientific evidence. It will be interesting to see how these new findings affect that grade, if at all. I agree that a well designed clinical trial needs to be conducted before previous evidence of the effects of phytoestrogens on menopausal symptoms can be debunked.

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