Phytoestrogens as Therapeutic Alternatives to Traditional Hormone Replacement in Postmenopausal Women

Elena M. Umland, Pharm.D.; Jacintha S. Cauffield, Pharm.D.; Julienne K. Kirk, Pharm.D.; Tracy E. Thomason, Pharm.D.


Pharmacotherapy. 2000;20(8):981-990. 

In This Article

Epidemiologic data illustrate strong associ-ations between diets high in foods containing phytoestrogens and a reduction in coronary heart disease (CHD), breast and other cancers, and menopausal symptoms. However, controlled clinical trials that encourage health care providers to endorse phytoestrogens as an alternative to conventional hormone replacement therapy (HRT) in postmenopausal women are lacking. Most data that support or refute widespread use of phytoestrogens come from animal and epidemiologic human studies. In comparison, controlled clinical trials have assessed the effects of conventional HRT on CHD risk factors and osteoporosis by changes in bone mineral density (BMD).[1,2] Cohort studies in humans identified the role of HRT in breast cancer risk.[3] Epidemiologic studies further illustrated the relationship with breast cancer[4] as well as effects of HRT on overall mortality.[5]

In addition to limited clinical trial data on the efficacy of phytoestrogens, the following questions are unanswered:

  • What differences in biologic activity, if any, exist among phytoestrogens?

  • Does each individual phytoestrogen induce its own specific therapeutic effects?

  • What are the therapeutic dosages of each subclass of the compounds?

  • What are the long-term side effects of the agents?

  • Do phytoestrogens, in therapeutic dosages, induce endometrial hyperplasia similarly to unopposed estrogen therapy when taken by a woman with an intact uterus?

  • Do therapeutic dosages confer the same cardiovascular and osteoporosis protection and risk reduction as conventional HRT?


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