green-eyed woman in red top against a red background eats a bowl of tofu with chopsticks

My patients know that their estrogen levels drop during menopause, and that dip in hormones can make it harder to sleep. They are having hot flashes, night sweats, and wake up with brain fog. They might be a little irritable. They are also concerned about their bone health as estrogen decreases, and so they are looking for safe, natural ways to replace that estrogen. 

Many women do not want to take Hormone Replacement Therapy (HRT), and are looking for alternatives. One that has been around for centuries is soy. There has been a steady increase in the interest in and availability of soy products since the 1960s. Many of you already have tried tofu, tempeh, edamame, roasted soy nuts, or soy milk. 

But the women I talk to have often done some online research, and they are worried about whether soy can cause an increased risk of breast cancer. This is because many years ago there was research that showed that soy did cause an increase in breast size…. in laboratory animals– but not in humans! When rodents were given really high levels of soy and isoflavones, which are the active ingredients in soy, they did show an increased breast size. So, people thought that this would be the case with humans. 

But further research was very reassuring, and the body of extensive research tells us that soy is a safe food for women to have in their diet and it does not increase the risk of breast cancer. In fact, there was a study on breast cancer survivors who were on various forms of chemotherapy from tamoxifen to aromatase inhibitors, and it was found that women who had one serving of soy per day in their diet after their breast cancer actually had a reduction in their recurrence rate. American Cancer Society says that women can safely have soy at all times of life, including during the midlife and menopause years.

Of course, if you still have concerns, or are a breast cancer survivor, do talk to your healthcare provider about your choices.

More About Soy and Supplements

Soy contains isoflavones, these are the active ingredients and have been shown to help alleviate the hot flashes and night sweats women often deal with during menopause. If you want to try a supplement, you should look for at least 50 milligrams of isoflavones. You can start with that, and then slowly increase. If you’re thinking about eating more foods with soy, it’s a little different. 1 cup of soy milk has approximately 25 milligrams of isoflavones and that’s a good place to start, because soy foods can cause a little gas. So, start with 1 cup and then gradually increase to 2 cups per day.

Be aware though, that studies have shown that many Caucasian women, particularly those of Northern European descent, do not have the genetic capability to metabolize soy into its natural and active metabolite. This active metabolite, known as S-Equol is what helps with the menopausal symptoms of hot flashes and night sweats. Many women just cannot convert soy to the active form for relief. But Japanese researchers finally came up with S-Equol in pill form that you can find online. Nature Made is a company that offers this under the name Equelle. I am not a spokesperson for this company, but I do have patients who are breast cancer survivors and others who cannot take estrogens because of migraines or a history of blood clots, who are finding relief, with Equelle. I also recommend it for my patients who are just not doing as well as we’d like with their hormonal treatment. They could be having bleeding or other problems, so to manage those symptoms, sometimes reducing the amount of bio-identical estrogen means more hot flashes and night sweats. In those cases, adding in a little Equelle seems to do the trick without adding more estrogen. 

Black Cohosh

Many of the soy or isoflavone supplements you see are combined with other herbs like black cohosh. Black cohosh has been shown in numerous randomized, placebo-controlled trials – which have the highest standard in proving effectiveness–to help some women with their hot flashes and night sweats. In fact, Black cohosh is one of the only herbs that’s been shown to be better than placebo when it comes to alleviating hot flashes and night sweats. If you do want to try it, I would recommend getting a product called Remifemin. Again, I don’t work for them, but I know that this formula contains pharmaceutical grade black cohosh and has rigorous quality control standards, so you know that you can trust that you are getting what the package says is inside. Also, it’s important to know that if black cohosh is going to work for you, you will start to see benefits within 6 – 8 weeks. But if you don’t see any benefit within that time frame, then most likely, you won’t see much improvement afterwards. We think that’s because some of us just don’t have the receptors for black cohosh. So, if it’s not working, save your money, and try something else.

Getting Phytoestrogens Through Your Skin

There are now lotions and creams available that can deliver phytoestrogen isoflavones to your skin. We know that the loss of estrogen does accelerate the aging of our skin, affecting its thickness, how it stays hydrated, its elasticity, wrinkling, and the amount of collagen it holds on to. There have been studies reported by the NIH that support phytoestrogens as effective in the treatment of aging skin by improving skin elasticity by preventing the loss of collagen. The noticeable affects will not be as great as with actual Hormone Replacement Therapy, and of course, sun protection and not smoking are still key to keeping your skin looking good!

Looking younger is one of the secret reasons many women use phytoestrogens and other estrogens. They’re not just for hot flashes!

Food First

You all know I’m all about food and nutrition first, because we absorb more of the nutrients from the whole food matrix. If you’re going to try introducing soy into your diet you might want to start with a half serving, as soy products can cause stomach upset and gas in some people, and then slowly increase your servings. Many women see menopausal symptoms reduced by about 30%, and that’s pretty good if you are suffering, right?

So, what is your tofu burger or edamame salad going to do for you beyond calming down your hot flashes? A few good things. Soy is a great source of plant-based protein. If you are trying to reduce your cholesterol and how much animal-based protein you are eating, soy is an excellent substitute and can reduce your risk of cardiovascular disease and atherosclerosis.  

To sum up, remember, soy contains a plant-based or phytoestrogen that is safe to have at all times of life, including menopause. Many studies show that soy helps to protect our bone health and reduce the risk of fracture. Unfortunately, soy is not a cure-all. It doesn’t help with vaginal dryness, pain with sex, or reducing any of the urinary tract issues. It is really much more effective for your whole body and to help control those hot flashes and sweats. 

How do you like your soy?  Please feel free to share your recipes.

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