Hormone Replacement Therapy Arlington TX

There's reason to believe at least one of the most popular alternatives, soy, may not be so safe after all—at least when you get the high quantities needed to ease hot flashes.

Gilda Cipriano, MD
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Omar Sarmini, MD
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Hormone Replacement Therapy and the Estrogen Dilemma

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By Catherine Guthrie

Walk into any health food store and you’ll see shelves packed with natural alternatives to hormone replacement therapy (HRT). And as evidence of the risks of HRT continues to pile up—namely, heart disease, breast cancer, and stroke—the market for these products should only expand. If they’re natural they must be safer, the thinking goes.
But are they?

There’s reason to believe at least one of the most popular alternatives, soy, may not be so safe after all—at least when you get the high quantities needed to ease hot flashes. (As part of a balanced diet, soy has protein and bone-building properties you don’t want to pass up.) But there’s also encouraging news about a hot flash tamer that turns out to be safer than we thought—as well as other HRT alternatives to consider.

First, here’s how soy works and why it’s problematic. The reason it may ease hot flashes is that it’s a phytoestrogen, or plant-based estrogen, which means it behaves in the body much the same way synthetic estrogen does. Specifically, its isoflavones park in the same cellular spot the body reserves for estrogen. So when a woman’s natural estrogen levels dwindle during menopause, causing those famously uncomfortable overheated moments, soy’s isoflavones offer the body an estrogen fix that may cool the fire.

But the very fact that soy is a powerful phytoestrogen complicates the picture. The reason HRT raises breast cancer risk is that too much estrogen is thought to stimulate breast cell growth, which can lead to cancer. Because soy isoflavones behave like estrogen in a woman’s body, the concern is that they may have the same cell-stimulating effect. And the problem is, scientists don’t know how much is too much.

“We know that the phytoestrogens in soy are somewhat weaker than the estrogens in HRT,” says Colleen Piersen, a researcher at the Center for Botanical Dietary Supplements Research at the University of Illinois, at Chicago. “But we just don’t know if they’re safer.”

Ounce for ounce, soy supplements may be even chancier than soy foods. “A lot of these supplements aren’t just crude extracts,” says Piersen. “They’ve been purified to further concentrate the active ingredient, which is where the potential danger lies.”

The bottom line? “Women at high risk for breast cancer shouldn’t take soy supplements,” says Piersen. As for soy foods, she’s reluctant to make specific recommendations, but she says the best approach is to eat them as part of a regular diet and not load up on them disproportionately. Several factors can put a woman into a high-risk category, including having a first-degree relative (a mother, sister, or daughter) who had the disease, particularly before menopause. Other red flags include having already had breast cancer, early menstruation, and late onset of menopause.

And what about women who aren’t at high risk? The problem is that it’s not easy to say who will develop cancer and who won’t. Keep in mind that only a small...

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