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A Review of the Evidence for the Use of Phytoestrogens as a Replacement for Traditional Estrogen Replacement Therapy
M. Gina Glazier, MB, BCh;
Marjorie A. Bowman, MD, MPA
Arch Intern Med. 2001;161:1161-1172.
Estrogen replacement therapy (ERT) is recommended for postmenopausal
women primarily for reduction of menopausal symptoms and prevention of osteoporosis
and cardiovascular disease. However, only 35% to 40% of women ever start ERT,
and many do not continue it. One of the reasons women are reluctant to receive
postmenopausal ERT is that they perceive prescription estrogens as being "unnatural."
Because of this, there is increasing interest in the use of plant-derived
estrogens, also known as phytoestrogens. This article reviews the evidence
for the potential of phytoestrogens, either in dietary or supplemental form,
to replace traditional forms of ERT. A comprehensive search of the English-language
literature identified more than 1000 articles published in the past 30 years
about phytoestrogens. In total, 74 studies were selected for inclusion in
this review based on relevance, inclusion of human subjects wherever possible,
and study design. The studies examine phytoestrogens' inhibition of the growth
of cancer cell lines in vitro and in animals. They also look at the role of
phytoestrogens in the reduction of cholesterol levels, and the use of one
phytoestrogen derivative, ipriflavone, in the prevention of osteoporosis.
Some small studies examine the role of phytoestrogens in the prevention of
menopausal symptoms. Evidence for the potential health benefits of phytoestrogens
is increasing. However, the clinically proven health benefits of prescribed
ERT far outweigh those of phytoestrogens. Therefore, there is insufficient
evidence to recommend the use of phytoestrogens in place of traditional ERT,
or to make recommendations to women about specific phytoestrogen products.
From the Department of Family Practice and Community Medicine, University
of Pennsylvania School of Medicine, Philadelphia.
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