Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed. Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit. It’s packed with nutrition Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients: • fiber • protein • omega-3 fatty acids • antioxidants It may help to reduce your risk of heart disease Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.

1. MENOPAUSE -ROLE OF ISOFLAVONES
DR ALKA MUKHERJEE
NAGPUR M.S. INDIA

2. DR ALKA MUKHERJEE
MBBS DGO FICOG FICMCH PGDCR PGDMLS MA(PSY)
Director & Consultant At Mukherjee Multispecialty Hospital
MMC ACCREDITATED SPEAKER
MMC OBSERVER MMC MAO – 01017 / 2016
Present Position
 Director of Mukherjee Multispecialty Hospital
 Hon.Secretary INTERNATIONAL COUNCIL FOR HUMAN RIGHTS
 Hon.Secretary NARCHI NAGPUR CHAPTER (2018-2020)
 Hon.Secretary AMWN (2018-2021)
 Hon.Secretary ISOPARB (2019-2021)
 Life member, IMA, NOGS, NARCHI, AMWN & Menopause
Society, India, Indian medico-legal & ethics association(IMLEA),
ISOPRB, HUMAN RIGHTS
 Founder Member of South Rapid Action Group, Nagpur.
 On Board of Super Specialty, GMC, IGGMC, AIIMS Nagpur,
NKPSIMS, ESIS and Treasury, Nagpur for “ WOMEN SEXUAL
HARASSMENT COMMITTEE.”
mukherjeehospital@yahoo.com
www.mukherjeehospital.com
https://www.facebook.com/
Mukherjee Multispeciality
https://www.instagram.com/
Achievement
 Winner of NOGS GOLD MEDAL – 2017-18
 Winner of BEST COUPLE AWARD in Social
Work - 2014
 APPRECIATION Award IMA - MS
 Past Position
 Organizing joint secretary ENDO-GYN
2019
 Vice President IMA Nagpur (2017-2018)
Vice President of NOGS(2016-2017)
Organizing joint secretary ENDO-GYN
Organizing secretary AMWICON – 2019
ECTOPIC PREGNANCY

3. Introduction
• 25% of women have severe menopausal symptoms, which can
seriously affect a woman’s quality of life
• Millions of women worldwide now live 30-40% of their lives
after the menopause.
• HRT is effective treatment for the relief of vasomotor
symptoms although other options, including non-
pharmacological ones, are available

4. Definitions
• HRT: Oestrogen to treat menopausal symptoms. Oestrogen
should be combined with a progestogen in women who
retain their uterus
• Non-hormonal therapies: Treatments for menopausal
symptoms that do not contain sex steroid hormones
• Menopause: The permanent cessation of menstruation due
to loss of ovarian follicular activity.

5. Menopause – what and when
• The menopause may be
– Natural or induced
• Natural menopause is the permanent cessation of the
menstrual cycle due to loss of ovarian follicular activity
• Only known retrospectively one year after the last period
• Average is 51 years

6. Components of the Menopausal
Assessment
cleveland clinic journal of medicine volume 75 20082008

7. Frequency of Menopausal
Disorders
Katon, J. G., et al. (2015).

8. Diagnosis - symptoms
1. Vasomotor
• Flushes
• Night sweats
• Insomnia
2. Sexual dysfunction
• Vaginal dryness
• Dyspareunia
• Decreased libido
3. Musculoskeletal
• Joint aches
• Fat redistribution
4. Psychological
• Depressed mood
• Anxiety
• Irritability
• Mood swings
• Lethargy
Short Term

9. Diagnosis - symptoms
Long term
1. Osteoporosis
• 1 in 3 increase in risk of fracture
2. Cardiovascular disease
• MI and stroke most common cause of death >60y
• Oophoretomised women have 2-3 fold risk of CHD
3. Urogenital
• Lower urinary tract and pelvic floor atrophy
leading to frequency, urgency, nocturia,
incontinence, recurrent infections

14. Risks/Uncertainties of HRT
Risks
• Breast cancer
• Venous thrombo
embolism
• Endometrial cancer
• Gall bladder disease
Uncertainties
• Coronary heart disease
• Stroke
• Dementia

15. Contraindications to HRT
• History of breast cancer
• Coronary heart disease
• Previous venous thromboembolic event
• Transient ischaemic attack or previous stroke
• Unexplained vaginal bleeding
• High risk endometrial cancer
• Active liver disease

16. Cautions to HRT
• Gallbladder disease (oral ET)
• Hypertriglyceridemia (>400 mg/d) (oral ET)
• Diabetes
• Hypoparathyroidism (risk of hypocalcemia)
• Benign meningioma
• Intermediate or high risk of breast cancer
• High risk of heart disease
• Migraine with aura (oral ET)

17. Vasomotor Symptoms
• Hot flashes/Night sweats
• 80% women
• Median duration over 7
years
Impact:
 Physical
 Psychological
 Social
 Healthcare utilization

18. Non-pharmacological treatments
for vasomotor symptoms

19. Cognitive behavioural therapy (CBT)
• Reduced the impact (problem rating) of vasomotor symptoms
with and without a history of breast cancer.
• Reduction in problem rating: 47-52% vs usual care control 14-
27% at 6 and 26 weeks
• Reduction in frequency: 29-40% vs control 12-22% at 6 and 26
weeks
• Improvements in mood, sleep and quality of life.
BMJ 2017;359:j5101

20. Lifestyle Advice
Avoid hot drinks especially caffeinated ones and
alcohol
Stop smoking
Fans and layering
Use of vaginal moisturisers

21. Vitamin E
• Fat-soluble vitamin
• Has very marginal efficacy in reducing hot flushes (average
reduction of one hot flush per day)
• Dosage/side-effects: 800 to 1000 international units (IU)
per day in divided doses, taken with food.
• Reduce frequency in vasomotor symptoms
• Non-toxic BMJ 2017;359:j5101

22. Diet and Supplements
• Dietary or supplementary phytoestrogens modestly
improve hot flushes (average reduction in the
number of hot flushes of 1.3 per day) and vaginal
dryness.
 The bean of the soy plant (Glycine max L.,
family Fabaceae, formerly Leguminaceae)
 Used in both foods and phytotherapeutic
supplements
• Isoflavones (soy) or black cohosh may relieve
vasomotor symptoms
• The isoflavones include the biochemicals genistein,
daidzein, glycitein, biochanin A, and formononetin
BMJ 2017;359:j5101

23. Isoflavones – A Natural Alternative
• Isoflavone has been proposed as a natural alternative to hormone
replacement therapy (HRT)
• Isoflavones have been identified to be effective in the relief of hot flashes.
• Effect of isoflavones on bone mineral density (BMD), isoflavones are
identified to decrease bone loss.
• N= 204 & Daily dose of 50 mg up to 6th and 12th week
• Advantageous effects of isoflavone on frequency and severity of hot flushes
in perimenopausal women
J Public Health. 2018 Mar; 47(3): 382–389.
J Steroid Biochem Mol Biol. 2014 March ; 140: 116–132
BJU Int 2014; 113: E119–E130

25. Salient Features of Soy Isoflavones
Isoflavones behave
similarly to hormone
treatment estrogen but
their estrogenic strength
is weaker
Plant derived estrogens
bind competitively to both
ER α and ER ß and activate
them
They have higher
binding affinity towards
ERβ than ERα
Genistein has a very
similar structure to
estradiol in many aspects.
These similarities aid in
isoflavone binding to the
active site of the receptors
25

27. Soy isoflavones-Mechanism of action in Osteoporosis
a) Soy isoflavones stimulates the activity and proliferation of osteoblasts (bond-building)1
b) Genistein and daidzein induce ER β transcription and binding and reduce mature
osteoclastogenesis & hence bone resorption2
c) Increase OPG2
d) Calcium adheres to the collagen, forming new bone tissue (Bone mineralization)
Pharmacogn Rev. 2010 Jul;4(8):111-7
J Bone Miner Res. 2008; 23: 715-720
27

28. Isoflavones on Menopausal Women with
climacteric symptoms
Study population : Menopausal women with climacteric symptoms (i.e., a minimum
of five hot flashes and/or moderate to severe night sweats per day).
Treatment:
• Group A: 40 mg isoflavones (n = 270) from 10 different countries
Assessment
• Change in frequency in climacteric symptoms at the end of 4 months
Effectively reduced hot flashes
and night sweats in
menopausal women
Open Journal of Obstetrics and Gynecology, 2014, 4, 42-46
Result
• Significantly reduced hot
flashes and night sweats in
menopausal women
28

30. There is a convincing evidence that isoflavones have beneficial effects
on cardiovascular disease risk factors
Results of various studies support the view that phytoestrogens have
protective effect on the risk of atheroscelerosis and arterial
degeneration through an effect on arterial walls, especially among
older Curr ()pin Lipidol 2001 Aug:12(4):433�7.
Isoflavones on Cardiovascular Risk Factors
Isoflavones
Reduce
cholesterol
Prevent
CAD

31. Isoflavones: CAD
• According to the Nutrition Committee of the American Heart
Association (AHA) there is increasing evidence that
consumption of soya protein in place of animal protein can
lower blood cholesterol levels and may provide other
cardiovascular benefits
• ACOG’s position ins that long term intake of soy and
isoflavones may improve blood cholesterol levels
Circulation, Novemember 14, 2000

32. J Clin Endocrinol Mctab 200 I Jul;86(7):3053-
60

33. Isoflavones
activities on
breast and uterus
Induce apoptosis
Inhibit cell
proliferation
Inhibit
differentiation in
cancer cells
Acta Pol Pharm 2000 Mar-Apr 57:2 135-55
Isoflavones: Cancer

34. Isoflavones : Obesity & Diabetes
• Evidence is emerging that phytoestrogen play beneficial role
in obesity & diabetes.
• Nutritional intervention studies suggest that isoflavones
favorably alter insulin resistance, glycemic control and serum
lipoproteins in postmenopausal women with type 2 diabetes
there by improving their cardiovascular risk profile
Diabetes Care 2002 Oct;25(10): 1709-14, Beneficial effects of soy phytocstrogcn intake in
post menopausal women with type 2 diabetes by Jayagopal V ct al, Department of Medicine,
University of nun, U.K
Am J Clio :'J utr 2002 Dcc;76(6): 1191-201

35. SOY ISOFLAVONES SAFETY
• Isoflavones do not adversely affect the breast,
thyroid or uterus of postmenopausal women.
Nutrients. 2016 Dec; 8(12): 754.
• Isoflavones do not stimulate the vaginal maturation index.
Nutrients. 2016 Dec; 8(12): 754
35

36. Exercise
Regular physical activity:
 Done with the intention of improving or maintaining
physical fitness or health
 Performed as a part of a class with support from a health
professional

37. Yoga
• Improving physical and mental symptoms
• Improved sleep quality and exercise also improved mood
• In perimenopausal and postmenopausal: (N=107) for 12
weekly for 90-minute/day decrease 66% VMS
Hioki, J Yoga Phys Ther 2018, 8:1

38. Acupuncture
• Acupuncture has been an integral part of clinical
medicine in Asia for several thousand years
• Acupuncture has increased in popularity and use in the
U.S. in the past 40 years
• Vasomotor symptoms are a common indication for
acupuncture

39. Weight loss
• Longitudinal studies show that higher BMI is a risk factor for
vasomotor symptoms
• The NAMS guideline advises that weight loss in overweight
women may be beneficial for menopausal symptoms
• Reductions in weight, BMI and abdominal circumference
were related to significant decreases in hot flash
Menopause, Vol. 22, No. 11, 2015

40. Summary
• Individualize therapy based on clinical factors and patient preference.
• Non-HRT treatment is effective taking care of the VMS symptoms in
majority of women
• Isoflavones has been proposed as a natural alternative to hormone
replacement therapy (HRT)
• There is convincing evidence that isoflavones have beneficial effects on
cardiovascular disease risk factors
• Isoflavones have beneficial role on obesity & diabetes, flavourably alter
insulin resistance, glycemic control, serum proteins in type 2 diabetes there
by improving cardiovascular risk profile
• Calcium + Vitamin D analog role to reduce risk of fractures in post
menopausal patients
• All postmenopausal women should embrace appropriate lifestyle measures

41. Thank you