The "phyto" in phytoestrogens is from the Greek for plant, an apt prefix since phytoestrogens are found in all manner of plant foods. There are several classes of phytoestrogen compounds:

• Coumestans are contained in bean sprouts, red clover, and sunflower seeds.

  Lignans are formed when bacteria in the human gut "nibble on" compounds found in such grains as rye and wheat and in seeds like sesame and linseed.

• Isoflavones exist in many different types of plants, including "everyday" fruits and vegetables, but they are especially prominent in soy--apparently the most potent food in terms of its estrogen-like effects on the body.

So far, some 300 plants with estrogen-like activity have been identified, including common foods such as carrots, corn, apples, barley, and oats. Yet products made from soybeans--tofu, for instance--have received the lion's share of attention because they appear to pack a much more potent estrogenic punch. Indeed, researchers have observed that in countries where people eat diets high in soy foods, such as Japan, China, and Korea, breast cancer rates are much lower than in the West, death from prostate cancer is minimal, and the unpleasant symptoms of menopause appear scant.

Understanding the hypothesis behind the protective effects of the phytoestrogens in soy and other foods can be a bit tricky, especially when it comes to women, because it relies on seemingly contradictory concepts that have to do with whether a woman is pre- or post-menopausal. Namely, scientists speculate that during childbearing years, prior to menopause, phytoestrogens stave off breast cancer by blocking the action of some of the body's naturally occurring estrogen and thereby acting as antiestrogens.

Consider that in females, estrogen is necessary for reproduction as well as for the development of the breasts and other secondary sex characteristics. But it can also cause a problem, because inside breast tissue it can encourage cancerous tumors to develop.

After menopause, however, when a woman's natural estrogen declines by 70 percent, phytoestrogens provide an estrogen "lift" to make up for the "lack" of the hormone--without raising cancer risk. In men, phytoestrogens appear to act as a blocker of testosterone--the male hormone that, while necessary for a man's maleness, can spur the growth of prostate tumors. And they accomplish the task without making men "feminine."

Q. What is the incidence of depression among women at the onset of menopause? For how long are antidepressants usually prescribed for menopausal depression?

A. "There is a mental health side to menopause that is as much a part of the physical process as our minds are part of our bodies," says Rosemary Tofalo Bowes, Ph.D., a Washington D.C.-based psychologist. "Yet, just as menopause is a natural passage, not itself a physical illness, the mental side of this passage should not be confused with mental illness."

Menopause, the cessation of menstrual periods, occurs on average at age 51.There is NO evidence to suggest that women are more susceptible to clinical depression after menopause. Because of declining estrogen levels after menopause, many women experience short-term physical symptoms such as hot flashes, irregular uterine bleeding and vaginal dryness. Irritability, depression (feeling "depressed" as opposed to a clinical diagnosis) and mood swings are the most common emotional symptoms.

They are not believed to be the result of declining estrogen levels, but rather the result of the physical symptoms of menopause. For example, when hot flashes occur at night (night sweats), the quality and quantity of sleep can be significantly affected, leaving one more susceptible to mood swings. Women who develop constructive responses to menopause tend to live healthier and more balanced lives. Dr. Bowes offers the following tips:

DON'T:

• smoke or abuse alcohol try not to be too thin or allow yourself to be too heavy drink caffeine or soft drinks, except in moderation fret or focus on negative thoughts
• close down and think you are alone

DO:

• exercise and stretch use relaxation techniques, especially deep breathing watch your diet, and be wary of fats and cholesterol think positive thoughts try to be flexible try to laugh as often as possible
• see your friends

Drinking Raises Estrogen Levels In Women Taking HRT
By Damaris Christensen

For postmenopausal women who take estrogen replacement therapy, drinking the equivalent of one to two glasses of wine can lead to a threefold increase in the levels of estrogen circulating in their blood, according to a new study. "If alcohol alters the intended biological effects of estrogen replacement therapy, it could weigh negatively when assessing the risks against the benefits of hormone replacement," said researcher Dr. Elizabeth S. Ginsburg, of the division of obstetrics and gynecology at Brigham and Women's Hospital in Boston. For example, increased blood levels of estrogen may heighten a woman's risk of breast cancer, Ginsburg speculated.

Previous studies have linked estrogen replacement therapy with the development of breast cancer, she noted. But this link is highly controversial, pointed out Trudy L. Bush, a professor of epidemiology and preventive medicine at the University of Maryland School of Medicine in Baltimore. "I don't see any clinical implications from this study," she said, adding that the observed rise in estrogen levels may have no effect. "In premenopausal women, estrogen levels may vary more than threefold over the course of a month." An estimated 25 percent of U.S. women over age 50 take estrogen replacement therapy to combat the symptoms of menopause, prevent bone loss and stave off heart disease. (Note: This was written prior to the abrupt halting of the WHI Study (Women's Health Initiative) due to concern over unexpected results.

Read more about it The HRT Controversy: Conventional Hormone Replacement Therapy: The Risks Outweigh The Benefits.) Ginsburg's team looked at the effects of drinking alcohol in 24 postmenopausal women, 12 of w hom used estrogen replacement. In the study, published Wednesday in the Journal of the American Medical Association, the women were admitted into a hospital in the afternoon and fed specified meals and snacks. The following morning, each woman was given either an alcoholic drink or a non-alcoholic drink. Her blood was sampled every 10 minutes for six hours.

Each woman remained in the hospital and the next morning was given either an alcoholic or non-alcoholic drink _ whichever she had not received the day before. Again, her blood was tested every 10 minutes for six hours. Estrogen levels of the women on estrogen replacement began to rise within 10 minutes of taking a drink of alcohol, but not after the nonalcoholic drink, the researchers found.

As a woman's blood-alcohol levels rose, so did her blood-estrogen levels; as alcohol levels dropped, so did estrogen levels. The estrogen levels remained elevated for up to five hours, the team reported. Women who were not using estrogen replacement did not show any significant changes in their blood-estrogen levels, which were much lower to start with, the study showed. "It's a very interesting study," said Dr. William C. Andrews, a professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk, Va. "But it's too early to say whether this has any implications for a woman who may have one or two drinks once in a while. I don't think that, at this point, this should affect a woman's choice to use estrogen replacement therapy," he said. The study did not replicate "real life," Ginsburg noted, since each of the women ate a controlled diet, drank a specified amount of alcohol and was carefully monitored.

More research is needed to look at whether these high estrogen levels occur in a less controlled setting, and if they might raise a woman's chance of developing breast cancer, Ginsburg added. © Medical Tribune News Service

Heavy bleeding, while usually not medically serious, can cause major disruption in a woman's life. It can cause embarrassment and result in a decrease in exercise and other beneficial activities. If severe enough, it can also result in anemia.

Dysfunctional Uterine Bleeding (DUB) refers to excessive bleeding that is not related to fibroids, polyps, endometriosis, adenomyosis, pregnancy, cancer or other identifiable causes. It is usually related to hormone imbalance or changes and is more likely to occur during perimenopause when women often do not ovulate regularly. About half of the cases are women between 40 and 50 and 20% are adolescents. Some of the common imbalances are excessive estrogen, lack of progesterone or an imbalance of these hormones. Hypothalamic dysfunction, pituitary or adrenal hyperplasia (which is usually associated with excessive hair growth or other signs of virilization) or thyroid problems can also cause heavy bleeding.

Drugs such as steroids and psychopharmacologic agents can inhibit ovulatory function and result in bleeding problems. But because bleeding can be an indication of cancer, fibroids, endometriosis, polyps or pregnancy, it is important to have it evaluated by your health care provider. An abnormality of the arteries supplying the uterus can also cause bleeding, but this is rare. Dr. Winifred Cutler found that for some women, excessive bleeding may be a consequence of having intercourse during menses. Obesity, polycystic ovary syndrome, stress, crash diets, and excessive exercise can all disrupt ovarian function.

Those on hormone replacement therapy may experience bleeding problems but it is rarely a cause of heavy bleeding. DIAGNOSIS The most important step is to determine what is causing the bleeding. Dilatation and Curettage (D&C) involves scraping the interior of the uterus and may still be used for diagnosis,. However, a procedure which reduces the risk of uterine puncture and is less expensive, is aspiration curettage which removes a thin layer of the endometrium with suction.

While an endometrial biopsy (a sample of the uterine lining is taken to determine if suspicious cells are present) has been standard procedure to check for precancerous conditions, the use of ultrasound which shows the thickness of the uterine lining is becoming more common. Studies reported in both the American Journal of Obstetrics and Gynecology and the Journal of Reproductive Medicine found that ultrasound was an effective screening tool for the presence of uterine abnormalities. It identifies those who need further diagnostic evaluation such as a biopsy if the test is abnormal or inconclusive.

This procedure allows a view of the whole uterus. A biopsy may not be representative of the condition of the entire endometrium. If abnormalities are found further procedures such as Magnetic Resonance Imaging (MRI) which uses a magnet to create images of live tissue, Computerized Axial Tomography (CT or CAT) which takes X-ray pictures of slices of a region, and hysteroscopy which allows the physician to look at the inner walls of the uterus and cervix may be used.

TREATMENTS One of the key questions in dealing with DUB is recognizing whether you are dealing with life-threatening bleeding (causing severe anemia, or caused by cancer) or lifestyle-threatening bleeding which is the most common cause of hysterectomies in this country. (See issue 3.3 on hysterectomy.) While heavy bleeding can be very disruptive to your daily activities, the safest approach is appropriate diagnosis and therapy beginning with the least invasive procedures. While DUB is the reason given for 20% of hysterectomies in this country, there are less drastic measures available that may solve the problem. Nonsteroidal anti-inflammatory drugs such as Advil may work for some women.

These are to be started one week before menses and continued through the flow. For perimenopausal women, oral contraceptives may be effective. Cyclic progesterone treatment or hormone replacement therapy are additional options. For more severe cases Danazol or injections of Depo-Provera or Depo-Lupron may be used. (D&C) may stop the bleeding, but it may return and is seldom used. Endometrial ablation (burning away or vaporizing the uterine lining) with laser or electrocautery is also often an effective alternative to hysterectomy.

A report this year in the New England Journal of Medicine reported that after five years 79% to 87% of women were happy with this surgery and it controlled bleeding in at least 85% of the women. During five years of follow up, only 9% underwent hysterectomy and 10% had another ablation. One possible down side to this treatment is future endometrial cancers may be harder to diagnose due to scar tissue in the uterus. A procedure which uses a catheter with a balloon attached is being studied. The catheter is inserted into the uterus. The balloon is inflated with sterile solution so it fills the uterus and takes its shape. Then a heating element raises the temperature to 189 degrees. This destroys the endometrial lining. This is still an experimental procedure but new techniques will be evolving.

SELF-HELP If you have consulted with your health care provider, you are dealing with heavy bleeding and no cause has been identified, here are some things you can do for yourself.

• Diet: If you are losing a lot of blood, you want to protect yourself from anemia by getting extra iron. Liver is a good animal source. A non-animal source is legumes, but you should take vitamin C (75mg.) with it because it aids absorption. Seeds, nuts, blackstrap molasses, some fruits such as raisins, dates, and prunes and some vegetables such as beets, corn, spinach, sweet potato, and dandelion greens, are also good. Fresh, dark green, leafy vegetables are a good source of Vitamins K and C and iron. Deficiencies in these may contribute to heavy bleeding. Herbs: Lady's mantel, Vitex (chasteberry), wild yam root, uva ursi, raspberry leaves, garden sage, black haw bark, golden seal, yellow dock, turmeric, silymarin and pau d'arco. Bioflavonoids: Citrus fruit inner peel, buckwheat, elder, hawthorn, horsetail, shepherd's purse. Essential Fatty Acids: Oils -- flax seed, borage seed, black currant, and evening primrose. Homeopathy: Lachesis, sepia, belladonna, ipecacuanha, secale, sabina, china, crocus sativa, natrum mur, sulfur. Supplements: Zinc, Copper, Iodine, Vitamin B6 Warning: Large doses of vitamin C may thin the blood and increase bleeding.
• Acupressure, yoga: Some women find specific yoga positions or acupressure points helpful.

The belief is that these approaches balance the body and stabilize energy flow, allowing the body to heal. See Heavy Menstrual Flow & Anemia by Dr. Susan Lark for further information.

For some women hysterectomy is the only solution. However, this surgery is too often used for problems that are not life-threatening. Because it is so common, we may not recognize its seriousness and too many women are not told of the possible side effects such as reduced sex drive, urinary problems, constipation, or back pain. If you consider surgery, be sure you are fully informed.

HERBS FOR PERI-MENOPAUSE

As we approach menopause, our menstrual cycles shift. In some women they get longer, in others they get shorter. Cycles double up, overlap, and become more irregular. We may begin to experience migraines, bloating, breast tenderness, hot flashes and moodiness as our hormones change. Herbs can be used to restore balance to our menstrual cycles in menopause.

A cyclic herbal elixir chosen for the individual woman will provide the most relief. Nonetheless, even single herbs may provide substantial relief -- provided our cyclical nature is respected. Our menstrual cycles can be divided into two phases. Phase One begins on the first day of menses and ends at ovulation, fourteen days before the next menses. Phase Two begins at ovulation and runs to the first day of menses. Different herbs are needed in the two phases.

• Herbs For Phase One

  In Phase One of the menstrual cycle, estrogen dominates. The estrogen causes uterine and breast tissue to proliferate. It also helps mature an egg. In Phase One, less than perfect menstrual cycles can be balanced by herbs that help the body cycle up estrogen. Both cycles that are too long and cycles that are too short are helped by the same herbs. In a long cycle, herbs increase the effect of circulating estrogen, allowing an earlier ovulation. In a short cycle, herbs increase the ability of estrogen to form adequate progesterone binding sites, which will stabalize the cycle. In both cases, the herbs should be taken only during Phase One of the cycle --Day one to Day fourteen.

  Dong Quai (Angelica sinensis) helps promote the body's use of, and response to, available estrogen. Dong Quai is available as a tincture that can be added to a little warm or cold water. Most of us need about 30 drops of tincture three times a day. Dong Quai is also available as thin slices of cured root. One/16th of a slice of root once a day is about right for most women. The root can be chewed or brewed into tea. (Dong Quai is also available in powder form. The quality and potency of the powder varies greatly, and may not be adequate.)

  Gotu Kola (Centella) helps the body utilize circulating thyroid hormones. Thyroid is important to ovulation. Gotu Kola is particularly helpful in women with long cycles because they may be having trouble maturing an egg. Thyroid levels increase at night, so Gotu Kola will be most effective if taken midday, at dinner, and right before bed in Phase One.

  Herbs for Phase Two

  In Phase Two (from ovulation to menses) progesterone is the dominant hormone. Progesterone is secreted by corpus luteum that is formed when the egg matures. This hormone organizes the tissue in our breasts and uterus for pregnancy. As we approach menopause, many of our eggs fail to secrete enough progesterone. We always have some estrogen circulating in the background. When progesterone dies back, estrogen takes over. Estrogen dominance in Phase Two will make the lining of the uterus thicker and our breast tissue "disorganized." This causes water retention, breast tenderness, and longer menses. Herbs that help maintain our progesterone phase are most helpful when taken from ovulation to menses.

  Chasteberry (Vitex agnus) probably stimulates the hypothalamus to increase Luteinizing Hormone which matures the egg and the corpus luteum. Chasteberry is a basic herb for women with longer menstrual cycles.

  Yellow Pond Lily (Nufar ) can help restore balance to the overly short menstrual cycle. It is a tonic sedative to "heat" in the ovaries.

  Herbal Teas that provide minerals in dissolved form can be a tremendous aid in Phase Two. During this phase, tissue is manufactured and broken down at a rapid pace. These activities generate a lot of waste that the liver must process. Providing an abundance of bioavailable minerals will help your body handle the increased waste load without stress. Mineral rich herbal teas also provide a good source of calcium which becomes increasingly important as you approach menopause. Good mineral rich tea can be brewed from any combination of: Lemon Balm, Raspberry, Green Oat Straw, Nettles, Dandelion, and Mormon Tea. A strong cup of tea once a day in Phase Two will minimize bloating, breast tenderness, and headaches.

  Garlic as food, in capsule or in tincture can be very helpful in the PMS period -- especially if the blood pressure rises premenstrually -- which happens frequently to women in their 30s and 40s. This blood pressure rise is often accompanied by an increase in blood fats. Fat filled blood does not move well through our capillaries and often causes premenstrual headaches, acne, and hemorrhoid flare-ups. Garlic "thins" the blood by increasing its electrical charge, allowing it to flow better.

  HERBS FOR MENOPAUSE

  As we move into menopause, our cycles will become increasingly unpredictable. Cyclical heral elixirs do not fit any longer because the phases blur together. Eventually, our menstrual cycles stop. As our estrogen levels drop, our hypothalamus will begin secreting large amounts of Follicular Stimulating Hormone (FSH) in a vain attempt to make our ovaries secrete estrogen. High levels of FSH often change the levels of thyroid in our bodies. These hormonal changes account for many of the metabolic shifts we experience in menopause: Hot flashes, night sweats, headaches, bloating, mood changes, etc. Herbs can be wonderful allies in this change.

  Dong Quai (Angelica sinensis) can be taken on a daily basis in menopause. It increases the effectiveness of the estrogen that now is eleased primarily from our fat tissue (rather than from our ovaries). Dong Quai can substantially soothe menopausal discomfort.

  Black Cohosh (Cimecifuga) or *Baneberry (Actea) are often helpful in menopause. (These two herbs work identically, so either one can be used. I prefer Baneberry because it is usually harvested more environmentally.) These herbs quiet the hypothalamic screams for estrogen. The hypothalamus perceives them as estrogen breakdown products. Estrogen breakdown products signal the hypothalamus that there is enough estrogen in the system, and less FSH is manufactured. Five to ten drops of either herb, taken as needed, can quiet a hot flash or ease other menopausal discomfort as the body adapts to menopause. More is not better though. Taking more than 15 drops at one time can increase the discomfort.

  Chasteberry (Vitex agnus) can also be taken on a daily basis in menopause, and it works wonderfully for many women, again by soothing the hypothalamus. Chasteberry is more individual though, and can cause discomfort in some women.

  As our estrogen levels decline, other hormones that were always in the background (like small amounts of testosterone) play a greater role in our metabolism. This can make our kidneys retain more sodium and water which raises our blood and cerebrospinal fluid pressure. We may experience bad headaches when the pressure rises.

• Pulsatilla (Anemone) can be wonderful here. Five drops of Pulsatilla when we feel a tightness over the eyes can turn an impending migraine around. It is also good for emotional surges that are hard to deal with. Pulsatilla is a "low dose" herb, however. Do not take more than 10 drops at a time.

  There are many other herbs that will help us through the emotional changes that often come with menopause. *Blue Vervain (Verbena) can be used as a tonic in a menopausal woman who experiences sudden angry outbursts. It relaxes the arteries, and creates a sense of relief and well being. Oat tincture (Avena) can help cycle up endorphins and help us relax at night (which can decrease those night sweats). It is a great soother when life gets a little exhausting. Kava Kava (Piper methysticum) can prevent headaches caused by tight muscles in the neck and shoulders, and can keep the mind feeling light.
  
  Finally, as our estrogen levels decrease, we have to pay greater attention to our calcium metabolism if we are going to keep our bones strong. A daily cup of calcium rich herbal tea becomes important. The calcium in herbal tea is absorbed directly into our blood from the stomach. It is more bioavailable than other sources of calcium that are absorbed through our intestine. A cup of Oat Straw, Nettle, Dandelion Leaf, and Mormon Tea with Raspberry Leaf and Peppermint for flavor will boost our calcium levels. Dandelion Root vinegar is easy to make, and a tablespoon of that vinegar in a salad dressing will provide a significant amount of easily absorbed calcium.
  
  CONCLUSION Ultimately, herbs do not work the way prescription drugs do. Usually herbs do not suppress symptoms. Instead, selected for a particular individual, herbs will change blood and hormone flow so that the body achieves a balance. A good balance cures the symptoms.
  
  A woman experiencing an unpleasant transition to menopause can benefit greatly from an individual herbal consultation. (Herbal consultations are available by mail as well as by personal visit.) The herbalist can select a combination of herbs that will support the liver, the kidneys, and the entire body as the woman goes through the metabolic change of menopause.
  
  The herbalist will also know of herbs that can ease other problems like flooding, fibroids, and vaginal dryness. A good herbalist will also recommend appropriate dietary and life style changes that will support a healthful balance in the individual woman. Exploring herbal alternatives before starting on hormone replacement therapy will also ensure that the woman knows that she has considered all of the choices and has chosen a path through menopause that really is best for her and her body. Read more about herbs in Power Surge Recommendations.

  Kathy Shull Abascal, C.H., J.D., P.D.T.
  Power Surge Herbal Consultant
  

Side effects with FemPatch are similar to those seen with other estrogen replacement therapies. As with all estrogen products, there are possible common side effects such as: headache, nausea, abdominal cramps, fluid retention, irregular bleeding, breast tenderness or increase or decrease in weight. Estrogens also have been reported to increase the risk of endometrial carcinoma in postmenopausal women.

PROGESTERONE CONTENT OF BODY CREAMS

More than 400 mg progesterone per oz:

• Pro-Gest Natural Progesterone Cream (Emerita: Portland, OR) Bio Balance (Garon Pharmaceuticals: Scottsdale, AZ) Progonol (Bezwecken: Beaverton, OR) OstaDerm (Bezwecken: Beaverton, OR) Pro-Alo (Healthwatchers Sys.:Scottsdale, AZ) PhytoGest (Karuna Corp.:Novato, CA) NatraGest (Broadmoore Labs, Inc.:Ventura, CA) Angel Care (Angel Care, USA: Atlanta, GA) Equilibrium (Equilibrium Lab, Boca Raton, FL) Pro-G (TriMedica: Scottsdale, AZ) ProBalance (Springboard, Monterey, CA) Femme Naturale (Sarati Inernational, Pheonix, AZ)

  Creams containing 2-15 mg progesterone per oz:

  Pro-Dermex (Gero Vita Int'l.:Reno, NV) Endocreme (Wuliton Labs: Palmyra, MO) Life Changes (MW Labs: Altanta) Protesterone-Plus (Prof. Health Products:Sewickley, PA)

  Creams containing less than 2 mg or NO progesterone/oz:

  Yamcon (Phillips Nutr.: Laguna Hills, CA) Born Again (Phytopharmica: Green Bay, WN) Fermarone (Wise Essen, Inc.:Minneapolis, MN) Wild Yam Cream (Alvin Last, Inc.: Yonkers, NY) Progestone-HP (Dixie Health, Inc.: Atlanta, GA) Progestone 10 (Dixie Health, Inc.: Atlanta, GA)

• Woman Wise (Jason Natural Cosmetics: Culver City, CA)

The Illinois Center for Clinical Trials is helping women who are experiencing hot flashes. Women ages 40-65 who are experiencing menopause or are hysterectomized may be eligible for a research study which provides free medication, physical exams and diagnostic tests. Those who qualify and complete the study will receive $125. If you are in the Chicago area (or know someone) and would like more info, please e-mail us or call (312) 565-5180.

(Note: This was written prior to the abrupt halting of the WHI Study (Women's Health Initiative) due to concern over unexpected results. Read more about it The HRT Controversy: Conventional Hormone Replacement Therapy: The Risks Outweigh The Benefits.)

Help us explore the herbal traditions that healers from other countries have brought to New York City. If you are a woman over the age of 18 and are symptomatic for:

• Endometriosis Fibroid Tumors Menopausal Hot Flashes
• Menorrhagia (Heavy Menstrual Flow)

We invite you to participate in a study investigating the herbal preparations used by other cultures to treat these conditions. If you are interested, please call: (212) 544-1095 Dr. Kronenberg
Columbia-Presbyterian Medical Center

The Institutional Review Board of Columbia-Presbyterian Medical Center has approved the solicitation of subjects to participate in this study. (IRB#7395).

Soy products, including tofu, tempeh, soy milk and soy cheese, can help reduce the risk of cancer and reduce symptoms of menopause. Soybeans contain powerful phytochemicals (plant compounds that can act therapeutically when eaten) that have been, and still are the subject of much research. Isoflavones are just one set of compounds discovered in soy. Isoflavones are phytoestrogens (plant estrogens) that have an inhibiting effect on hormone-related cancers such as prostate and breast cancers. These compounds may also have a positive effect on menopause by mimicking estrogen, which may reduce some of those difficult symptoms such as hot flashes.

• Is there soy in your future?

Soy, which contains relatively high levels of the phytoestrogens that some scientists now think may help stave off breast and prostate cancer as well as unpleasant menopausal symptoms, has an image problem in the United States. When Americans think of soy-based foods like tofu, for instance, they conjure up bland blocks of floating bean curd unacceptable to many Western palates.

Yet there is more to soy than bean curd. Food manufacturers now make soy products with Western taste buds in mind--everything from chocolate soy milk to soy cheese to soy ice cream to soy-based meat analogues meant to resemble turkey, chicken, hamburger, and bologna. But many of these items can be high in fat and low in essential nutrients such as calcium, a problem when people use them in place of dairy foods.

Another issue is that just as it's too early to know if soy is the miracle food some researchers suspect, it's impossible to tout specific soy products for their phytoestrogen content. Scientists at Tufts did find in one small experiment that four brands of tofu had about 10 times as much of the phytoestrogen genistein as a commercially available soy drink. But because research on the matter is just under way, and because of the variability due to differences in soy bean varieties and processing methods, exactly how much phytoestrogen a particular food contains remains largely an unknown.

One thing researchers are willing to speculate about is that, based on Asian eating habits, it looks as though only about two ounces of traditional soy foods a day are needed to reap the possible cancer-fighting, menopause-mitigating benefits in their phytoestrogens. Among those traditional soy foods: not just tofu but also tempeh and miso (described in the adjacent column). Although they are as fatty as many cuts of meat, they are low in saturated fat, the kind that is most apt to result in clogged arteries. And, prepared properly, they can satisfy even many inflexible meat-and-potato palates.

You can usually find tofu in the produce section of a regular supermarket, while tempeh and miso are generally available in health food stores and Asian markets. Following are some ideas for cooking these items along with nutritional information. There are no guarantees, of course, that the phytoestrogens in these foods will help temper the symptoms of menopause or fight cancer; it's just too early in the research game for that. At the very least, however, these dishes will help broaden your repertoire for healthful eating.

Tofu - By itself, tofu tastes rubbery and flavorless to many people. But in recipes, it acts like a sponge that soaks up the flavors of the other ingredients. Crumble it into a pot of spicy chili sauce, add it to casseroles and soups, or use it in vegetable stir-fries. The nutrient content of tofu varies by brand and consistency (it comes soft, firm, and extra firm), but a three-ounce serving contains in the neighborhood of 50 calories, about 20 of which come from fat--just about all of it unsaturated. It also has no cholesterol and very little sodium--about 1 percent of the 2,400-milligram daily limit recommended by the government. Tofu contributes some protein, too, and many brands provide up to 150 milligrams of calcium, the amount you would find in a half cup of milk. They may provide a little iron as well. Check the "Nutrition Facts" panel before purchasing.

Tempeh - A chunky, tender, and chewy cake of soybeans usually mixed with a grain such as rice or millet, tempeh (pronounced TEMpay) has a rich flavor sometimes described as smoky or nutty or akin to that of mushrooms. It can be steamed and marinated in a lemon-based or barbecue sauce and then grilled until browned. Chunks of tempeh can also be added to spaghetti sauce, sloppy joe, or chili mix or pan fried with mushrooms, onions, and bread crumbs for a delicious stuffing. Three ounces of tempeh supply about 150 calories (30 to 40 from fat), up to 80 milligrams of calcium (10 percent of the RDA for an adult), and as much as 20 percent of a woman's RDA for iron (3 milligrams' worth).

Miso - A salty condiment in which soybeans and sometimes a grain such as rice are combined with salt, miso can be used to flavor soups, sauces, dressings, and marinades. A quarter cup in a quart of water makes a decent soup stock. A tablespoon of miso has 60 to 80 calories and very little to no fat. It is quite high in sodium, however, which is why it should be used sparingly. A single tablespoon contains about 600 milligrams, or a fourth of the daily recommended maximum.

• Proven Safe?

At the end of the symposium, the researchers offered suggestions for the most important types of research needed for the field to evolve, including research on:

• ... the actions of phytoestrogens that are weakly anti-estrogenic, ... the actions of anti-estrogens that are weakly estrogenic, ... factors that influence dietary absorption of phytoestrogens, and
• ... how endogenous and exogenous hormones work

Jan Ziegler

Some scientists have even wondered if there is something genetically different about Asian women that might explain their lower breast cancer rates. However, the fact that American descendants of Asian migrants to the U.S. have higher breast cancer rates than their ancestors largely disproves that notion. In addition, a study at the National University of Singapore found that premenopausal Chinese women who did not have breast cancer tended to eat more soy products than very similar Chinese women who did have breast cancer, suggesting that even if genetics is part of the "equation," something about life-style has an impact as well.

It may even be found someday that the phytoestrogens in soy do some of the "heavy duty" work of estrogen replacement therapy: keep postmenopausal women at a lower risk of having a heart attack (estrogen raises the level of "good" HDL-cholesterol, which keeps arteries clear) and reduce their chances of suffering osteoporosis (estrogen also helps preserve bone density). Future studies hold the key.

Just want to leave you with a quote from an interivew I found with Dr. Bernadine P. Healy who was talking about the PEPI trial: "I think the biggest surprise certainly was the HDL effect of micronized progesterone....Also, we have to find out more about micronized progesterone. Why is it so different from Provera? Physiologically, you wouldn't expect that it should be." Interesting.

The LH (not LSH) is a measurement of another pituitary hormone (luteinizing hormone) which in the menstruating woman is called in to make the egg mature after FSH has started the process - so a high LH (over the lab's usual norms for menstruating women) suggests menopause also.

• What is hormone replacement therapy?

  Hormone replacement therapy refers to providing a woman who has gone through menopause with hormones that her body has stopped producing. Menopause, also referred to as the "change of life," occurs when a woman's ovaries stop producing the hormones estrogen and progesterone. When menopause occurs, menstruation stops and a woman is no longer able to conceive. The average age of menopause is about 50 years old. Menopause can also occur when a woman has an operation in which her ovaries are removed (oophorectomy). This type of menopause is known as surgical menopause because it has occurred due to a surgical procedure.

  Why is menopause important?

  U.S. women now live one-third of their lives after menopause. Women are living longer. The average life expectancy for a U.S. woman is about 76 years. This is important because scientists are discovering many physical changes that occur after menopause that influence a woman's risk of disease, including bone loss, coronary heart disease and cancer.

  What are the benefits of hormone replacement therapy?

  One immediate benefit of hormone replacement therapy is the relief of uncomfortable symptoms that may occur with menopause, such as "hot flashes" (a wave of heat and sweating), night sweats and painful intercourse. Hormones also help alleviate other menopausal symptoms, such as changes in urination, irritability and depression.

  Osteoporosis - Another benefit of therapy is prevention of bone loss. Bone loss speeds up after a woman's body stops producing estrogen on its own. This bone loss, which results in fragile, brittle bones that break easily, is called osteoporosis.

  Are there other benefits to hormone replacement therapy?

  Coronary heart disease - In addition to the relief of menopausal discomforts and the prevention of osteoporosis, hormones appear to reduce a woman's risk of serious coronary heart disease, including heart attack. After menopause a woman's risk of having a heart attack rises quickly, approaching the same risk as for a man. In addition, the first heart attack is more likely to be fatal among women than among men. A woman who takes estrogen has about a 50% less chance of death from coronary heart disease than a woman not taking estrogen.

  For women taking both estrogen and progestin, the exact amount of the benefit is not clear. It appears that the combination of both hormones can still lower a woman's risk of oronary heart disease, but it is not certain if the benefit will be as great as 50%.

  What are the risks?

  The risks depend on the type of treatment prescribed, whether the woman has a uterus, and how long hormones are taken. With short-term therapy of less than 5 years, there are very few risks of treatment.

  Endometrial cancer - If estrogen alone is taken by a woman who has a uterus, there is an increased risk of endometrial cancer (cancer of the lining of the uterus). This increased risk can be eliminated by the addition of a second hormone, a progestin, to the regimen. This is the reason it is important for a woman who has a uterus to be taking both hormones. Another important fact about endometrial cancer is that it is usually caught early and is rarely fatal. Because the primary symptom of this cancer is vaginal bleeding, your clinician will monitor you closely for any signs of unusual bleeding.

  Breast cancer - There have been many studies done to look at whether hormones cause breast cancer in postmenopausal women. The studies do not agree. Some find no increased risk. Some find a small increased risk after many years (10 to 15 years or more) of regular use. With short-term therapy (less than 5 years), studies show that women are not at increased risk of breast cancer.

  Are there different kinds of hormone replacement therapy?

  Yes. Sometimes estrogen alone is prescribed, other times both estrogen and a progestin are prescribed. Most often, a woman will be given estrogen alone if she does not have her uterus (has had a hysterectomy). If the woman has a uterus, then she usually will take both estrogen and progestin. Hormones can be given in oral tablets, vaginal creams, or patches placed on the skin.

  What are the side effects?

  Side effects of estrogen include breast tenderness, edema, nausea, headache, and breakthrough bleeding. Progestins may cause fluid retention, acne, premenstrual-like symptoms, anxiety, depression, and irritability. These side effects are not medically serious, although they can be bothersome, and can often be helped by changing the dose or medication.

  How do I know if hormone replacement therapy is right for me?

• There is no question that short-term therapy will help relieve menopausal symptoms. Whether or not you will benefit from taking hormones for many years to prevent disease and prolong life must be based on your risk factor profile. It's important to discuss the risks and benefits of therapy with your physician so that you understand how they apply to you. For example, a woman at high risk of coronary heart disease or osteoporosis may benefit from long-term treatment even more than a woman not at risk of these diseases.

Robert James Gallo, M.D., F.A.C.O.G.

(Note: This was written prior to the abrupt halting of the WHI Study (Women's Health Initiative) due to concern over unexpected results. Read more about it The HRT Controversy: Conventional Hormone Replacement Therapy: The Risks Outweigh The Benefits.)

Doctors have other reasons to think that soy might be a treatment for menopausal symptoms. One is the rarity of these problems in Asian countries, where the soybean is common. Indeed, Burke said there is no phrase in Japanese for "hot flash."

Power Surge has welcomed many wonderful authors. Here is a list of their most recent books.

• Barbach, Lonnie, Ph.D. -- The Pause De Angelis, Barbara, Ph.D. - TV Informercial, "Making Love Work" and
  
  "Ask Barbara:The 100 Most-Asked Questions About Love, Sex & Relationships." DeAngelis, Lissa, CCP and Molly Siple -- Recipes For Change DeMarco, Carolyn, MD. --Take Charge Of Your Body Friday, Nancy -- The Power Of Beauty; My Mother, Myself Hufnagel, Victoria, M.D. -- No More Hysterectomies; No More Menopause Kamen, Betty, Ph.D. -- Hormone Replacement Therapy - Yes Or No? Libov, Charlotte -- The Complete Guide To Keepintg Your Heart Healthy; What To Do If Things Go Wrong; 50 Essential Things To Do When The Doctor Says It's Heart Disease Northrup, Christiane, M.D. - Women's Bodies, Women's Wisdom Ojeda, Linda, Ph.D. -- Menopause Without Medicine Pogrebin, Letty Cottin -- Getting Over Getting Older Rako, Susan, M.D., - The Hormone Of Desire:The Truth About Testosterone, Sexuality and Menopause Sheehy, Gail -- Silent Passage; New Passages

  Weed, Susun -- Menopausal Years:The Wise Woman Way