SYMPOSIA Saturday, May 27, 10:30-12:30
Phytochemicals, Menopause, and Hormone Replacement
Speakers: Robert Clarke, PhD, Leena Hilakivi-Clarke,
PhD, Bruce Trock, PhD, William Wong, PhD, Pauline Maki, PhD
Menopause is a natural consequence of aging
and the associated decline of ovarian follicular development, with a
mean age of onset around 50 years of age. This process can begin up
to 6-8 years earlier, with the onset of an often-symptomatic perimenopausal
period. Each woman's experience of perimenopause/menopause can vary
significantly in the pattern of symptoms and their relative severity.
Common symptoms include vaginal dryness, hot flashes, sleeplessness,
reduced cognitive function, depression, irritability, and varying timing
of menses (progresses until menstruation ceases). Menopause also is
associated with an increase in body weight, increased risk of cardiovascular
disease and increased bone resorption (can lead to osteoporosis).
Changes in the production of the ovarian hormones
estrogen and progesterone are common links between a loss of ovarian
function and the symptoms and consequences of menopause. Thus, it has
been standard practice for health care providers to recommend the use
of an estrogen-based hormone replacement therapy - often a therapy that
also includes a progestin. Such therapies provide significant benefit
for several menopausal symptoms and associated problems including osteoporosis,
incidence and severity of hot flashes, cognitive function, and dysthymia.
However, evidence that estrogen-based therapies reduce the risk of cardiovascular
disease in the postmenopause has not been reproduced in recent studies
in large populations. Furthermore, conventional therapies are associated
with an increased risk of breast and endometrial cancers.
The use of complementary and alternative approaches
for managing menopausal symptoms has increased in recent years - particularly
among those women for whom taking estrogens may be problematic, e.g.,
breast cancer survivors and women with an increased risk of developing
breast cancer. Complementary and alternative approaches that have gained
popularity for selected symptoms include acupuncture, aerobic exercise
and strength training, diet modification, and the use of dietary supplements.
Among these latter approaches, those that are becoming most common include
the use of soy products and/or supplementation with related phytoestrogenic
compounds (e.g., genistein or other isoflavones), and botanicals or
phytochemical preparations.
Despite widespread use, the efficacy, safety,
and mechanism of action of these complementary and alternative approaches
remain controversial. In the proposed session, a series of experts will
address the major issues relating to the management of menopausal symptoms
in a manner that compares the relative risks and benefits of complementary
therapies with conventional estrogen-based hormone replacement therapies.
The primary goal is to provide attendees with an objective, evidence-based
assessment of efficacy and safety in humans; relevant observations and
mechanistic insights from animal and cell culture models will be included.
The topics for presentation have been selected to reflect the diversity
of menopausal symptoms and the more common alternative approaches for
symptom management, e.g., soy foods and isoflavones. The session is
designed to provide short, focused presentations that address the primary
goal from the clinical and basic science research perspectives. Presentations
will be targeted at a level that is accessible to a wide range of meeting
participants. It is anticipated that five speakers will present for
25 mins each; a further 5 mins is set aside for discussion of each presentation.
Finally, the chair will lead a 30 min panel and attendee wrap-up discussion.
Given the importance and controversial nature of the subject, an open
discussion with full audience participation is considered to be a more
effective use of time than the inclusion of a sixth speaker.