1. Complementary therapies for menopausal symptoms Complementary therapies for menopausal symptoms Rod Baber

2.  Estradiol was isolated in 1923 and first synthesized in 1928  The first commercial inexpensive estrogen preparation was conjugated equine estrogens (CEE or ‘Premarin’) in 1942  For western post menopausal women with troublesome symptoms CEE became the treatment of choice and remained so until publication of results from ‘The Women’s Health Initiative’ (WHI) clinical trials in 2002.  Adverse findings from those trials led many women to seek alternative therapies, mostly to alleviate troublesome menopausal symptoms  These alternatives were often based on ‘Eastern’ traditional therapies including compounded Chinese herbal preparations, Black Cohosh and Phytoestrogen preparations derived from Soy and red Clover.  Of these, by far the most widely used in ‘The West’ are phytoestrogens Some Background

3. Dietary Isoflavones reduce incidence of menopausal symptoms 0102030405060708090100 Singapore Japan China Malaysia Europe Incidence Hot Flushes (%) Rekers H. Burger HG, Boulet MJ, editors. A Portrait of Menopause. Parkridge, New Jersey: The Parthenon Publishing Group; 1991; p. 23-43. Ismael NN. A study on the menopause in Malaysia. Maturitas 1994;19(3):205-9. Tang GW. The climacteric of Chinese factory workers. Maturitas 1994;19(3):177-82. Isoflavone Excretion (nmol/day) 0250500

4. Phytoestrogens  Phytoestrogens are plant constituents with a di-phenolic structure similar to oestrogen.  They are found in a wide variety of edible plants.  They bind to estrogen receptors but preferentially to ER  They may act as weak oestrogens in some circumstances. β MoleculeRelative potency Estradiol100 Coumestrol0.202 Genistein0.084 Daidzein0.013 FormononetinConverted into Genistein & Daidzein Biochanin AConverted into Genistein & Daidzein

5. Estrogen Receptors  There are at least two different receptors for Estrogen  These receptors are found in different concentrations in different tissues throughout the body in CVS, Bone, Ovary, Brain and Urogenital tract in Breast, Uterus, Brain & Ovary  ER Beta modulates the effects of ER Alpha in cells with both receptors  Cellular sensitivity to E2 at low concentrations is reduced in cells with both receptors  There are two different estrogen receptors. β α α β β α

6. Actions of Estrogen agonists, antagonists and SERMs Effects will vary with type of SERM and organ system Receptor mediated effects blocked Normal Receptor mediated Estrogenic effects

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