بررسی تأثیر فیتواستروژن‌ها بر علایم یائسگی: یک مرور نظام‌مند

نوع مقاله : مقاله مروری

نویسندگان

1 دانشیار، مرکز تحقیقات مامایی و بهداشت باروری و گروه مامایی و بهداشت باروری، دانشکده‌ی پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 دانشجوی دکتری تخصصی سلامت باروری، کمیته‌ی پژوهشی دانشجویان، دانشکده‌ی پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمه: یائسگی به عنوان یکی از مسایل بهداشت باروری زنان دارای اهمیت ویژه‌ای است. کمبود استروژن در این دوران، منجر به عوارض متعددی می‌شود. علاوه بر گرگرفتگی که مهم‌ترین علامت یائسگی است، زنان ممکن است خشکی واژن، اختلالات خواب، افسردگی، کاهش تراکم استخوان و بیماری‌های قلبی- عروقی را نیز تجربه کنند. به منظور کاهش مشکلات تهدید کننده‌ی زندگی، زنان یائسه از درمان‌های مختلفی نظیر روش جایگزین هورمونی استفاده می‌کنند. در بین درمان‌های جایگزین، فیتواستروژن‌ها جایگاه خاصی دارند. این مطالعه، با هدف بررسی تأثیر فیتواستروژن‌ها بر علایم یائسگی انجام شد.روش‌ها: مطالعه‌ی حاضر، یک مرور سیستماتیک بر روی بررسی‌های انجام شده می‌باشد. جستجو در پایگاه‌های اطلاعاتی Science direct، Scopus، Pubmed، EMBASE، Google scholar، Scientific Information Database (SID) و IranMedex بین سال‌های 2017-2013 با استفاده از کلید واژه‌های یائسگی، کلیماتریک، فیتواستروژن‌ها، ایزوفلاون‌ها و استروژن‌های غیر استروئیدی همراه با علایم یائسگی انجام شد.یافته‌ها: در نهایت، 25 مقاله شامل 7 متاآنالیز، 14 کارآزمایی بالینی، 2 مطالعه‌ی هم‌گروهی و 2 مطالعه‌ی مقطعی، درباره‌ی اثر فیتواستروژن‌ها بر علایم یائسگی به دست آمد. این مقالات، اثر فیتواستروژن‌ها را بر افسردگی، واژینیت آتروفیک، گرگرفتگی، شاخص‌های بیماری قلبی- عروقی و فشار خون، عملکرد شناختی، وضعیت استخوان و خطر سرطان زنان مورد بررسی قرار داده بودند.نتیجه‌گیری: فیتواستروژن‌ها به دلیل داشتن خواص استروژنی، برای بهبود علایم یائسگی می‌توانند به عنوان یک درمان پیشنهادی مد نظر قرار گیرند. به این امید که کیفیت زندگی زنان در این دوران حساس از زندگی بهبود یابد.

کلیدواژه‌ها


عنوان مقاله [English]

The Effect of Phytoestrogens on Menopause Symptoms: A Systematic Review

نویسندگان [English]

  • Zohreh Keshavarz 1
  • Samira Golezar 2
  • Mahboubeh Hajifoghaha 2
  • Shiva Alizadeh 2
1 Associate Professor, Midwifery and Reproductive Health Research Center AND Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 PhD Candidate in Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Background: Menopause is a major concern in women’s productivity. Low estrogen in this period brings about many complications. Besides hot flashes, which are the most common menopausal symptom, women might experience vaginal dryness, sleeping disorders, depression, low bone density, as well as cardiovascular diseases. To decrease these life-threatening complications, postmenopausal women receive varying treatments including hormone replacement therapy (HRT). Among the replacement therapies, phytoestrogens are special. The present study was conducted to investigate the effect of phytoestrogens on menopause symptoms.Methods: This was a systematic review of the previous studies. The search was conducted through Science Direct, Scopus, PubMed, EMBASE, Google Scholar, Scientific Information Database (SID) and IranMedex databases during 2013-2017, using the keywords menopause, climacteric, phytoestrogens, isoflavones, non-steroidal estrogen, and menopausal symptoms.Findings: Ultimately, 25 articles, including 7 meta-analyses, 14 clinical trials, 2 cohort studies, and 2 cross-sectional ones were found focusing on the effect of phytoestrogens on menopause symptoms. These studies measured the effect of phytoestrogens on depression, vaginite atrofica, hot flashes, cardiovascular diseases indices and blood pressure, bone status, and the risk of cancer in women.Conclusion: The results revealed that having estrogenic effects, the phytoestrogens could be considered as a proposed treatment to relieve menopause symptoms in the hope of improving women’s quality of life during this time span.

کلیدواژه‌ها [English]

  • Phytoestrogens
  • Menopause
  • Systematic Review
  1. Casper RF. Clinical manifestations and diagnosis of menopaus. UpTodate [Online]. [cited 2013]; Available from: URL: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-menopause
  2. van UpTodate J, Faddy MJ, Themmen AP, de Jong FH, Peeters PH, van der Schouw YT, et al. Relationship of serum antimullerian hormone concentration to age at menopause. J Clin Endocrinol Metab 2008; 93(6): 2129-34.
  3. Golian TS, Bazzazian S, Bakhtiarian A, Ghobadzadeh M. Effects of calci soya balance and vitagnus on menopausal symptoms. Iran Red Crescent Med J 2014; 16(10): e13651.
  4. Woods NF, Mitchell ES. Symptoms during the perimenopause: Prevalence, severity, trajectory, and significance in women's lives. Am J Med 2005; 118(Suppl 12B): 14-24.
  5. Whiteman MK, Staropoli CA, Langenberg PW, McCarter RJ, Kjerulff KH, Flaws JA. Smoking, body mass, and hot flashes in midlife women. Obstet Gynecol 2003; 101(2): 264-72.
  6. Huang AJ, Subak LL, Wing R, West DS, Hernandez AL, Macer J, et al. An intensive behavioral weight loss intervention and hot flushes in women. Arch Intern Med 2010; 170(13): 1161-7.
  7. Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000; 152(5): 463-73.
  8. Randolph JF, Jr., Sowers M, Bondarenko I, Gold EB, Greendale GA, Bromberger JT, et al. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition. J Clin Endocrinol Metab 2005; 90(11): 6106-12.
  9. Freedman RR, Roehrs TA. Sleep disturbance in menopause. Menopause 2007; 14(5): 826-9.
  10. Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: A community survey of sleep and the menopausal transition. Menopause 2003; 10(1): 19-28.
  11. Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000; 96(3): 351-8.
  12. Richard A, Rohrmann S, Mohler-Kuo M, Rodgers S, Moffat R, Guth U, et al. Urinary phytoestrogens and depression in perimenopausal US women: NHANES 2005-2008. J Affect Disord 2014; 156: 200-5.
  13. Lima SM, Bernardo BF, Yamada SS, Reis BF, da Silva GM, Galvao MA. Effects of Glycine max (L.) Merr. soy isoflavone vaginal gel on epithelium morphology and estrogen receptor expression in postmenopausal women: a 12-week, randomized, double-blind, placebo-controlled trial. Maturitas 2014; 78(3): 205-11.
  14. Yaralizadeh M, Abedi P, Najar S, Namjoyan F, Saki A. Effect of Foeniculum vulgare (fennel) vaginal cream on vaginal atrophy in postmenopausal women: A double-blind randomized placebo-controlled trial. Maturitas 2016; 84: 75-80.
  15. Greendale GA, Derby CA, Maki PM. Perimenopause and cognition. Obstet Gynecol Clin North Am 2011; 38(3): 519-35.
  16. Cheng PF, Chen JJ, Zhou XY, Ren YF, Huang W, Zhou JJ, et al. Do soy isoflavones improve cognitive function in postmenopausal women? A meta-analysis. Menopause 2015; 22(2): 198-206.
  17. Thorup AC, Lambert MN, Kahr HS, Bjerre M, Jeppesen PB. Intake of novel red clover supplementation for 12 weeks improves bone status in healthy menopausal women. Evid Based Complement Alternat Med 2015; 2015: 689138.
  18. Woodard GA, Brooks MM, Barinas-Mitchell E, Mackey RH, Matthews KA, Sutton-Tyrrell K. Lipids, menopause, and early atherosclerosis in Study of Women's Health Across the Nation Heart women. Menopause 2011; 18(4): 376-84.
  19. Santen R, Loprinzi CL, Casper RF. Menopausal hot flashes. UpTodate [Online]. [cited 2016]; Available from: URL: https://www.uptodate.com/contents/menopausal-hot-flashes
  20. Heydari L, Suhrabi Z, Sayehmiri F, Sayehmiri K. Effect of herbaceous medicines effective in hot flashes of menopause women: A systematic review and meta-analysis in Iran. Iran J Obstet Gynecol Infertil 2014; 17(109): 16-25. [In Persian].
  21. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002; 137(10): 805-13.
  22. Liu ZM, Ho SC, Woo J, Chen YM, Wong C. Randomized controlled trial of whole soy and isoflavone daidzein on menopausal symptoms in equol-producing Chinese postmenopausal women. Menopause 2014; 21(6): 653-60.
  23. Levis S, Strickman-Stein N, Ganjei-Azar P, Xu P, Doerge DR, Krischer J. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: A randomized, double-blind trial. Arch Intern Med 2011; 171(15): 1363-9.
  24. Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Aghamiri V, Nazemiyeh H, Soltanpoor S. The effect of Hop (Humulus lupulus L.) in treating early menopausal symptoms in post-menopausal women: A randomized clinical-controlled trial. Razi j Med Sci 2015; 22(131): 14-24. [In Persian].
  25. Liu ZM, Ho SC, Chen YM, Ho S, To K, Tomlinson B, et al. Whole soy, but not purified daidzein, had a favorable effect on improvement of cardiovascular risks: A 6-month randomized, double-blind, and placebo-controlled trial in equol-producing postmenopausal women. Mol Nutr Food Res 2014; 58(4): 709-17.
  26. Lagari VS, Levis S. Phytoestrogens for menopausal bone loss and climacteric symptoms. J Steroid Biochem Mol Biol 2014; 139: 294-301.
  27. Thomas AJ, Ismail R, Taylor-Swanson L, Cray L, Schnall JG, Mitchell ES, et al. Effects of isoflavones and amino acid therapies for hot flashes and co-occurring symptoms during the menopausal transition and early postmenopause: A systematic review. Maturitas 2014; 78(4): 263-76.
  28. Abdi F, Roozbeh N. The effects of Humulus Lupulus L.)Hops) on Menopausal Vasomotor Symptoms: A Systematic Review and Meta- analysi. Iran J Obstet Gynecol Infertil 2016; 19(26): 9-17. [In Persian].
  29. Greendale GA, Tseng CH, Han W, Huang MH, Leung K, Crawford S, et al. Dietary isoflavones and bone mineral density during midlife and the menopausal transition: cross-sectional and longitudinal results from the Study of Women's Health Across the Nation Phytoestrogen Study. Menopause 2015; 22(3): 279-88.
  30. Tit DM, Lazar, Bungau S, Pallag A, Bei D. The evaluation of the effectiveness of phytoestrogens in improving, reduction or suppression of the climacteric symptomatology. Studia Universitatis Vasile Goldis Seria Stiintele Vietii (Life Sciences Series) 2013; 23(4): 513-8.
  31. Chilibeck PD, Vatanparast H, Pierson R, Case A, Olatunbosun O, Whiting SJ, et al. Effect of exercise training combined with isoflavone supplementation on bone and lipids in postmenopausal women: a randomized clinical trial. J Bone Miner Res 2013; 28(4): 780-93.
  32. Gold EB, Leung K, Crawford SL, Huang MH, Waetjen LE, Greendale GA. Phytoestrogen and fiber intakes in relation to incident vasomotor symptoms: Results from the Study of Women's Health Across the Nation. Menopause 2013; 20(3): 305-14.
  33. Chen MN, Lin CC, Liu CF. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric 2015; 18(2): 260-9.
  34. Tranche S, Brotons C, Pascual dlP, Macias R, Hevia E, Marzo-Castillejo M. Impact of a soy drink on climacteric symptoms: An open-label, crossover, randomized clinical trial. Gynecol Endocrinol 2016; 32(6): 477-82.
  35. Atteritano M, Mazzaferro S, Bitto A, Cannata ML, D'Anna R, Squadrito F, et al. Genistein effects on quality of life and depression symptoms in osteopenic postmenopausal women: a 2-year randomized, double-blind, controlled study. Osteoporos Int 2014; 25(3): 1123-9.
  36. Ghazanfarpour M, Sadeghi R, Roudsari RL. The application of soy isoflavones for subjective symptoms and objective signs of vaginal atrophy in menopause: A systematic review of randomised controlled trials. J Obstet Gynaecol 2016; 36(2): 160-71.
  37. Zhang YB, Chen WH, Guo JJ, Fu ZH, Yi C, Zhang M, et al. Soy isoflavone supplementation could reduce body weight and improve glucose metabolism in non-Asian postmenopausal women--a meta-analysis. Nutrition 2013; 29(1): 8-14.
  38. Liu ZM, Ho SC, Chen YM, Woo J. Effect of soy protein and isoflavones on blood pressure and endothelial cytokines: A 6-month randomized controlled trial among postmenopausal women. J Hypertens 2013; 31(2): 384-92.
  39. Carmignani LO, Pedro AO, da Costa-Paiva LH, Pinto-Neto AM. The effect of soy dietary supplement and low dose of hormone therapy on main cardiovascular health biomarkers: A randomized controlled trial. Rev Bras Ginecol Obstet 2014; 36(6): 251-8.
  40. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry 2015; 57(Suppl 2): S222-S232.
  41. Quaas AM, Kono N, Mack WJ, Hodis HN, Felix JC, Paulson RJ, et al. Effect of isoflavone soy protein supplementation on endometrial thickness, hyperplasia, and endometrial cancer risk in postmenopausal women: A randomized controlled trial. Menopause 2013; 20(8): 840-4.
  42. Chen M, Rao Y, Zheng Y, Wei S, Li Y, Guo T, et al. Association between soy isoflavone intake and breast cancer risk for pre- and post-menopausal women: A meta-analysis of epidemiological studies. PLoS One 2014; 9(2): e89288.
  43. Qu XL, Fang Y, Zhang M, Zhang YZ. Phytoestrogen intake and risk of ovarian cancer: a meta- analysis of 10 observational studies. Asian Pac J Cancer Prev 2014; 15(21): 9085-91.
  44. Budhathoki S, Iwasaki M, Sawada N, Yamaji T, Shimazu T, Sasazuki S, et al. Soy food and isoflavone intake and endometrial cancer risk: The Japan Public Health Center-based prospective study. BJOG 2015; 122(3): 304-11.
  45. Umland EM, Karel L, Santoro N. Bazedoxifene and Conjugated Equine Estrogen: A combination product for the management of vasomotor symptoms and osteoporosis prevention associated with menopause. Pharmacotherapy 2016; 36(5): 548-61.
  46. Rahn DD, Carberry C, Sanses TV, Mamik MM, Ward RM, Meriwether KV, et al. Vaginal estrogen for genitourinary syndrome of menopause: A systematic review. Obstet Gynecol 2014; 124(6): 1147-56.
  47. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 2013; (12): CD001395.
  48. Droke EA, Hager KA, Lerner MR, Lightfoot SA, Stoecker BJ, Brackett DJ, et al. Soy isoflavones avert chronic inflammation-induced bone loss and vascular disease. J Inflamm (Lond ) 2007; 4: 17.
  49. Han KK, Soares JM, Jr., Haidar MA, de Lima GR, Baracat EC. Benefits of soy isoflavone therapeutic regimen on menopausal symptoms. Obstet Gynecol 2002; 99(3): 389-94.
  50. Messina M. Soy foods, isoflavones, and the health of postmenopausal women. Am J Clin Nutr 2014; 100(Suppl 1): 423S-30S.
  51. Pardhe BD, Pathak S, Bhetwal A, Ghimire S, Shakya S, Khanal PR, et al. Effect of age and estrogen on biochemical markers of bone turnover in postmenopausal women: a population-based study from Nepal. Int J Womens Health 2017; 9: 781-8.