EARLY FLASH POINTS

By J. MADELEINE NASH

Four years ago, when she was 47, Nina Shandler turned into a red-eyed wretch, wrung out by hot flashes that banished sleep. There she was, lying in bed, soaking in her own sweat, awakened "at two-hour intervals every single night by a self-generated tropical typhoon." She knew the term hot flash but hadn't expected to encounter one this side of 50. What conventional wisdom had neglected to convey to Shandler is that long before menopause occurs and menstrual cycles cease, women in their 30s and 40s can be subject to distressing symptoms. Like adolescence in reverse, the transition out of fertility, called perimenopause, is a time of wild hormone swings. And they can trigger a long list of problems, among them hot flashes, pimples, dry skin, insomnia, depression and lapses of memory.

Shandler, the author of several cookbooks, sought solace in the usual place--her kitchen. The result, Estrogen: The Natural Way (Villard, $24.95), will be in bookstores next month. It contains 250 recipes that Shandler devised for foods to relieve her discomfort, including salad dressings and soups, muffins and mousse cake. Just one slice of mousse cake a day, she swears, keeps those hot flashes at bay.

How does Shandler work her medicinal magic? The ingredients she weaves into each and every recipe--flaxseed, soy milk, tofu--contain chemical compounds known as phytoestrogens, which are estrogens produced by plants. Forget the fact that tofu doesn't taste particularly good, Shandler breezily advises. "It's like flour. Flour is a useful ingredient. Nobody expects it to taste good." Just throw a little silken tofu into a blender, add a splash of vanilla extract, a sprinkling of cocoa powder, a dollop of maple syrup, and you'll see. "I truly love this food," she insists, and so, apparently, do her husband and kids.

For the 40 million female baby boomers reluctantly edging toward the half-century mark and beginning to suffer the symptoms of perimenopause, phytoestrogens are shaping up as the next big health fad--as big, perhaps, as fiber and omega-3 fatty acids rolled into one. The reason: many women are unhappy with the options mainstream medicine has to offer. For younger women in perimenopause, gynecologists sometimes prescribe low-dose birth-control pills to even out hormone levels. And as full menopause draws nearer, physicians typically prescribe Premarin, an estrogen derived from pregnant mares' urine. But while the benefits of Premarin are considerable--among other things, it may reduce the risk of heart disease and osteoporosis--there are potential dangers. Women who take Premarin for many years can increase their chance of developing breast cancer (see box for the latest research).

Do phytoestrogens offer boomers a better bargain? Many women clearly think so. "Close to a natural wonder drug," says UCLA breast-cancer surgeon Dr. Susan Love in her recently published Dr. Susan Love's Hormone Book (Random House, $25). At 49, Love, a vocal and controversial critic of hormone-replacement therapy, has entered perimenopause. To cope, she exercises daily, adds phytoestrogen-rich foods like soybeans and flaxseed to her diet and doses herself with black cohosh, an herbal source of phytoestrogens that comes in liquid or tablet form.

For the dietary-supplement industry, the infatuation with phytoestrogens is a bonanza. At Capitol Drugs in West Hollywood, California, women of a certain age are stocking up on black cohosh and dong quoi, another estrogenic herb that can be added to tea. At Whole Foods in suburban Wheaton, Illinois, they are snapping up brand-name products like Remifemin and MenoBalance, both of which contain black cohosh, for anywhere from $30 to $80 for a month's supply. Yet none of these products have been adequately tested for safety and effectiveness because dietary supplements are not stringently regulated by the U.S. Food and Drug Administration.

For their part, health-food companies are bringing snack bars, shakes and breads containing soy and flaxseed to market, and mainstream food manufacturers are considering similar products. But women who fold these foods into their diet may be disappointed. Plants vary enormously in the amount of phytoestrogens they contain. And some soy products, especially powdered soy protein, are processed in ways that remove their phytoestrogens entirely.

What alarms many physicians is the perception that estrogens produced by plants are somehow intrinsically benign. For example, Hollywood screenwriter Christine Conrad, 54, author of another forthcoming book, Natural Woman, Natural Menopause (HarperCollins, $24), defines plant-derived hormones as "natural"--and implies that Premarin, which comes from horses, is not. Under the care of her naturopathic physician and co-author, Marcus Laux, Conrad claims to have safely and comfortably navigated her own menopause, which followed a hysterectomy she underwent at age 46. "The natural hormones," she says, "don't have side effects."

Or do they? Anecdotal reports suggest that in large doses phytoestrogens can promote the abnormal growth of cells in the uterine lining. Says Dr. Wulf Utian of Case Western Reserve University, a leading menopause expert: "One thing we do know is that unopposed estrogen leads to endometrial cancer." To prevent this, women on conventional estrogen-replacement therapy typically take progestin along with their Premarin. While boosters of alternative therapies argue that some phytoestrogens, at least, appear to act as antigrowth factors in the uterus and breast, most physicians remain unconvinced of their safety. "I believe in alternative medicine but not in alternative medication," says Dr. Harriette Mogul of New York Medical College. "To use something before we study it would be foolhardy."

To be sure, phytoestrogens look promising. Wake Forest University epidemiologist Dr. Gregory Burke has launched a clinical trial designed to measure the effects of soy phytoestrogens on 280 perimenopausal women. Already, he says, the results of a smaller, preliminary trial suggest that the estrogenic compounds soy contains--genistein and diadzein--relieve the severity of hot flashes and also lower cholesterol. But promising as it seems, cautions Burke, no one yet knows whether soy can provide what women want--all the benefits of Premarin without its negative effects.

--With reporting by Martha Smilgis/Los Angeles and Leslie Whitaker/ Chicago

With reporting by MARTHA SMILGIS/LOS ANGELES AND LESLIE WHITAKER/CHICAGO