# The Impact of Sulforapahane on Sex-Specific Conditions and Hormone Balance: A Comprehensive Review
## 4 Female Health
### Perimenopause and Menopause  
Perimenopause, the transitional period before menopause when a woman's body begins to undergo hormonal changes, is characterized by unpredictable fluctuations in levels of estrogen and progesterone. It can last several years, typically starting in a woman's 40s, and is characterized by irregular menstrual cycles, hot flashes, night sweats, mood swings, sleep disturbances, changes in libido, vaginal dryness, and declining fertility. Menopause is a natural transition in a woman's life, typically occurring by the early 50s, and is defined as that point at which a woman has not had a menstrual period for 12 consecutive months. It can be marked by loss of bone density and increased risk of osteoporosis, long-term cardiovascular risks due to decreased estrogen levels, and persistence of many of the symptoms of perimenopause. Estrogen and progesterone levels will have dropped significantly and stabilized at low levels and ovulation/fertility ends [50]. The search for natural and effective treatments for menopause-related symptoms has increasingly been directed towards phytochemicals like sulforaphene [27]. The central function of the Nrf pathway to modulate oxidative stress has been established along with the highly capable function of SF to activate this pathway. The complex relationship of this Nrf2-mediated reduction in oxidative stress and ovarian aging, including common factors exacerbated by the hormonal shifts occurring during menopause, has recently been reviewed [51], highlighting several important realities that ovarian aging drives, in addition to the obvious depletion of function: (a) development of menopausal syndromes; (b) increased risk of age-related diseases including osteoporosis, cognitive impairment, cardiovascular disease, and cancer; (c) epidemiologic associations between increased all-cause mortality and rates of cancer with premature ovarian failure compared to a normal menopausal age group; and (d) as a pacemaker for other organs aging during the lifespan. The review by [51] specifically links ovarian aging to the Nrf2-mediated antioxidant responses, including induction of GSH and the antioxidant response, apoptosis, and ferroptosis, which have been shown to be key factors in premature aging.  
The anti-inflammatory effects of sulforaphene may also play a crucial role in alleviating menopausal symptoms. Chronic inflammation is associated with metabolic syndrome, cardiovascular disease, and other conditions that are more prevalent post-menopause due to changes in estrogen levels. By down-regulating pro-inflammatory cytokines and supporting cellular defense mechanisms, SF could potentially reduce the risk of these menopause-related health issues [52].  
Additionally, the influence of SF on estrogen metabolism has been investigated. It has been suggested that sulforaphene may support the detoxification of estrogen metabolites through the upregulation of phase 2 detoxification enzymes, thereby contributing to a more favorable balance of estrogen metabolites [53]. This may be particularly relevant during menopause and perimenopause, when estrogen production shifts predominantly to peripheral tissues, altering the hormonal landscape [54].  
One further relationship between SF and menopausal changes relates to the capacity of SF to influence gut health (the microbiome) [17]. The microbiome has been documented to have an important impact upon the progression and quality of life in menopause [55]. Thus, the incorporation of SF as a dietary intervention offers significant promise for improving health outcomes in menopausal women.