Hormone replacement therapy (HRT) was for many years a standard approach to managing peri-menopausal and menopausal symptoms, and protecting women against heart disease, building stronger bones, maintaining youthful skin, and supporting healthy brain function.

Millions of women in America were prescribed Premarin or Prempro, without much question, to replace the human sex hormones that naturally taper off in menopausal women — primarily estrogen and progesterone.

This standard use of HRT changed when data from the Women’s Health Initiative (WHI) study was made public in 2002. The evidence from this study set off a firestorm of controversy, and healthcare providers and their female patients were shocked to learn that HRT was not as protective, or as safe, as they had once assumed.

Since the results of the WHI were released, several alternatives to traditional (Premarin and Prempro) HRT therapy have taken center stage.  SpaceCoastMedicine.com welcomes Women’s Health Nurse Practitioner Kristine Maki to address questions related to one of these alternatives—bioidentical hormone replacement therapy (BHRT).

SCM&HL: The results of the WHI set Women’s Health back on its heels in 2002.  What are the take-aways from that multi-center research study?

Ms. Maki: WHI is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer and fracture in postmenopausal women. This 15-year project involves over 161,000 women ages 50-79, and is one of the most definitive, far reaching programs of research on women’s health ever undertaken in the U.S.

The Estrogen plus Progestin Study arm of the WHI was stopped in July 2002 because of increased risks of cardiovascular disease and breast cancer in women taking active study pills (Premarin and Provera), compared with those on placebo (inactive pills).

This aspect of the study focused on the synthetic hormones Premarin (conjugated equine estrogen) and Provera (progestin) rather than hormones that mimic those that our younger bodies actually make. The WHI involved older women, who were beyond the point where hormone replacement is most beneficial.

Recent studies suggest that STARTING hormone replacement more than 10 years after menopause (average age 51) may be harmful.  Additionally, the women participating in the WHI took oral pills instead of applying the hormones to their skin.

Oral estrogens change as they pass through our stomach and liver and cause an increase in bad cholesterol and decline in good cholesterol, which can increase our risk for heart disease. The study, while thought provoking, caused women to reexamine the need for hormone replacement.

It also points to the fact that scientific medical studies are rarely easy to interpret and that most women need a health care provider who can spend the time with his or her patients to help them decide what is right for them.

SCM&HL:  What was the reaction to and impact of the WHI?

Ms. Maki: The WHI influenced many practitioners to stop prescribing and women to stop taking hormone replacements, which had been prescribed by physicians for years.  The media and many practitioners painted all HRT with the same broad stroke, advising in medical alerts that the risks apply regardless of the type of hormones.

After hearing that hormones caused an increase in cancer and heart disease, I personally discontinued my Prempro immediately. Initially I did not feel much of a change, but as time passed, my lack of hormones was more and more noticeable. I became tired quickly, felt more anxious, and noticed that I was losing both a lot of hair as well as my temper.

Suzanne Somers published several books and I read them, but wasn’t convinced; after all she was an actress, not a medical professional.  Nonetheless she had excellent medical references and the doctors she saw for hormone replacement after she was diagnosed with breast cancer were well recognized for their excellence. I decided to get more information and for years went to medical conferences and found out what was really going on with hormone replacement therapy.

My focused review of the literature on the topic and the reanalysis of the WHI showed associated risks only for conjugated equine estrogens and synthetic progestins — not bioidentical hormones, and that BHRT was a great option for women.

SCM&HL: What is bioidentical hormone replacement therapy (BHRT)?

Ms. Maki: BHRT is a prescription alternative to conventional hormone replacement therapy that has existed for over 20 years, is molecularly identical to the hormones that are produced in the body, and is characterized by individual treatment doses which are not commercially available.

For example, Premarin contains synthetic estrogens originally produced from horse urine. It does contain several types of estrogen, but none that are found in a human. On the other hand, Estradiol (E2) is made in our body and has over 400 specific uses.

For two years, Oprah suffered from menopausal symptoms and a low thyroid condition. She wasn’t feeling herself, and doctors she consulted had no answers. In less than three days after starting on bioidentical hormones, her menopausal problems were gone and she was singing praises. Now, Oprah is bringing her experiences into the national consciousness with her Jan. 15, 2009 television show which highlighted bioidentical hormones.

Bioidentical E2 is made from natural plant compounds and synthesized to the exact structure and function as the E2 produced within the human body. We also have progesterone (the hormone of pregnancy, but important throughout our lives) and testosterone (important for sex drive and other good things).  Everyone has different needs, so it’s important that everyone has personally dosed BHRT based on her lab values, symptoms and other needs.

SCM&HL: Are BHRT better than synthetic hormones?

Ms. Maki: The great advantage of bioidentical hormones is that they are more natural, and our body can metabolize them as it was designed to do, minimizing side effects. Moreover, the compounded bioidentical hormones can be matched individually to each woman’s needs — something that’s not possible with mass-produced products.

SCM&HL: How safe are BHRTs?

Ms. Maki: The issue of safety keeps arising from the critics of BHRT, as well as the argument that they are not specifically “approved” by the FDA. The FDA has approved the same types of hormone molecules that act as messengers that turn on and off productions of bodily functions. The FDA is a federal agency and does a good job regulating manufactured drugs.

The FDA is not given the job to regulate BHRTs. That job is given to state agencies, and in many states the BHRTs are monitored even more closely than the FDA does. The FDA will make comments on BHRT manufacturers that make exorbitant claims, but does not act as a watchdog, as the states do an excellent job of that. The DEA (Drug Enforcement Agency) does watch over BHRTs, especially those that are considered controlled substances, such as testosterone.

The PCCA (Pharmaceutical Compounding Centers of America) is very involved in all compounded drugs, especially BHRT, and reputable compounding pharmacies are part of it. A good compounding pharmacy has just as good internal quality controls as those found in large pharmaceutical companies. You can rest assured that if you get BHRTs from a reputable compounding pharmacy you will have a top notch quality product that has been thoroughly tested and safe.

European medical studies suggest that BHRT are safer than synthetic versions. BHRT are much closer to what your body actually makes and it’s logical that they would be safer than synthetic hormones whose structures are different than those our bodies contain.

Although the drug companies and their sales people imply that BHRT medications aren’t manufactured carefully and lack quality control, that simply isn’t true about the majority of registered compounding pharmacies. They have excellent quality control and produce medications that pass rigorous testing standards

SCM&HL: In your practice, how do you approach the management of peri-menopausal and menopausal symptoms?

Ms. Maki: Most women are happy when their periods are over and some minimize their symptoms of menopause, but each woman is different.  Some women barely notice the changes as they are occurring, but unfortunately many suffer later in life with heart disease, osteoporosis, Alzheimer’s etc. that may have been avoided or minimized through proper hormone replacement given at the appropriate dose in a timely fashion. Others go to their doctors and take hormones just to get through the bad times and quit, but still may be facing future problems with hormone lack.

There continues to be a lot of confusion and even fear related to hormone replacement. I am devoted to clearing up the HRT story and setting the record straight for women. In my case, it took a couple years without hormones to recognize their importance.

Through extensive personal research, watching Oprah and Robin McGraw, but especially listening to my patients’ feedback (some say it gave them their life back) I became convinced again of the importance of BHRT.  I am glad to be back on my BHRT, and enjoy discussing how it can be extremely beneficial to most women.

Women who approach age 50 and beyond may be greatly benefited by estrogen and progesterone. In my practice I recommend estrogen to be applied on the skin (transdermally) or vaginally, whereas progesterone can be taken both orally and transdermally.

We use Hobbs Pharmacy in Merrritt Island as our local compounding pharmacy. Additionally we have found MedRX in Orlando to be excellent.  They both have very stringent control policies and have a superior safety rating.

My goal is to help inform women about their options so that they can make the choice that’s best for them. The final decision remains with the individual.

If you don’t like how you feel and want to regain a sense of being in balance with the hormones that control so much of our well being, BHRT may be for you. Our hormones don’t decline because we age; rather we age because our hormones decline.

To reach Ms. Maki call 321-305-5970 or e-mail KristineMaki@gmail.com

ABOUT THE AUTHOR

KRIS MAKI is licensed in Florida as a Registered Nurse and Nurse Practitioner, and is a Registered Nurse Certified Women’s Health Nurse Practitioner.  She was educated at Methodist Hospital in Lubbock, TX and Ball State University in Indianapolis, IN. Ms. Maki practiced as a labor and delivery nurse and maternal fetal intensive care nurse from 1988-2004, and is a member of the American Academy of Anti-Aging Medicine and the International Society for the Study of Women’s Sexual Health. She has been married to Lance Maki, MD, for 44 years and they have five adult children and six grandchildren – and counting. You may reach her at KristineMaki@gmail.com or 321-305-5970.

Dr. Maki is proud to be a sponsor of the 25th annual National Kidney Foundation Surf Festival’s Tandem Surf and Stand-Up Paddle Surf events at the Cocoa Beach Pier.

Dr. Maki, known as the ‘Father of East Coast Tandem Surfing,’ specializes in longevity and life quality. Restoring vitality, sexuality and balancing hormones is Dr. Maki’s area of expertise.

“Tandem Surfing has a rich heritage that has shaped surfing culture for generations,” said Dr. Maki.

Dr. Lance Maki is the Father of East Coast Tandem Surfing.

“It’s a beautiful expression between a man and woman that is both athletic and artful. A synergy of surfing prowess with partnership skills only found elsewhere in figure skating and adagio dance.”

The paddling onFriday, Sept. 3 will began at 10:30 a.m., and will take about 40 minutes to complete. The event included routes for both beginners and advanced paddlers, including canoers, kayakers and surfboarders. Refreshments will be served at the MAKImd office and all donations went to the National Kidney Foundation for patient care.

MAKImd Restoration Medicine is located at 190 S. Sykes Creek Pkwy, Suite 3, on Merritt Island, across from Merritt Square mall. For more information about the MAKImd Restoration Medicine Paddle In call 321-305-MAKI (6254).

‘Father of Tandem Surfing’ Practices What He Preaches

Dr. Maki, known as the ‘Father of East Coast Tandem Surfing,’ specializes in longevity and life quality. Restoring vitality, sexuality and balancing hormones is Dr. Maki’s area of expertise.

Dr. Maki received his M.D. degree from Texas Tech University Medical School in Lubbock, Texas and completed his residency in Obstetrics and Gynecology through the integrated residency at Wright Patterson AFB/ Miami Valley Hospital/ Wright State University in Dayton, Ohio.

He was an Air Force Flight Surgeon and Aerospace Physiologist, and is board certified, and a fellow, in both OB/Gyn and Anti-Aging/Functional Medicine.

“MAKImd Restoration Medicine is a unique medical practice that deals with the issues of aging with an approach that realizes that not all issues may be medical in nature,” said Dr. Maki.

he Makimd team uses a multi-faceted method of dealing with the physical and medical issues associated with slowing the aging process – as well as addressing the mental and emotional aspects of aging.

“The Makimd team uses a multi-faceted method of dealing with the physical and medical issues associated with slowing the aging process – as well as addressing the mental and emotional aspects of aging.”

With Dr. Maki are his wife of 43 years, Kristine Maki, RN, and renowned medical psychotherapist Dr. Duncan Bowen, PhD.

“As a team, we can address issues from all aspects of concern you may have with regaining the youthful vigor and vitality you once had,” said Kristine Maki.

Kristine received her RN degree from Methodist Hospital in Lubbock, Texas and trained at Ball State University, becoming a Women’s Health Nurse Practitioner in 1999. She has over 20 years experience in Women’s Health and specializes in Bioidentical Hormone Replacement for women.

Additionally she is an expert in Aesthetics, having trained with a plastic surgeon in Northern California. Kris is a member of the International Society for the Study of Women’s Sexual Health as well as the American Academy of Anti-Aging Medicine.

To schedule an appointment please call 321-305-MAKI (6254).