Menopause
Doctors try to strike right hormonal balance
The object is to minimize the side effects and risks.
BY ELENA IGLESIAS
SPECIAL TO EL NUEVO HERALD
Marsha Jouben found herself in a desperate situation, with hot flashes every 20 minutes accompanied by anxiety. For four years she had not been sleeping well, burdened by night sweats.
“I come from a family where women have had many difficulties with menopause,” she says. “I was looking for a female doctor who could also be a role model of sorts, after various experiences with male doctors who did not understand me.”
When she met Dr. Nancy Eklund she knew she had found the key that would open the door to a better quality of life. Eklund, a specialist in bioidentical hormone replacement therapy, is the founder of the Miami Center for Holistic Healing.
“I try to work on general health, balancing hormones and everything else,” said Eklund. “I practice functional medicine, conventional and integrated, depending on the needs of each patient. I focus on nutrition, and on psychological and spiritual health.”
When Eklund sees a patient for the first time, she looks at her family history, relations, work environment and the age of her house. “All of that can affect health,” she says.
Eklund says it is better to imitate the body’s natural functions. “If we are replacing missing hormones, it’s better to find the best way to replace the exact hormones the body has lost,” she says. “That is what the term ‘bioidentical hormones’ means. They have molecules that are identical to the ones the person produces.”
The Women’s Health Initiative’s decision in 2002 to call off its study of thousands of older women because of concerns that the hormone replacement therapy being tested was putting women at risk for breast cancer, strokes and heart attacks, scared a lot of women off HRT, Eklund said.
“But you have to consider which people were being studied, what was the population, and the drugs they were taking,” she says. “Unfortunately, the study focused on older women who no longer had menopause symptoms. And those were not the women we usually treat. We treat women who have the symptoms.”
The study tested Prempro, made up of equine estrogen and synthetic progesterone.
“Yet when human natural estrogen is applied on the skin through patches, cream, gel or with aerosol, those effects do not appear because it does not go directly to the liver,” says Eklund. “I don’t see the reason to use oral estrogen in a treatment, especially when it is not bioidentical.”
She recommends natural estrogen that is applied on the skin and natural progesterone taken orally. She also says that in the WHI study the progestin used was not bioidentical, resulting in negative side effects.
Eklund said that many women go to her for treatment because they cannot persuade their doctors or gynecologists to prescribe hormones. “They fear the patient could develop some problem and then blame them for having used hormone treatment,” she says. “That is the real tragedy: the level of fear that exists with this kind of therapy in both doctors and patients.”
Eklund insists that hormonal therapy can be done in a safer way.
“Many conventional doctors prescribe natural estrogen on the skin and natural progesterone orally,” she says. “What I do differently is prescribe the dose to a level that sometimes is not commercially available. So I use a pharmacy that prepares medicines to fit the patient’s needs. For example, I may order a capsule of natural progesterone that is different from what is available at a conventional pharmacy.”
Eklund also prescribes natural supplements that help the body metabolize hormones. She uses, for instance, DIM (diindolylmethane), an extract of broccoli and cauliflower known for its anti-cancerous properties, together with turmeric, an herb used in curry powder from India, to help metabolize the estrogen.
“To some doctors, doing nothing is better than doing something. And the consequence is that women suffer. They come to my office begging for help because they can’t think clearly, are irritated, can’t sleep and are having hot flashes. And yet they cannot get help because of the existing fear.”
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