Ask: At a recent mammogram, a nurse suggested I consider hormone replacement therapy, as it is beneficial for older women. I’m 84 and took HRT for 20 years after a hysterectomy at 42. But then I stopped due to reports linking it to strokes and heart disease. I noticed a big drop in energy (which is still low) and I also have thinning hair.
Maureen Perks, Wollaston, Stourbridge, West Midlands.
Answer: I have long been an advocate of hormone replacement therapy (HRT), having followed the research and prescribing it to many patients over the years. While there is much evidence of its benefits for symptoms such as hot flashes, it also reduces the risk of osteoporosis and helps women maintain muscle strength.
However, there are some potential side effects, although the risks are low.
As far as age is concerned, the greatest benefits are seen when HRT is started as soon as possible after the onset of menopause (which usually occurs between the ages of 45 and 55).
Most experts recommend not starting HRT after age 60 or ten years after menopause, because a key study suggested that there are a higher number of “vascular events” (for example, strokes and heart attacks) in these women compared to those taking a placebo.
Most experts recommend not starting HRT after age 60 or ten years after menopause, because a key study suggested there are a higher number of “vascular events” (file photo)
That’s not to say that some patients over that age limit will never benefit, but the decision should depend on individual circumstances (their symptoms and risk factors) and a discussion between the patient and doctor.
One factor to consider is that we know that HRT can improve quality of life in women of all ages, and your description of lack of energy and hair loss are symptoms that may well improve if you restart HRT.
If you go on further treatment, I imagine you’ll be given one containing estrogen just because you’ve had a hysterectomy (in other words, you wouldn’t have progesterone either, since progesterone essentially regulates menstruation and prepares the body for pregnancy). It would also be a lower dose than would be prescribed for a patient under 60, since estrogen receptors in the body’s tissues are more sensitive in older women, so less is needed (decreasing the risk). of possible side effects). .
In my opinion… The effect of Wegovy on our diet.
It’s pretty clear that the foods most people eat are behind our obesity epidemic and its catastrophic health consequences. And concern about the role of ultra-processed foods in particular is becoming an outcry.
The manufacturers of these “industrialized” foods have achieved a silent invasion, introducing them into our diet right under our noses.
But with much of the world’s processed food production in the hands of just 20 giant companies, who has where, too, to confront their power and influence? However, now, riding over the hill, comes the cavalry. Last week it was reported that the increasing use of “fat loss” jabs like Wegovy means people are buying less food, according to US giant Walmart; These comments apparently led investors to “dump” shares of snack and soft drink makers.
I have met several people who tell me that since they joined Wegovy, they have almost no interest in food and have lost weight.
If they are cutting back on buying high-calorie, low-quality foods they no longer enjoy, that’s amazing. Could this, finally, be a turning point?
However, HRT is not recommended if you have high blood pressure or any other condition that your GP thinks increases your risk factors, such as a history of transient ischemic attacks (TIAs or “mini strokes”) or pulmonary embolism (a clot that blocks a blood vessel in the lungs).
I would talk to your GP – you might try HRT for a year and then reassess it to see if it gives you the benefits you expect. If this is successful, and as long as your GP agrees, you will be able to continue after this.
Ask: A year ago I had a scan as part of the follow-up for my advanced prostate cancer. I was surprised to receive a letter that said “just a quick note to assure you that the ultrasound of your abdomen showed that the cyst on your pancreas is completely benign and requires no further action.” I didn’t know I had a cyst on my pancreas! How can they say it is benign? Wouldn’t it require a biopsy to confirm it? Is it possible that it will change in the future?
Richard Francis, Fareham, Hampshire.
Answer: I’m sorry for the anxiety this has caused, but I hope to assure you that this is unnecessary.
Pancreatic cysts are most often detected in scans to look for other problems; They rarely cause symptoms, but they are discovered more frequently than in the past because modern imaging technology now detects them.
They become increasingly common with age, especially after age 65.
You’re right, a single ultrasound cannot confirm with certainty that a cyst is not precancerous, and although more than 90 percent will be made up of fluid only, closer inspection is recommended.
For cysts up to 2cm in size, this would mean an MRI or CT scan every one to two years to check for changes.
Larger cysts should be examined by endoscopic ultrasound, in which a thin fiberoptic camera is passed through the esophagus and stomach until it reaches the duodenum.
In some cases, a sample of the cyst will be taken at the same time. This could lead to another form of testing, magnetic resonance cholangiopancreatography, or MRCP, a special type of MRI that produces detailed images of the pancreas.
Most people do not need these cysts removed, but I suggest you ask for a referral to your GP, preferably a specialist gastroenterologist for further investigations and imaging, for clarity and peace of mind.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail. co.uk. Dr. Scurr cannot correspond personally. Answers should be taken in a general context. Consult your family doctor if you have any health problem.