I am 86 years old and have been taking HRT since I was 40, when I had a hysterectomy. I think it has kept me healthy and active.
I have never broken a bone, although osteoporosis runs in my family, and this must be thanks to HRT. Now my GP wants me to stop using the patches because he says I’m too old to take HRT. What do I have to do?
Dr. Ellie Cannon responds: Doctors are always cautious about older patients taking prescription medications because they are more likely to suffer side effects, some of which can be dangerous.
In the case of hormone replacement therapy (HRT), it may increase the risk of having a stroke or life-threatening blood clot.
NHS guidelines also state that patients should take HRT for as short a time as possible and recommend that women stop taking it every few years to determine if it is making a significant difference to their symptoms.
Doctors are always cautious about older patients taking hormone replacement therapy (HRT), as it may increase the risk of a stroke or life-threatening blood clot.
However, that does not mean that an 80-year-old woman cannot categorically take it.
First of all, there is no age limit for taking HRT. Second, menopause treatment is supposed to be personalized for each patient.
This is because the symptoms affect women in different ways. Some women will need higher (or lower) doses of HRT than others. And there are those who benefit from taking these replacement hormones for decades, while others may only need them for a year or two.
It is also important to consider the different types of HRT that are available.
Patches are considered to have a lower risk of stroke than tablets, and there are also low-strength patches that contain less estrogen that may reduce this risk even further.
Additionally, HRT gel is even safer than patches, because it can be used in very small doses. These are all options worth discussing with a GP.
However, for anyone concerned about the risk of developing osteoporosis, it is essential to understand that HRT (while shown to protect against the bone-thinning disease) is not the only way to prevent it. Walking can keep it at bay, as can a diet with sufficient amounts of calcium and vitamin D. Adults need 1,000 mg of calcium per day to reduce the risk of bone fractures.
In June I developed a rash on my feet, legs and buttocks. My GP diagnosed me with scabies and the treatment seems to be working. However, it is apparently transmitted through close sexual contact, often sexual, and I haven’t been intimate with anyone for over a year. Could this really be scabies?
Dr. Ellie answers: Scabies is a skin infestation caused by a parasite called a mite. Itching is caused by the body’s response to the mites and their eggs on the skin.
Parasites usually concentrate on the fingers, abdomen, genitals, arms and buttocks.
In recent years I have noticed an increase in the number of patients with scabies in my GP practice, suggesting that it is more common than before.
These mites are also slowly becoming resistant to current treatments. It is true that it usually requires close physical contact to spread scabies, which is why it is often transmitted during sexual relations. Brief physical contact, such as a handshake, is unlikely to cause scabies.
However, mites can also survive for several days in humid environments. Contaminated sheets and clothing should always be washed at high temperatures to kill mites and their eggs.
The most common treatment is an antiparasitic liquid called Derbac M, also known as malathion. For most patients, it is quick and effective.
I have had balance issues since having a pacemaker fitted in 2019. I feel like I am drunk at all times. I was seen by a neurologist who says I don’t have any brain problems like like Parkinson’s. Could my pacemaker be to blame?
Dr. Ellie answers: It is important to always consult a GP if there are balance problems.
Not only is it a very distressing symptom, but it can also lead to falls and life-changing injuries. But discovering its cause can be complicated, because there are several possible triggers.
For example, if dizziness occurs when suddenly standing up or sitting down, it could be due to out-of-control blood pressure.
However, in rare cases, pacemakers have side effects.
The devices are equipped to monitor the heartbeat. For most who receive them, they greatly improve quality of life and even save lives. However, a small percentage of patients may suffer from something known as pacemaker syndrome.
This occurs when the electrical activity in the heart is not regulated properly, meaning the organ does not beat as it should. As a result, people may experience dizziness, fatigue, and lightheadedness. Some even faint.
Anyone who experiences balance problems after pacemaker placement should see a cardiologist to explore the possibility of this syndrome.
There are tests that specialists can perform in the hospital to determine if the device is the culprit. If so, then a different type of pacemaker may be used. A GP can refer you to a cardiologist.
My fears if we remove GPs from breast checks
I was concerned to read about a government scheme that will allow women to refer themselves for breast cancer screening without first consulting a GP.
In Somerset, they will be able to call the non-emergency phone line 111 (or use the NHS app) to report a breast lump and will then be directed to a specialist clinic for cancer screening. If successful, the plan will be rolled out across the country.
Currently, any woman registered with a GP will be invited to have an NHS breast exam every 3 years between the ages of 50 and 71.
I don’t support this. Delays in cancer diagnosis cost lives and we must speed up this process, but the vast majority of new lumps are not cancerous. Testing every lump could lead to unnecessary invasive investigations and will undoubtedly clog up NHS resources.
Do you agree? Do you think your breast cancer could have been diagnosed sooner if you had been able to self-refer? Please let me know using the email address below.
Will deathbed song bring peace?
Frank Sinatra’s My Way was chosen as one of the best songs to listen to in your final moments, as discovered by the Marie Curie charity
I was surprised last week when the Marie Curie charity published a list of the most popular songs that people want to hear in their final moments.
My Way by Frank Sinatra, Hey Jude by The Beatles and Over The Rainbow by Judy Garland were among the top responses. I’m sure these are all great songs, but the idea of playing music at the end of life is a foreign concept to me.
Sadly, last year I experienced the death of four members of my family. None of them asked for music to be played at the end. However, that doesn’t mean it doesn’t bring peace and happiness to others.
Do you have a song you would like played on your deathbed? Has any family member requested it? Please write and let me know.
Do you have a question for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk
Dr. Cannon cannot engage in personal correspondence and her responses should be taken in a general context.
