Doctors Won’t Prescribe Hormone Therapy to Woman Over 60

DEAR DR. ROACH: In a recently published column, you stated, “As always, the decision belongs to the patient,” while addressing a concern about the benefits and risks of stopping a statin drug. Oh, really? Then, why is it that, once I turned 60, not a single doctor will prescribe hormone replacement therapy (HRT) to stop my debilitating post-menopausal symptoms? After suffering from menopausal symptoms starting at age 42, I was finally prescribed HRT at age 57. What relief I felt, as it was the only remedy to alleviate my hot flashes, weight gain, lack of sleep and vaginal dryness.

Once I hit 60, I was ordered to stop HRT, and no one since will prescribe it for me now. I am 66, suffer from hot flashes daily and have my sleep interrupted at least five times a night with terrible night sweats. I have tried just about every over-the-counter offering with zero effectiveness.

I will gladly trade the greater risk of heart attack and stroke, and the possible shorter life span, for relief from symptoms that affect my daily quality of life. Clearly, the choice is not mine, because if I had a choice, I would ask for continued prescriptions of HRT to give me relief. Why don’t I have that choice as a patient? -- R.M.T.

ANSWER: A patient always has the right to refuse a treatment recommended from a physician. However, the physician has the obligation to consider the risks and benefits of a treatment, and is not obliged to prescribe a treatment that they do not think is appropriate.

If a patient asks me for a treatment that has been shown to be ineffective and has the potential for serious adverse effects, I don’t prescribe it, but will work with the patient to find alternative treatments. For example, some nonhormonal prescription treatments are moderately effective for hot flashes and sleep disturbance, and topical estrogen is very effective for vaginal dryness.

However, the case of HRT for symptoms of menopause is more complicated, because estrogen is the most effective treatment we have for menopausal symptoms, particularly for hot flashes. There are risks to HRT, but the benefits for some women are so great that they are willing to accept some risks.

You mentioned the risk of heart disease and stroke. A landmark study called the Women’s Health Initiative helped to define and quantify those (and other) risks. Its effect has been to dramatically reduce the prescribing of menopausal hormone therapy, but the results should not be interpreted to mean that hormone treatment is always inappropriate, even in women who are in their mid-60s, where risks are higher.

Moreover, a woman’s entire health status should be considered when deciding whether to prescribe hormone treatments. In women with a history of an estrogen-dependent tumor (like many breast cancers), a history of a blood clot or a stroke, or a few other issues, the harm almost certainly outweighs the benefits. Otherwise, a wise clinician looks at the patient’s risk for heart disease, blood clots and similar conditions. Women at a very high risk for heart disease should probably avoid estrogen. Using lower-dose estrogen by patch (rather than pills) is wise for women at moderate risk, such as those who are in their 60s.

Physicians do not want to prescribe medications that will harm their patients, and most have stopped prescribing menopausal hormone therapy entirely for women, to prevent disease. However, it still has a role in treating symptoms. I recommend you seek out an expert in treatment of menopausal treatments and have a frank discussion about your willingness to assume risk in order to have a better quality of life.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to

ToYourGoodHealth@med.cornell.edu.

© 2023 North America Synd., Inc. All Rights Reserved

Understanding Dementia A Key To Compassionate Care

Alzheimer’s disease is one of the more prominent forms of dementia, but there are many additional types of dementia that also can cause both physical and cognitive alterations. Understanding the complexity of dementiacanbebeneficialtobothdementiasufferersandtheircaregivers. Dementia is a general term used to define a decline in mental ability severe enough that it can interfere with daily life, offers the Alzheimer’s Association. Alzheimer’s disease is the most common type of dementia. Dementia is not a disease but a term used to describe a wide range of symptoms. The words “senility” and “dementia” often are incorrectly used interchangeably. However, serious mental decline is not a normal part of aging.

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How Fluoridated Water Helps Our Teeth

Seventy-five percent of U.S. households have drinking water treated with fluoride at a level that prevents tooth decay and is safe for drinking. Because fluoride occurs naturally in water but not always at levels high enough to help protect teeth, it is often added to municipal tap water. Bottled water doesn’t contain fluoride, so you may need to supplement with a fluoridated mouthwash if your main source of drinkingwaterisbottledorwellwater. Fluoride helps children’s developing teeth by entering the bloodstream where it’s carried to the jawbone to help form healthy tooth enamel. Adultsandchildrenbothbenefitfrom fluoride because it mixes with saliva in the mouth to neutralize decaycausing acids and helps repair tooth enamel.

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Did you know?

While it might be tempting to lower mower blades when summer temperatures reach their hottest, it is possible to cut grass too short. Homeowners who want to cut back on the time they spend mowing their lawns under the hot summer sun should avoid lowering their mower blades too low, as doing so can cause significant damage to the lawn. Lawns that have been cut too low are less capable of surviving drought and are unlikely to thrive. When grass is cut too short, the stem tissue from the grass is exposed, and that exposure can lead to unsightly grass that turns yellow or brown. Grass that is cut too short also may suffer from weaker roots, which in turn makes the grass weaker and less likely to grow in strong. In addition, weaker grass is more susceptible to weed growth, which can be both a nuisance and an eyesore. When mowing, homeowners should remove no more than one-third of the grass blade. Mowing at this height will promote strong roots and protect the grass when the weather gets especially hot in the summer.

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Spring and summer are synonymous with increased hours of sunlight, warm temperatures and, oftentimes, an increased reliance on water to feed recreational pursuits and lawn and garden needs.

The Water Information Program states that 3.9 trillion gallons of water are consumed in the United States each month and the average person uses 176 gallons of water per day. Water conservation may be essential when the risk for weather-related drought looms. Practicing year-round conservation efforts can help ensure smart usage of local watersheds, lakes and reservoirs and help maintain these water sources for years to come. It also helps the average person reduce his or her carbon footprint while saving people a little money along the way.