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.

Now Accepting all Major Insurances, Medicare, Workers’ Compensation, and No-Fault!

• Chiropractic manipulation

• So Tissue Mobilization

• erapeutic Stretching and Strengthening. Don’t “deal” with your pain, make an appointment today!

Naples Valley Chiropractic

130 S Main St., Naples, NY 14512 (585) 374-2670

HEALTHY COOKING TECHNIQUES

Use minimally refined ingredients. Select among whole grains and ingredients that have not been refined. The closer a product is to its natural state, the more nutritional properties it is likely to have retained.

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.

***

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

President

How to handle car trouble while driving

Stay with the vehicle. Once you have called for help and set up flares or triangles, stay with the vehicle, though do so at a safe enough distance so you are not in harm’s way.

General Manager ...........................Manuel Karam

Director of Advertising Sales ............................Colleen Mann

Distribution

Harrison Creative Director

Leone Production Supervisor

Wasson Circulation Manager

Rapone

We specialize in collision repair, so you can count on us for quality work. Frame straightening, custom color matching, dent and ding removal, insurance specialists

SIMPLE STRATEGIES TO BE A MORE EFFICIENT DRIVER

Avoid idling. Idling was once advised to warm up vehicles so they did not stall once they leave the driveway and hit the open road. However, that stalling occurred when cold carburetors could not get the appropriate mix of air and fuel in the engine.But carburetors have long since been replaced by electronic fuel injection systems, negating the need to warm up a vehicle to avoid stalling. The Environmental Protection Agency and the U.S. Department of Energy note that modern engines will warm up by being driven and urge drivers to avoid warming up their cars for more than 30 seconds.

Thank you so very much to the Pleasant Valley Baptist Church. Your new building that houses your clothing closet is amazing. You are all a good example of God’s love & generosity!

Good for Mamma G’s Restaurant

A shout-out to Mamma G’s Restaurant in Henrietta: I ordered food to go for three and they got one order wrong, including forgetting the dessert. When I phoned to see if it could be corrected, they not only obliged cheerfully, but also provided the replacement food completely for free, which included a main course. If only more businesses engaged in these practices! We all make mistakes, but these folks were bent on correcting their error, and doing it pleasantly and promptly. Thanks, Mamma G’s - great management!

Yard Sale Thief

On July 8th we were having a neighborly yard sale in [local town]. Around noon we had a torrential downpour. I had tarped two tables with items that could not get wet. Other items were on another table and the ground which could get wet. We went into the house to get out of the rain. My wife had looked out the window and said a woman who had a black SUV was putting a gas can in her car. Then she said I think she is putting it back on the ground. After the rain stopped we went out to find out that over $150.00 worth of items were stolen. I never expected this at a yard sale. Yes, I should have kept watch over it continuously.

Dogs at music in the park

We are senior citizens and enjoy going to listen to the music in the park. We really don’t know why people insist on bringing their dogs. There are so many of us who go to listen to the music, not watch their dogs. It is very annoying. Please people, leave you mutts home.

Loud popping mufflers

Lately I have been exposed to this new theory that a “popping,” like a shot gun, muffler is cool. It scares me when I’m in my yard. Sounds like a drive-by out here in God’s country. I can only imagine what that back pressure is doing internally to your engine. Backfires are not cool. Why would you want everyone noticing you? I sure hope you don’t make any bad choices, bc you would be easily identified. Motorcycles seem much louder lately also, and there’s a generation that isn’t sure when and how to shift. Again, why draw attention to your ignorance? I guess, don’t worry, mommy will buy you another one if you ruin it. Haha.