I’m 86 and I’ve been on HRT since my early 40s when I had a hysterectomy. I believe it has kept me healthy and active.
I’ve never broken a bone – even though osteoporosis runs in my family – and this must be thanks to the HRT. Now my GP wants me to stop using the patches as he says I’m too old to be on HRT. What should I do?
Dr Ellie Cannon replies: Doctors are always cautious about older patients taking prescription medicines because they are more likely to suffer side effects – some of which can be dangerous.
In the case of hormone replacement therapy (HRT), it can raise the risk of a stroke or life-threatening blood clot.
NHS guidelines also state that patients should be on HRT for as short a time as possible, and recommend that women come off it every few years to find out if it is making a significant difference to their symptoms.
Doctors are always cautious about older patients taking hormone replacement therapy (HRT), as it can raise the risk of a stroke or life-threatening blood clot
However, that does not mean a woman in her 80s categorically cannot take it.
Firstly, there is no upper age limit to taking HRT. Secondly, menopause treatment is supposed to be personalised to each patient.
This is because the symptoms affect women in different ways. Some women will need larger – or smaller – HRT doses than others. And there are those who benefit from taking these replacement hormones for decades, while others may need them for only a year or two.
It’s also important to consider the different types of HRT that are available.
Patches are considered to have a lower stroke risk than tablets, and there are also low-strength patches which contain less oestrogen that can reduce this risk even further.
Moreover, 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 worried about the risk of developing osteoporosis, it’s crucial 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 well as a diet with sufficient amounts of calcium and vitamin D. Adults need 1,000mg of calcium a day to lower the risk of bone breaks.
In June I developed a rash on my feet, legs and buttocks. My GP diagnosed me with scabies and it does appear that the treatment is working. However, apparently it is spread through close – often sexual – sexual contact, and I have not been intimate with anyone for well over a year. Could this really be scabies?
Dr Ellie replies: Scabies is a skin infestation caused by a parasite called a mite. The itching is caused by the body’s response to the mites and their eggs on the skin.
The parasites often congregate in the fingers, tummy, genitals, arms and bottom.
In recent years I have noticed a rise in scabies patients at my GP surgery, which suggests it is more common than it once was.
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 sex. Brief physical touch – such as a handshake – is unlikely to lead to scabies.
However, mites can also survive for several days in humid environments. Contaminated bedsheets and clothes should always be washed at hot temperatures to kill the mite and eggs.
The most common treatment is an anti-parasitic liquid called Derbac M – also known as malathion. For most patients, it is quick and effective.
I’ve had balance problems since I had a pacemaker fitted in 2019. It feels like I’m drunk at all times. I’ve been seen by a neurologist who says I don’t have any brain issues such as Parkinson’s. Could my pacemaker be to blame?
Dr Ellie replies: It’s important to always see a GP about balance problems.
Not only is it a very distressing symptom, it can also lead to falls and life-changing injuries. But unpicking its cause can be complicated, because there are several possible triggers.
For example, if the dizziness occurs when standing or sitting up suddenly, it might be due to out-of-control blood pressure.
However, pacemakers, in rare cases, do have side effects.
The devices are fitted to control the beating of the heart. For most who receive them, they massively improve quality of life and are even life-saving. However, a small percentage of patients can suffer something known as pacemaker syndrome.
This is when 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 light-headedness. Some even faint.
Anyone who experiences balance problems after a pacemaker is fitted should see a cardiologist to explore the possibility of this syndrome.
There are tests that specialists can carry out in hospital to work out whether the device is to blame. If it is, then a different type of pacemaker can be used instead. A GP can make a referral to see a cardiologist.
My fears if we cut out GPs from breast checks
I was concerned to read about a Government scheme that will allow women to refer themselves for a breast cancer check without seeing a GP first.
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 then will be directed to a specialist clinic for a cancer check. If successful, the scheme will be rolled out across the country.
Currently, any woman registered with a GP will be invited for NHS breast screening every 3 years between the ages of 50 and 71
I don’t support this. Delays in cancer diagnoses do cost lives, and we need to 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 certainly clog up NHS resources.
Do you agree? Do you believe 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 death-bed song bring peace?
Frank Sinatra’s My Way was chosen as one of the top songs to listen to in your final moments, as found by charity Marie Curie
I was taken aback last week when the end-of-life charity Marie Curie released a list of the most popular songs that people want to listen to in their final moments.
Frank Sinatra’s My Way, The Beatles’ Hey Jude, and Over The Rainbow by Judy Garland were among the top answers. I’m sure these are all great songs, but the idea of playing music at the end of life is a strange concept to me.
Sadly, in the past year, I’ve experienced the deaths of four family members. Not one of them requested that music was to be played at the end. However, that’s not to say that it doesn’t bring peace and happiness to others.
Do you have a song that you would like played on your death bed? Has a family member requested one? Please write in and let me know.
Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk
Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.
