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Doc: Balancing the risks and rewards of HRT

Keith Roach
To Your Health

Dear Dr. Roach: I’m a 67-year-old woman in excellent health except for having rheumatoid arthritis, which doesn’t restrict me. I exercise daily and I’m not overweight. My bone scans are good. My gynecologist, whom I had been seeing for over 20 years and who specialized in menopausal women, retired. She strongly recommended I continue her prescribed hormone replacement therapy, which I’ve been on since menopause for hot flashes. I’m on the lowest dose of progesterone and a patch. There is no family history of breast or other cancers, no heart disease, blood clots or osteoporosis.

My plan was to see my internist for any gynecological issues as opposed to finding another gynecologist. She tactfully questioned why I am on HRT at all due to the associated risks. I explained that my previous doctor had been a strong advocate and believed that the positive benefits outweighed the risks in my case. My gynecologist had felt that HRT helps to keep all organs healthy: mental acuity, bones, heart, etc. I have read up on this topic, but I’m unsure as to what to do.

M.Z.

Dear M.Z.: HRT has risks and benefits, and a person’s personal and family history, as well as her preferences, need to guide the decision. You are taking an estrogen patch, about which our data is less certain.

Combined estrogen and progestin treatment is associated with a small increase in the rate of breast cancer and a larger increase in risk of blood clotting, but it brings a benefit in hip fractures and colon cancer. There is no good evidence that HRT protects against or increases risk for dementia.

The effect on heart disease is more controversial, with some data showing that women younger than 60 (especially those who begin HRT at onset of menopause) had no harm and some possible benefit from HRT, whereas those who began HRT over 60 showed an increase in heart disease risk. As a woman ages, her risk for heart disease increases, and the potential for harm likely also increases.

Most authorities feel short-term HRT is a reasonable option for women around the time of menopause. However, you are more than a decade past menopause, and I would not recommend continuing the HRT. At this point, you are using it to prevent disease, and there isn’t enough evidence to support that.

Dear Dr. Roach: I have been diagnosed with glossitis. I was told to have vitamin B-12 shots. Some online medical sources claim there is no cure, nor do they know what it comes from.

J.R.D.

Dear J.R.D.: “Glossitis” means “inflammation of the tongue.” Atrophic gastritis is a particular form, in which the tongue is smooth, shiny and reddened, that is sometimes associated with nutritional deficiency, including iron and vitamin B-12, but also Sjogren’s syndrome, candida infection and celiac disease. I’d be surprised if you were recommended B-12 shots without a definite diagnosis, which is easy to make after blood testing. It’s important to make a diagnosis, because the other causes can be serious and are treated very differently.

Email questions to ToYourGoodHealth@med.cornell.edu.