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Dr. Roach: Does HRT affect the duration of hot flashes?

Keith Roach
To Your Health

Dear Dr. Roach: If women are prescribed a hormone replacement for hot flashes, do the hot flashes return once the medicine is discontinued. If you take hormone replacement therapy, are you just delaying the symptoms for a while and will have to deal with hot flashes either way?

C.H.

Dear C.H.: Hot flashes are a common symptom when women go into menopause -- 60% to 80% of women will experience them. About half of women will stop having hot flashes after about five years. The remainder will have a longer duration. A third of women will still experience them after 10 years, and in about 10%, they continue for 20 or more years after menopause.

Dr. Keith Roach

The most effective treatment is hormone replacement therapy -- specifically, estrogen. But estrogen should not be given without a progestin in women who have a uterus, i.e., those who have not had a hysterectomy. HRT neither shortens nor lengthens the duration of symptoms. If a woman was destined to have hot flashes for seven years, and takes HRT for five years with relief, she will still have two more years of hot flashes.

Although women are generally not treated with HRT for longer than five years, some choose to continue treatment longer, even knowing that HRT increases risk of blood clotting and may increase risk of breast cancer and heart disease. The degree of risk is debated and likely depends on many factors.

Dear Dr. Roach: I am a 63-year-old female who has suffered with Epstein-Barr virus twice in the past two years. My understanding is that for many people, this virus lies dormant until a trigger, such as stress, causes it to emerge.

My symptoms consisted of fever, extreme exhaustion and weakness. After three weeks, I am slowly feeling better. I never want to feel like this again! Aside from maintaining a healthy diet, exercising and stressing less, do you have any suggestions as to how I can stay symptom-free in the future?

R.K.

Dear R.K.: Epstein-Barr virus is the classic cause of infectious mononucleosis, which is a common condition in children and adolescents. Its symptoms of early fever followed by days or weeks of fatigue are nonspecific. Other viruses and even a parasite can cause a similar symptoms. Blood testing can confirm the diagnosis.

EBV is in the herpes family, and like all herpesviruses, it does lay dormant in the body. Unlike herpes simplex or varicella-zoster, it is very unlikely to recur. It is very rare to get mononucleosis from EBV more than once, although it happens occasionally if the immune system is severely depleted, such as in advanced HIV. It is almost unheard-of to get it at age 63.

Blood test results for EBV can be misinterpreted. If you ever had EBV -- say, in childhood -- you will have a positive antibody test for the IgG antibodies. Active infection stimulates the IgM antibodies. I suspect you may have had the IgG antibodies that were misinterpreted as active infection. If you really had recurrent EBV with positive IgM antibodies (or other, more precise tests of viral activity), then a visit with an immunologist and an infectious disease specialist is wise.

Your own advice -- healthy diet, regular exercise, decreasing stress -- are all good, commonsense ways of improving your immune system. I would add regular sleep to the list, and unless you really have had active EBV, which would surprise me, you shouldn’t need more than that.

Readers may email questions to ToYourGoodHealth@med.cornell.edu