Rewards and risks of switching up your HRT regime

QAI’m 54 and have been on HRT for several years. While I really appreciate the fact that I don’t have flushes and sweats any more, I’m fed up with having periods.

Several of my friends have “no bleed” versions, so is this something I could try? And are there any downsides to switching to these? The hormone in HRT that stops flushes and sweats is oestrogen, but this can cause thickening of the lining of the womb, which can lead to the development of abnormal cells that can increase womb cancer risk.

To prevent this, a second hormone, progesterone, is added in, which thins the womb lining.

Around the time of the menopause, when natural periods are still occurring, even occasionally, this is normally given for two weeks each month. It creates a regular monthly bleed when the progesterone is stopped in the same way you get a withdrawal bleed in the pill-free week when you are taking the combined oral contraception.

Once your own ovaries are definitely not working any more, around a year after your last natural period, then taking the progesterone every day means that you do not get any bleeds. But the womb lining stays thin in a ‘continuous combined’ HRT regime.

The dose of progesterone is higher in the two weeks it is taken on the cyclical regime and some women find this gives them some water retention and sometimes mood swings. So overall, most women prefer the continuous method. The overall dose of progesterone, though, is the same.

Unfortunately, the combination of progesterone and oestrogen does raise the risk of breast cancer slightly more than oestrogen alone, but one way you can protect your womb lining and minimise this extra risk is to have a Mirena coil fitted.

This releases progesterone where it is needed – straight into the womb lining – but only a very small amount goes into the general circulation, meaning the amount the breast tissue is exposed to is very small.

I suggest you talk it through with a doctor at your practice who has an interest in women’s health. You should be able to find out the doctor’s interests on the surgery website, but if not, ask the receptionist.

Q

A couple of months ago I tripped on an icy pavement and ever since then my ring finger gets a bit stuck when I bend it, then clicks when I manually straighten it out. I thought it might just get better, but it hasn’t. Would strapping it help?

AThe tendons that flex the fingers pass through a tight ligament at each joint and if these become inflamed then the tendon can get stuck when you try to bend your finger. It is a condition known as trigger finger.

The more you bend it, the more inflamed the area can become, and strapping it straight, using a special splint, can help. But you do need to wear this for six weeks for it to make a difference. You can buy these online and from chemists.

A steroid injection can be helpful but, if the condition persists, then releasing the tendon from its sheath is the answer.

This is a relatively minor surgical procedure that can be done as a day case, but you will need to keep your finger strapped up for around four weeks afterwards.

Currently, most hospitals are not taking referrals for non-urgent conditions – and this does classify as that – but hopefully with the fall in Covid cases, hospital services should soon be returning to normal.

Your GP will be able to give you more information about when a referral can be made in your area.

QI keep getting cracks at the corner of my mouth. I contacted my GP via the surgery’s new email system and a prescription for anti-fungal cream was promptly sent to my local chemist, a service that I thought was very efficient.

Unfortunately, the cream hasn’t worked. Any suggestions? Do I send another email or ask to actually see my GP?

A

Angular stomatitis, which is the medical name for this problem, is commonly due to a fungal infection, so anti-fungal cream is the usual first line treatment.

However, it can be due to allergy, either to lipstick, lip salve or even face cream. Even if you haven’t treated yourself to a new product, sometimes old favourites change their ingredients – look out for the tell-tale words ‘new formulation’.

If the condition persists despite avoiding any possible culprit products, then sometimes a bacterial infection can be to blame. Angular stomatitis can also be a sign of low iron levels and, less commonly, of a deficiency of vitamins B or C.

It sounds like your surgery has a good online contact system, so I would suggest the best way of getting further advice from your GP is to send an email with some photos of the affected area.

If it’s not clear how to do this then ask the receptionist.

Your GP will then be able to prescribe a different type of treatment and arrange for you to have any blood tests that she thinks are necessary.

I know it can seem strange not actually seeing the doctor, but for a relatively minor problem like this it isn’t usually necessary.

I know from experience that I can usually deal with at least three email queries, sometimes more, in the time it takes to see one patient in person.

This means, as you have discovered, that patients get a much quicker service and the days of waiting two weeks to get an appointment should now be a thing of the past.

● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.