Do you think HRT has a role in treating dementia?
It may be a daft question, but as it’s so helpful in sorting out menopausal problems such as forgetfulness, it crossed my mind that scientists may have gone down, or could go down, that route in a trial.
Dinah Price, Caerleon, Newport.
This is a fascinating question and, in fact, it’s something that’s exciting much scientific interest at the moment.
With 5 per cent of women over 60, and 10 per cent of those over 75, showing some evidence of dementia, it’s also something of considerable public health importance.
As you will know, the menopause results in a decline in the hormone oestrogen. There is already plenty of evidence that oestrogen is important for mental function.
For example, oestrogen increases the production of a chemical messenger, acetylcholine, which plays a vital role in the hippocampus — the area of the brain that is key to learning and memory.
With 5% of women over 60, and 10% of those over 75, showing some evidence of dementia, whether HRT has a role in treating dementia is a question of importance (stock image)
Oestrogen also influences the glutamate chemical system, which is important for hippocampus function, too.
This helps explain why some women complain of ‘brain fog’ and memory problems during the menopause.
By this logic, hormone replacement therapy (HRT) — specifically, oestrogen replacement therapy — would help to protect post-menopausal women’s cognitive function (and reduce the risk of Alzheimer’s disease, in particular).
In my 30 years of prescribing HRT, those of my patients who have taken it have reported that they felt it improved their mental abilities.
Yet hard scientific evidence for the idea that oestrogen supplementation conserves brain function in post-menopausal women has been mixed so far.
For instance, one study carried out in 2016 by Stanford University in the U.S. found that it didn’t improve cognitive performance.
In my 30 years of prescribing HRT, those of my patients who have taken it have reported that they felt it improved their mental abilities, says Dr Martin Scurr (stock image)
But as research demonstrates that regular exercise and a healthy sleep pattern protect brain function — and as we know that HRT benefits both — I think it may have a spin-off effect in terms of preserving brain function.
In other words, protection against dementia would not be a direct outcome of HRT, but it could be a secondary result.
Yet what about the risks associated with HRT?
As readers will know, it has a chequered history after major research linked it to a risk of breast cancer and heart problems. However, those findings were later shown to be flawed.
Despite this, women who want the treatment often struggle to get it even now because some doctors are still hesitant about its use.
There is a tiny increase in the risk of breast cancer while women are taking HRT (it drops once they’re no longer on it), but the fact remains that HRT is an essential part of healthcare for many women, even if more research into its role in brain health is needed.
You recently mentioned that needing the loo frequently could be connected to the pituitary gland behind the nose.
I’ve been needing the loo a lot, and for a long time I’ve been bothered by mucus behind my nose, too. Are they linked?
Mary Sutherland, Bridgend, Perth.
The pituitary gland secretes hormones that play a key role in several functions throughout the body, including urination.
I can see why you might think it is connected to your other problem, but although the pituitary gland is close to the nose, it’s actually part of the brain (i.e. it sits inside the skull), while the nasal airways are outside the skull.
But while there is no relationship between your two symptoms, they are clearly both causing you concern, so I would recommend investigating them further.
Both are common problems and, in many cases, there are steps that can be taken to resolve them.
A frequent need to go the loo is often the result of an infection, so the first step is to have your urine tested at your GP practice.
Ideally, this will involve a fresh sample being sent to a laboratory, although some GPs prefer to carry out a simple urine dipstick test there and then.
One thing they’ll look for is excess glucose (sugar) in the urine. This is a sign of diabetes, which is a common cause of excessive urination (polyuria).
A frequent need to go the loo is often the result of an infection, so the first step is to have your urine tested at your GP practice (stock image)
Your doctor may only send the sample to a laboratory if there are other abnormalities, such as traces of blood, protein or pus.
Any of these should be looked into further, as they can be a sign of a urinary tract infection, or age-related changes in kidney function.
As for your nasal symptoms, the thick mucus is a sign of chronic rhinosinusitis.
This inflammation of the lining of your nose and sinuses may be due to a number of causes, most commonly allergy.
Your dry mouth at night (mentioned in your longer letter) also indicates this, because the congestion may be causing you to breathe through your mouth when you are sleeping.
The best initial solution would be to try a nasal rinse.
You can make this yourself at home by adding a small teaspoon of ordinary table salt and an equal measure of bicarbonate of soda to a pint of cooled, boiled water.
Store this in the fridge, and use it twice a day for a few weeks — lean over a wash basin, tip some of the solution into the cupped palm of your hand and sniff it several times into each nostril.
Doing this breaks the cycle of inflammation, and your symptoms should settle down.
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email firstname.lastname@example.org — include your contact details. Dr Scurr cannot enter into personal correspondence.
Replies should be taken in a general context and always consult your own GP with any health worries.
IN MY VIEW… TEST NATURAL IMMUNITY OF NHS WORKERS
Although I firmly believe that everyone involved in healthcare should have the Covid jab —because I trust the science — rather than making it mandatory, as the Government now has, would it not be better to check the immunity of those NHS workers who have not decided to have the vaccine yet?
Natural immunity is superior to, and lasts longer than, the immunity derived from Covid vaccinations. So why don’t we test those unvaccinated staff for the presence of antibodies?
If they have this proof of immunity, they wouldn’t need to be forced to be vaccinated — at the risk of losing their jobs, and putting the NHS under further pressure.