DR. ELLIE CANNON: I’ve been on hormone replacement therapy for 21 years. Why do I still have hot flashes?
After experiencing menopausal symptoms at the age of 49 I was put on HRT patches and continued on them until I was 65. My hot flushes continued whilst wearing them and have worsened to the point where, now at 70, the slightest exertion sends sweat trickling down my face and soaking my hair. What could be the cause?
Doctor Ellie replies:It is quite possible that sweating is the result of menopause and a lack of estrogen.
However, the fact that it first appeared while you were taking HRT would indicate that something else was going on.
It’s good to know that there are no longer arbitrary limits on how long someone can use HRT.
If HRT controls the sweating and flushing caused by the menopause, it can be continued afterwards at the lowest possible dose, usually as patches.
Flushing and sweating on the face may be related to a skin condition called rosacea
For someone who does not want to use hormones, but still suffers from severe redness, an alternative hormone-free medication can be tried.
Clonidine is a high blood pressure medication but is approved for use during menopause. It is worth discussing with your GP whether this can help and whether it is safe.
However, flushing and facial sweating may be related to a skin condition called rosacea. It is common in women after menopause and causes redness and flushing of the face.
This is accompanied by an intense feeling of heat. There are topical medications available on prescription, such as brimonidine cream or metronidazole gel, which can help to calm any rosacea or redness and in turn reduce sweating. It is worth asking your GP for a prescription to try one of these.
There may also be facial sweating without an underlying cause. This is called primary hyperhidrosis.
There are specialized treatments – such as Botox – to reduce sweating and this may be an option after you have been referred to a dermatologist.
Every morning my eyes are sticky and swollen. I am 77 and take ibuprofen and co-codamol for arthritis. Could my problems be a side effect of this treatment?
Dr. Ellie responds: This would not be a typical side effect of ibuprofen or co-codamol. Sticky, wet eyes are often a condition called blepharitis. This can be uncomfortable and irritating.
The eyelids are usually covered in crusts with discharge and this is usually worse in the morning. They may also look inflamed and feel gritty. You may see pockets of fluid because the small glands on the eyelids can become clogged.
Treatment for blepharitis is a daily routine called eyelid hygiene, which involves unclogging any glands. First, warm the skin of your eyelids to help the fluid drain. You can do this with a washcloth soaked in very warm water for up to ten minutes, or you can purchase heat packs online.
Second, you massage the eyelids to get moisture out of the glands. Finally, clean the eyelids. You can get a cleaning solution or wipes for blepharitis at the store. A safe alternative is diluted baby shampoo.
Regular sticky eyes can also be caused by allergic conjunctivitis, possibly related to hay fever or infection. If this is the case, the eyelid hygiene method will not help and advice from the pharmacist is needed.
What gets you moving – or do you need a push?
The NHS recommends 150 minutes of activity per week
When I try to talk to patients about exercise, it often doesn’t go well. People who are sick want treatment, so they don’t like to hear, for example, that one of the best ways to treat high blood pressure or type 2 diabetes is to be more active. But that’s the truth.
Last week, the World Health Organization warned that 13 million Britons are at risk of these diseases – in addition to cancer and dementia, among others – due to inactivity.
The NHS recommends 150 minutes of activity per week – brisk walking, cycling, jogging, swimming, you name it. I admit that I struggle to combine it with a full-time job and family.
I would like to know, are you succeeding? What do you do and when? And what about your family – are they pushing you to move or is it the other way around? Please write to me at the email address below and let me know.
I’m 90 and have had a spotty, infected rash on my chest for a few months. A blood test showed I had a sodium deficiency and I was given tablets for three months, but they didn’t help. Neither do steroid creams. What should I do?
Dr. Ellie responds: Skin rashes can be difficult to diagnose and may require some treatment trials or visits to the GP to get a definitive answer. Even then, a miracle cure is not always possible.
Low sodium levels do not cause this type of rash, but low sodium levels may be the cause.
For example, we know that certain medications, such as antidepressants and blood pressure tablets, can reduce and also cause drug-induced rashes. Your GP or pharmacist can review the medication.
Steroid ointments are often used for skin problems and usually work when something is inflamed, such as eczema or other types of dermatitis. If it doesn’t work, there are two options. First, a strong enough steroid may not have been tried. Second, a steroid may not work at all if the problem was due to an infection.
Skin infections are not uncommon, and one infection that causes a blotchy rash is folliculitis. This causes small pimples and red spots and can be caused by a bacteria or a fungal infection.
A yeast-type folliculitis is more likely in someone with dandruff. A doctor can take a swab from one of the spots to test which insect is present. For yeast folliculitis, an antifungal shampoo is used as a body wash.
For bacteria it would be an antibiotic and a prescription would be required.
Using an over-the-counter antifungal shampoo containing ketoconazole as a body wash is a low-risk option.
If the waiting time for an appointment with a dermatologist is too long, you can also ask for teledermatology. In that case, the photos will be sent to a dermatologist.
Troubled by failed holiday operations
Medical tourism – the large numbers of people heading to Turkey and other destinations for cheap cosmetic surgery – is putting enormous pressure on the NHS, the British Medical Association warned last week.
I have seen it myself, as have almost every other doctor. Someone goes abroad for a nip and tuck, or a hair transplant, and when they get home, it all starts to fall apart.
No one thinks it will happen to them, but complications are common, especially if you get on a plane straight away and the aftercare instructions are in a different language.
Six Britons died after procedures in Turkey last year and many more ended up with infections or problems requiring NHS admission. However, failed operations or unpleasant-looking results cannot be fixed.
I’m curious if you, as a medical tourist, are happy with the results, or if you had a bad experience?