HEALTH MATTERS: Your health questions answered

• Dr. Joshua Wynne

Dr. Joshua Wynne

Talk about it

Q. I have been having a difficult time with menopause. Should I take hormone replacements?

A. There is perhaps no area in medicine where our advice has changed more radically over time than this issue. It turns out that less than a decade ago, the answer would have been an emphatic “yes,” for two reasons: first, hormone therapy, also called hormone replacement therapy, often leads to a meaningful reduction in the annoying symptoms of menopause, including hot flashes and night sweats; second, there was a general consensus that hormone therapy reduced the risk of cardiovascular problems as well.

The risk of cardiovascular problems after menopause is a real one, as menstruating women have a reduced risk of vascular issues compared with men, but they tend to catch up to men after menopause. So taking hormone therapy was recommended — it seemed to both reduce symptoms and cardiac risk. But it turns out that our impressions were wrong.

In 2002, the Women’s Health Initiative, a large and definitive clinical trial, reported the value of hormone therapy in women and this well-done study showed that hormone therapy actually results in a small but real increased risk of cardiovascular problems, especially in older women.

It also turns out that the subgroup of women who start hormone therapy early in menopause and use hormone therapy for a short time may actually get some risk benefit. But overall, the risks of routine treatment outweighed the benefits, which included a reduction in fractures.

Current recommendations regarding hormone therapy can be generally summarized as:

_ Only consider hormone therapy for relief of severe symptoms, but don’t take it solely for cardiovascular risk reduction.

_ Don’t take hormone therapy if you are at increased risk for complications of hormone therapy (such as a history of breast or uterine cancer or blood clots).

_ Most important, this is an intensely personal decision for women. Discuss it with your health care provider, and make sure that you make an informed decision that’s right for you.

Q. I’ve heard a lot about celiac disease. What is it, and how is it treated?

A. Celiac disease, also called sprue, is a condition that affects the lining of the small intestine that interferes with the ability of the intestine to absorb various nutrients. Although the precise cause is unknown, we do know that the damage to the intestine is the result of a reaction to consuming gluten, which is found in wheat and barley.

The malabsorption of various nutrients that ensues can result in a wide spectrum of bodily ailments, all of which can be treated by simply eating a gluten-free diet. In most cases, most or all of the signs and symptoms of the disease resolve within months to years after starting a gluten-free diet. The condition usually is diagnosed by passing a tube through the mouth into the small intestine (called endoscopy), and a picture of the intestine or a biopsy of the lining of the intestine is analyzed.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.