Dear doctor

Alternative to HRT

Q: I am only 42 but my doctor has told me I am entering the menopause. She has provided me with lots of information about the pros and cons of HRT. It seems to have risks and benefits. What do you think about it? Are there any natural alternatives?

A: Firstly, 42 is young to be menopausal - the average age in the UK is 50. A blood test for the hormone FSH can confirm if you're in any doubt. HRT is great for hot flushes, sweats, vaginal dryness and is the best way of preventing bone thinning (osteoporosis). You can't take HRT if you've had a thrombosis and taking HRT slightly increases your risk of getting a thrombosis from one woman in 10,000 per year to three women in 10,000 per year. Among 50-year-old non-HRT users, 45 women in every 1,000 will get breast cancer by the time they get to 70 years old. If you use HRT for over five years, there will be an extra two cases of breast cancer in every 1,000 women. You can boost your oestrogen levels by eating phytoestrogens-plant derived oestrogens in soy and linseed. 1,000mgs per day of calcium, not smoking and regular exercise help keep bones strong and a bone density scan every year can check for osteoporosis. Natural progesterone skin cream (eg Progest) remains unproven but some women swear by it.

Sore mouth

Q: I am 72 years old and am plagued by splits at the sides of my mouth which become so sore that I have to take my dentures out. It is stoppping me from enjoying my food. Any advice?

A: This problem, known as angular cheilitis, is likely to be caused by your dentures. If you don't regularly wear both top and bottom sets, your upper lip may be over-riding your lower lip, causing deep grooves at the angles of the mouth. Saliva and sweat collect in the grooves causing infection. You may want to get your dentures checked, wear both sets all the time, and scrub them daily with soap and water. Vaseline and Canesten cream help.

Phlegmy throat

Q: I have recently been to see my doctor over a throat problem that just won't go away. It feels like I have a lot of mucus I am constantly swallowing. It is making me feel very sick. My doctor gave me some mouthwash but this is not working. I am at a stage in life that is very tiring as I have an eight-year-old Down's syndrome child with insulin-dependant diabetes and this feeling is making me feel like I can't cope.

A: You might be suffering from acid reflux. With all the worries you must have about your child, it wouldn't be suprising if your stomach is producing excess acid. If a good swig of an antacid such as gaviscon (10mls, three times day) gets rid of the sensation, you have your answer. If not, you may want to ask your GP to refer you to a gastroenterologist. If the Gaviscon works, you can try to prevent a recurrence by cutting out acid, spicy foods and alcohol, eating small, frequent meals, losing excess weight and sleeping with an extra pillow. Managing your stress levels must be a challenge and I wonder whether you are able to put some time aside for yourself to help you cope.

Pregnancy pain

Q: I'm six months pregnant and am in more pain than I could ever imagine. I get a shooting pain through the pubic bone, round my whole pelvis, in my inner thighs and an ache in my lower back. My GP and midwife have suggested paracetamol and hot baths. Can you help?

A Your condition has a name - diastasis symphysis pubis (DSP). There is no known cure, though it does improve once you've had the baby. It's common and frightening. A lady called Angie Lambert had such a bad time with this condition in her pregnancies that she helped set up a self-help group with an expert advisory team. Contact the British Symphysis Pubic Dysfunction (SPD) Support Group (01843 587 356 or at

Wet nights

Q: My eight year old son still wets the bed. He's got a school trip next year and we really want to crack the problem. What do you suggest?

A: A star chart can work wonders. Award a star for a dry night, and a special star for a full week. If that doesn't work, ask your GP for referral to a clinic that can provide you with a bed-wetting alarm. It goes off when in contact with liquid. This wakes your child who then needs to change the sheets. There's useful advice from Eric (Enuresis Resource and Information Centre) on 0117 960 3060.

• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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