Dear doctor

Q I came off HRT after the most recent breast cancer scare. But my hot flushes are back with a vengeance and I can hardly function during the day. I also have dripping sweats at night which disturb my sleep and make me drowsy and bad-tempered during the day. My GP was a bit dismissive of alternatives to HRT but is there anything you can advise?

A There are lots of options, though no guarantees. Start with herbal remedies, available without prescription from health food shops or pharmacies. The average reduction in frequency and intensity is said to be about 25% with most. These include red clover (40-60mgs a day), black cohosh (100mgs a day), vitamin E (800IU a day) or a soy supplement (90mg isoflavines). Ginseng, fennel, wild yam and evening primrose oil are also marketed for hot flushes. I would probably go for red clover but there aren't good trials yet comparing the options. The next step would be to ask your GP for a prescription for the hormone progestogen, which can be taken orally or as a cream. If you want to avoid hormones altogether, you could try an antidepressant. The drugs fluoxetine, paroxetine and venlafaxine can all lessen the flushes by 50% or more, though all can cause significant side-effects.

Q In your column, you often say "see your GP". My problem is that our doctor has just had a nervous breakdown and there is a problem recruiting a locum. I have also heard of another GP nearby who has just committed suicide. Can you suggest any other health care worker I could approach for help and how can we patients make life easier for GPs?

A There is a national problem with suicide rates among GPs, among the highest for all professions (partly due to the job and partly due to ready access to lethal drugs). This should not be your problem. You pay taxes and are entitled to a quality service. And the people responsible for delivering that are called the PCT (Primary Care Trust). The number of your local PCT is available at any GP surgery, local library or telephone directory. They must allocate you a GP in your area - preferably one who is not suicidal or profoundly depressed.

You can walk into any GP surgery if you are seriously unwell. You can also go to casualty if you are extremely unwell and not in a hurry. For non-emergencies, a pharmacist can be a great help.

Q My blood pressure is a bit high (160/100). I've been told that if I change my lifestyle, I might be able to avoid medication. But the advice I was given wasn't specific and I fear I'm on the way to taking medication, which I'd rather avoid.

A Try to get your weight into the normal range, usually measured by your BMI (body mass index), calculated by dividing your weight in kgs by your height in metres squared. A BMI over 25 is a bit too hefty for comfort. Cut down on salt to less than 100mmol/day, which is 6g of sodium chloride, or 2.4g of sodium a day. Adding salt at the table and eating ready-cooked meals rapidly takes you over that daily limit. Try to exercise for 30 minutes a day. A brisk walk is ideal - anything less strenuous probably isn't enough, and anything more may be unsustainable. Don't overdo alcohol - no more than one to two glasses of wine, one pint of beer or a short a day. Eat potassium-rich foods such as bananas, and avoid the high-fat stuff. Have regular blood pressure checks. This may be enough to avoid medication, but don't feel you've failed if you end up on tablets.

· 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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