DEAR DR. DONOHUE: My OB-GYN doctor prescribed 25 milligrams of Vagifem (estrogen) vaginal tablets to combat vaginal dryness. I am an older woman and am fearful of starting estrogen replacement therapy. Is this risky? Should I try it? — L.A.

ANSWER: You have vaginal atrophy, one of the common consequences of decreased estrogen production, something that happens to all women after menopause. Vaginal tissues and lining cells shrink and thin. Itching, stinging, discomfort, soreness and painful intercourse result from too little estrogen. The logical response would be to replace estrogen. However, in 2002, the results of a large study called the Women’s Health Initiative warned about prolonged use of estrogen after menopause. It raises the risk of breast cancer, heart attacks, strokes and blood clots. That has made women and their doctors reluctant to choose long-term estrogen for postmenopausal women. Some of these findings have been reconsidered.

Low doses of estrogen used for the shortest possible length of time do not carry such frightening possibilities. Neither does estrogen use early in menopause. Your estrogen dose isn’t 25 milligrams, mg. It’s 25 micrograms — mcg. A microgram is one-thousandth of a milligram, and a milligram is a small amount in itself. A microgram is a very, very small amount. The Vagifem tablet is inserted into the vagina. The amount of estrogen absorbed into the blood via this route is tiny. Complete assurance that nothing bad will come of such a preparation isn’t possible, but the chances for any untoward consequences are minimal. You are the one who has to make the decision to use or not to use. It depends on the severity of your symptoms. If you choose not to use Vagifem, you still can use vaginal moisturizers, like Replens.

DEAR DR. DONOHUE: I read your article on essential tremor with interest. About 10 years ago, a neurologist diagnosed me with a condition called focal dystonia. In layman’s terms, he said it is called writer’s cramp and can be treated with Botox injections. I declined. It happens only when I hold a pencil, and my observation is that only my thumb trembles. My brother has the same condition. His doctor told him he has essential tremor. Are focal dystonia and essential tremor different, or just called by different names? — C.R.

ANSWER: Dystonias involve involuntary muscle contractions that twist body parts into awkward and painful positions. Writer’s cramp is a focal dystonia, one that occurs in a limited body area. The thumb and some fingers curl into contortions that make writing all but impossible. Botox is an effective treatment.

Tremors are shaking phenomena. Essential tremor makes the hand shake when a person performs a specific task like bringing a cup of coffee to the lips. The shaking leads to a path of spilled coffee. It has another name — familial tremor, because it runs in families. It is treated with Inderal or Mysoline. Sometimes, the muscle spasm of writer’s cramp induces shakiness, but the basic problem is involuntary muscle contraction.

DEAR DR. DONOHUE: I have a friend with inclusion body myositis. He now has trouble getting out of a chair. He is a former athlete. While researching this disease on the Internet, I came across an herbal medicine, Meyseton, which is said to cure inclusion body myositis. Do you think it will help my friend? — J.H.

ANSWER: Inclusion body myositis is muscle inflammation, muscle wasting and muscle weakness. The cause isn’t understood, but it might result from a virus. In five to 10 years, affected people are usually using a cane, walker or in a wheelchair. Since the esophagus (the swallowing tube) is a muscle, swallowing can be a problem.

Inclusion bodies are seen with an electron microscope, a scope many times more powerful than a regular microscope. The inclusions are deposits of amyloid, a protein, and they’re found in muscle cells. Tubular structures are other inclusions. They have an appearance similar to some viruses.

I don’t want to throw a damper on your herbal medicine, but it’s not employed by doctors who have the greatest experience with this illness.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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