Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: I am a 70-year-old woman who has been using Estrace vaginal cream weekly for several years. I am in excellent health, work out daily, run half-marathons and have my own business. I take 10 mg of atorvastatin daily. Ten years ago, I had melanoma removed from my arm.
My concern is the use of Estrace. My gynecologist recommended that I use it after a Pap smear, but my primary care physician is not of the same mind. I would appreciate your opinion on this. My mother had breast cancer in her 80s, my sister had uterine cancer, and my brother passed away from bladder cancer. — C.S.
ANSWER: As far as the safety of using estradiol (Estrace), the bioidentical hormone to major natural estrogen, I am definitely of the same opinion as your gynecologist. When used topically, it works on the vulva and the lining of the vagina, keeping the tissue healthy.
Without estrogen, the tissues that line the female perineum can become atrophic (thinned), predisposing a woman to discomfort, infections and incontinence. The Pap smear may have resulted in a finding that was suggestive of vaginal atrophy (increased neutrophils). Without treatment, the labia can even fuse together.
With long-term use, the estrogen levels in the body are only slightly higher in women who use topical estrogen compared to those who do not, so the absorption into the body is minimal. The only time I get concerned is with a person who has a personal history of an estrogen-sensitive tumor, such as endometrial cancer and some breast cancers. In those cases, I discuss options with both the patient and their oncologist.
DEAR DR. ROACH: Are you aware of any correlation between celiac disease and restless legs syndrome? My 72-year-old husband has had RLS for decades. He currently takes gabapentin and pramipexole, but still has symptoms. Plus, he has periodic limb movement disorder (PLMD), which occurs while he’s asleep. He isn’t aware of it, but it can keep me awake; we sleep in separate beds when it gets bad. — C.S.
ANSWER: The terminology can be confusing. Most people with RLS have periodic limb movements of sleep (PLMS), which sounds very much like your husband. PLMD is a separate sleep issue that doesn’t include other RLS features, such as an uncomfortable sensation in the legs while they’re at rest that causes an urge to move them. A person with RLS often has PLMS, but doesn’t have PLMD.
There is an increased risk of RLS among people with celiac disease. Most authorities tie these two together through iron deficiency. Unless celiac disease is managed with meticulous attention to diet, the body has difficulty absorbing iron.
Iron deficiency is very frequently found in people with RLS, and iron deficiency makes RLS worse. The diagnosis of iron deficiency needs to be made carefully because most people with RLS and iron deficiency do not have anemia. A ferritin level, rather than blood count, is the best initial test. If he does have iron deficiency, then treatment with iron supplementation can sometimes dramatically improve those nighttime symptoms.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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