Good health: Hormone replacement patch is complicated, controversial

Q When I was 39, I had a total hysterectomy. The doctor put me on hormone-replacement pills -- first strong, then gradually weaker ones. Now, I am on a patch, estradiol derm 50. My doctor told me to take it for the rest of my life, because it is good for the bones. I am 79 and now have a different doctor who told me to stop it. I tried, but I felt depressed and had hot flashes. I have used this patch for 40 years and have had no ill effects with it. What is your opinion?

A This is a very controversial area. Let me start with what is not controversial: The patch is good for your bones and protects you from fracture. It also appears to reduce the risk of colon cancer.

Unfortunately, it increases your risk for blood clotting in the deep veins of your legs, which can then spread to the lungs. Also, estrogen increases the risk of breast cancer.

The controversial part is what it does to your risk of heart disease. Recent data suggest that estrogen alone (with no progesterone, something a woman who has not had a hysterectomy shouldn't take), if given right at menopause, may reduce the risk of heart disease. However, giving estrogen with progesterone, especially in older women, clearly increases the risk of heart disease.

While I would not recommend estrogen therapy as a means of preventing disease, using estrogen to treat hot flashes is reasonable. There are other treatments you could try, such as venlafaxine. It is usually used as an anti-depressant,

I think it's reasonable for someone like you, once she understands the risks, to make her own decision.

The best estimate is that about one woman in 100 who takes estrogen for 10 years will suffer harm from it. It may be worthwhile for you to take that risk if nothing else you try is as effective at treating your symptoms.

Doctors work hard to minimize risk to patients, but there are times we forget that intelligent, well-informed patients are capable of making up their own minds about whether to take the risks.

Q Recently, I have been having pain in my right testicle, and I found a lump on the side of it. Could it be testicular cancer?

A Yes, of course, it could be testicular cancer. But many other conditions cause pain and swelling in the testicle, such as epididymitis, an inflammation usually caused by infection of the epididymis, one of the structures that carries sperm.

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Good health: Hormone replacement patch is complicated, controversial