I have been using HRT patches for the past ten months without incident. But recently they have been falling off within hours of applying them and my symptoms are creeping back. Could it just be a faulty batch?
L. Brassington, Tewkesbury, Gloucestershire.
Dr Martin Scurr replies: This is a common problem and the return of some of your menopausal symptoms suggests that as a result of your patches coming off, less oestrogen is being transferred via your skin. So why are they now falling off? Heat and sweating are often to blame (and don’t forget about the successive heatwaves we’ve experienced recently).
Other causes include moisturisers or suncream – even small traces will prevent good patch adherence. For the patch to stick properly, make sure you wash the area (usually the lower abdomen or buttock) and then dry very carefully with a soft towel, ensuring there is no dampness.
The patch must be applied with the palm of your hand (to get the warmth; fingers can be very cold), pressing it firmly for ten to 20 seconds – this warms it, which improves adherence.
If you develop redness, itching or discomfort from HRT patches – even after months of regular use – it could be an allergy or hypersensitivity to the adhesive. In these cases, it might be necessary to switch to a different brand.
HRT patches can fall off within hours of applying them for a number of reasons, including heat and sweating along with traces of suncream and moisturisers around the area of the patch
I’m 62 and have had a cough for six months, bringing up yellow-green phlegm – occasionally even enough to make me sick. It is embarrassing and disrupts my sleep. I’ve never smoked, eat healthily, am not overweight and have no respiratory conditions. A chest X-ray was clear. What do you suggest?
Name and address supplied.
Dr Scurr replies: It’s reassuring that you don’t mention symptoms that would cause added concern – such as weight loss, sweating or breathlessness. And it is reassuring that the chest X-ray was clear, which makes serious conditions such as lung cancer less likely.
In a non-smoker without a history of asthma or lung disease, I have two thoughts: one possibility is that you have acid reflux at night.
So-called ‘silent reflux’ does not cause the characteristic symptoms such as heartburn or indigestion – instead, the coughing is triggered by acid rising up into the oesophagus as you sleep, causing irritation.
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It’s been shown to reduce the risk of dementia, now research has found that the latest shingles jab – Shingrix – could help protect against blocked arteries, heart failure and stroke.
The findings were based on analysis by Oxford University, of data from over 72,000 people aged 60 and over.
It’s a compound within the vaccine, which stimulates immunity, that may explain the cardiovascular benefits.
In some people, small amounts of acid can also spill over into the throat and airways, leading to inflammation and excess mucus production. This mucus can become yellow-green due to inflammatory cells within the secretions, resulting in the phlegm you describe.
The second possibility is bronchiectasis, where the airways have become dilated and damaged, affecting the ability of the microscopic cilia (hair-like structures lining the airways) to clear away mucus – leading to a vicious circle of inflammation and infection, as bacteria flourish in this warm, moist environment. A chronic productive cough is the classic symptom.
A history of whooping cough can cause bronchiectasis, as can lung infections such as pneumonia. However, in many cases it’s not clear what has triggered it.
A chest X-ray might not pick up mild bronchiectasis – what is needed is a CT scan of the chest. I would suggest you should also have a sputum (phlegm) sample – potentially three, on different days – sent for bacteriological analysis. If this is confirmed, treatment may include a prolonged course of antibiotics, plus training by a physiotherapist in ‘postural drainage’ to encourage clearance of the retained secretions – something that should become part of your daily routine.
I recommend seeing your GP and asking about those further investigations and discussing the possibility of silent reflux.
In my view… Health screening should start young
It’s not just older people who need to think about health screening – even those in their 20s can benefit.
A recent survey of over 60,000 employees working for more than 1,000 companies found that 86 per cent had at least one significant cardiovascular risk factor or symptom that should be investigated.
What was most surprising was that over 24 per cent of employees under the age of 30 already carried a cardiovascular red flag such as raised blood pressure, obesity or significantly raised cholesterol.
Knowing you have risk factors means you can take action, before it’s too late.
On the NHS there is screening for breast cancer, cervical cancer, bowel cancer, lung cancer and abdominal aortic aneurysm (in men) – but these are all essentially for post-middle-age (apart from cervical screening, which starts at 25).
The message I take from this is if you work in an organisation that offers medical screening whatever your age, though especially if you are young and it hasn’t crossed your mind to, accept the offer.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Replies should be taken in a general context. Always consult your own GP with any health concerns.
