DEAR DR. ROACH:
In a recently published column, you stated, “As always, the decision belongs to the patient,” while addressing a concern about the benefits and risks of stopping a statin drug. Oh, really? Why is it then that no doctor will prescribe hormone replacement therapy to stop my debilitating post-menopausal symptoms once I turned 60? After suffering from menopausal symptoms starting at age 42, I was finally prescribed HRT at age 57. What relief I had, as it was the only remedy to alleviate my hot flashes, weight gain, lack of sleep and vaginal dryness.
Once I hit 60, I was ordered to stop the HRT, and no one since will prescribe it for me now. I am 66 now, suffer daily with hot flashes and have my sleep interrupted at least five times a night with terrible night sweats. I have tried just about every over-the-counter offering with zero effectiveness.
I will gladly trade the greater risk of heart attack and stroke, and the possible shorter life span, for relief from symptoms that affect my daily quality of life. Clearly, the choice is not mine, because if I had a choice, I would ask for continued prescriptions of HRT to give me relief. Why don’t I have that choice as a patient? — R.M.T.
ANSWER:
A patient always has the right to refuse a treatment recommended from a physician. However, the physician has the obligation to consider the risks and benefits of a treatment and is not obliged to prescribe a treatment they do not think is appropriate.
If a patient asks me for a treatment that has been shown not to be effective and has the potential for serious adverse effects, I don’t prescribe it, but will work with the patient to find alternative treatments. For example, some non-hormonal prescription treatments are moderately effective for hot flashes and sleep disturbance, and topical estrogen is very effective for vaginal dryness.
However, the case of hormone replacement therapy for symptoms of menopause is more complicated, because estrogen is the most…
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