A Question of Health

I TAKE hormone replacement therapy, which contains oestrogen and progesterone. The progesterone is present only during the second half of the month. I feel terrific when I am taking the oestrogen on its own, but dreadful when I start the progesterone. Why can't I just take the oestrogen?

Progesterone is added to HRT because it prevents the lining of the uterus from being overstimulated by oestrogen. When HRT was first introduced, women who took oestrogen on its own had an increased risk of cancer of the lining of the uterus. This cancer risk can be eliminated by taking progesterone for at least 10 days a month. You have several options. You could try a type of HRT that contains a different formulation of progesterone. Another possibility is to take tibolone, which is a unique form of HRT that does not contain progesterone. If all else fails, you may be able to take oestrogen on its own if you are prepared to have regular (probably once a year) biopsies of the lining of the womb to check for cancer. This is not as bad as it sounds, but you would need to organise it with a gynaecologist.

I AM a 34-year-old man with seborrhoeic dermatitis: dandruff and flaky skin on my forehead and cheeks, especially in cold weather. I have tried Nizoral shampoo and Daktacort cream, neither of which has had any effect. I am getting desperate and a brown paper bag seems the only option. Any suggestions?

A yeast infection with Pityrosporum ovale is one of the factors that causes seborrhoeic dermatitis. For your scalp, try Polytar AF, a shampoo that contains zinc pyrithione. For your face, you should try terbinafine (Lamisil) cream, which sometimes works better than Daktacort. You will need a doctor's prescription for this.

Please send questions to A Question of Health, `The Independent', 1 Canada Square, Canary Wharf, London E14 5DL; fax 0171-293 2182; or e-mail to health@independent.co.uk Dr Kavalier cannot respond personally to questions

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