A Question of Health: Don't worry about weight gain when you're taking HRT

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CAN YOU explain why I should have put on weight since I have been on a low dose of oestrogen for HRT? I am 60 and I swim 250m nearly every day, walk everywhere and eat lots of fresh fruit and veg and little fat, salt and sugar. My appetite has not changed and I eat no more; indeed I drink less alcohol than before I started HRT. Why does oestrogen cause weight to go up, and what can I do about it?

Women who are thinking about starting hormone replacement therapy are often concerned that it will make them put on weight. The best research into this is the Postmenopausal Estrogen and Progestin Intervention (with apologies for the American terminology), which compared the weight of women who took a placebo with women who took various types of HRT over a period of three years.

This study found that women who took a placebo gained more weight than women who took HRT. Women who took no hormones had an average weight gain of 4.6lb, while women who took HRT gained between 1.5 and 2.9lb. The lowest weight gains were recorded by women who took oestrogen on its own. Women who took HRT preparations containing both oestrogen and progesterone gained slightly more. So, the scientific evidence is that HRT does not cause weight gain. Keep up the exercise, continue with a low-fat healthy diet, and reduce your calorie intake a little more.

I AM a male in my late forties. At what age should I ask my GP for a prostate check?

It is terribly difficult to give a simple, straightforward answer to this question. There is certainly no need to check for non-cancerous enlargement of the prostate gland unless you are beginning to get symptoms. The common symptoms are a slow and weak urinary stream, and difficulty in starting or stopping the urinary stream. If you are worrying about cancer of the prostate, you are probably thinking of having a PSA test, which is a blood test that can pick up early signs of prostate cancer. But the PSA test is often unreliable - some people will have raised PSA levels even though they do not have cancer, and some people with cancer will have normal levels of PSA.

The best way to find out more about the PSA test is to read Screening for prostate cancer. Information for men considering or asking for PSA tests. This is published by the NHS Centre for Review and Dissemination at the University of York. You can get a copy from the NHS Information Service on 0800 665544, or on the Internet at http://www.york.ac.uk/inst/crd/ patprost.htm.

IS IT too late to have a flu vaccination?

The mini-epidemic of flu has probably passed its peak, but it is certainly not too late to have a flu jab, particularly if you are elderly or suffer from a chronic disease, such as asthma or bronchitis.

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