DEAR DR. ROACH: Recently you wrote about estrogen. I started taking Premarin when I was 50 years old, some 28 years ago. I was switched over to estradiol 0.5 mg when my insurance carrier no longer paid for Premarin, about three years ago. I received my last supply in April 2014 and reduced the dose to half a tablet. I did have menopausal symptoms for several months, but these have dissipated.

I want to continue on estradiol, but the insurance company is giving me a hard time because of recent data regarding estrogen use and increased risk of heart disease and stroke. I had my uterus and ovaries removed 15 years ago. I am otherwise healthy. But because of my age, I am more vulnerable to certain diseases. I am convinced that the extra intake of an estrogen compound has beneficial effects for me. I would like to make my own decision as to whether I am ready to accept certain risks to maintain what I feel keeps me looking and feeling young. — B.B.

ANSWER: Estradiol, the primary form of estrogen made by healthy young women, has both good and bad effects, as I mentioned in my previous column. However, in a woman without a uterus who has been taking it without progesterone since menopause, the risks are probably as small as they can be. Some data show that there is no increased risk of either heart disease or breast cancer, although there certainly is an increased risk of blood clotting. There are benefits to the bone and a reduction in colon cancer risk.

I feel very strongly that insurance companies should not be making health-care decisions. All people, having a good understanding of the risks and benefits of medication, ought to be able to make up their own mind. However, I have to ask where your doctor is in this whole process. Have you discussed with your doctor your individual risk? Why isn’t he or she working with the insurance company?

No expert organization recommends estrogen-replacement therapy just to prevent disease. However, if after a discussion you decide to continue on estradiol and your doctor prescribes it, you don’t need the insurance company if you are willing to buy it yourself. It’s available from large pharmacies for $10 for a three-month supply.

DEAR DR. ROACH: My husband was admitted to the hospital several months ago with poor heart function and only 10 percent kidney function. He has been on dialysis three times a week since then. We have been inquiring for several months about his current kidney function, and we cannot get an answer. We are just curious as to whether there has been any improvement. — S.K.

ANSWER: Dialysis is a way of replacing kidney function when the kidneys can no longer remove enough of the body’s waste materials. It sounds like your husband is on hemodialysis, where the blood is run through a machine that removes excess fluid and waste products, such as creatinine and potassium, which would otherwise increase in concentration in the blood. High potassium is life-threatening, and creatinine, though not dangerous, is the molecule we look at most commonly to estimate kidney function.

Very rarely, kidney function can return even after a prolonged time on dialysis. I have never seen a case, but one study showed two cases per thousand where dialysis could be stopped. The clue that kidney function was returning was that urine output, which normally is scant while on hemodialysis, had increased over time. Unfortunately, 99.8 percent of the time, the kidney failure is permanent.

— Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com

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