DEAR DR. ROACH: As I seem to be highly prone to urinary tract infections, I’ve been using vaginal Estrace for decades. I’m 82 years old. I’ve developed serious gastroesophageal reflux disease, and note that there’s a connection with female hormones. Two of my health care providers disagree on whether vaginal Estrace is or is not linked with GERD. I read a study online that made the link, but it doesn’t tell whether the women studied used oral or vaginal Estrace, or both. Is there a way to determine this? — C.D.C.

ANSWER: Several studies have confirmed that oral estrogen, and the combination of oral estrogen with progestin, increase the likelihood of symptomatic gastroesophageal reflux disease. There has not been a connection with vaginal estrogen, nor would I expect there to be, since the blood levels of estrogen in a woman using vaginal estrogen are not higher than a woman not using vaginal estrogen.

Dr. Keith Roach

Note that when a woman first starts vaginal estrogen, if she has severe thinning of the lining of the vulva and vagina, the estrogen can be absorbed somewhat into the body. Over time, as the lining becomes normal, the estrogen is no longer absorbed to any appreciable degree.

Unfortunately, anyone can develop GERD symptoms. It’s just that vaginal estrogen doesn’t increase that risk.

DEAR DR. ROACH: I’m a 71-year-old man, and my mind is still sharp. Nonetheless, I do seem to have “senior moments.” I can’t come up with a word or remember a name. A couple of years ago, I was about to purchase a popular memory drug and decided to ask the pharmacist about it. He told me I’d be wasting my money. He said I should things like working puzzles, crosswords, sudoku, cryptograms, etc. to keep my mind sharp. I already do that, and have been doing so for years. I’m physically active as well.

I’d very much value your ideas about this. — T.W.

ANSWER: I am in complete agreement with your pharmacist about over-the-counter supplements to prevent or treat dementia, which I doubt you have. Even the prescription treatments that are available are only modestly effective in that they can slow down the progression of Alzheimer’s disease for a little while.

There is a debate about the use of mind and memory exercises — whether they really have an effect on preventing dementia. I suspect that they can increase the strengths we have, so that if we do lose some brain function over time, at least we have started from a higher level. I’d agree that word-type activities like crosswords and cryptograms have separate benefits from number activities like sudoku, and visual puzzles are even a different brain area.

Physical activity has been shown to reduce dementia risk and a whole lot of other risks as well, including many cancers in addition to heart disease. The one area I did not hear you mention is diet. A whole-food plant-based diet has been shown to reduce dementia risk. Omega-3 fatty acids may have a protective role as well.

For the cost of an unproven supplement, most people would able to improve their diet a great deal, which has unquestioned long-term benefits.

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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 send mail to 628 Virginia Dr., Orlando, FL 32803.