DEAR DR. DONOHUE: I haven’t had a menstrual period for two years; I am 54. I do have hot flashes that are wiping me out. What can I do? I am afraid of estrogen because of the cancer scare, even though my doctor thinks I should take it. The flashes wake me up during the night. I find it hard to concentrate at work. Do you have any thoughts? — A.W.

ANSWER: Most women do experience hot flashes during menopause, but the flashes often stop after two years. For some women, however, they continue for years and years, sometimes for decades. The typical hot flash starts with a sensation of intense warmth on the face and upper chest, and then spreads to the rest of the body. Copious sweating might accompany the sensation. A diminished production of estrogen somehow upsets a woman’s thermostat, the heat-regulation center of the brain.
Short-term, low-dose estrogen appears to be relatively safe as far as breast cancer is concerned. “Short-term” means one or two years. At the end of that time, a gradual tapering of the dose seems to prevent a return of hot flashes. Any woman who has had breast cancer, heart disease, a stroke or vein clots isn’t a candidate for estrogen therapy. And women who have their uterus must also take progesterone to prevent estrogen stimulation of the uterine lining.
No one is able to give you 100 percent assurance that short-term estrogen never leads to breast cancer, but the evidence strongly suggests it does not.
Have you tried other ways of dealing with the flashes? Dressing in layers, so that one layer of clothing can be discarded at the onset of a hot flash, helps. Having an iced drink always at hand is another way to combat them. I think these ideas must have been thought up by a man.
Some women have found that herbal remedies work for them. Progestin therapy is another fairly reliable treatment. Soy foods can sometimes dampen hot flashes. Anti-depressants like venlafaxine and paroxetine have proven useful, as has the medicine clonidine.

DEAR DR. DONOHUE: I am 54 and uncircumcised. I cannot push my foreskin over the head of my penis anymore. The area is tender. What should I do? — R.T.

ANSWER: You can fix this only by seeing a doctor. When the foreskin can’t be retracted, the condition is phimosis (fie-MOE-siss). It promotes infection, and it sounds like you have one. The doctor has to distinguish between a fungal infection caused by the yeast Candida and a bacterial infection caused by one of many different bacteria. Antifungal or antibacterial creams usually can end the infection, but sometimes oral medicines are required.
If the skin cannot eventually be retracted, then circumcision should be considered.

DEAR DR. DONOHUE: I don’t think you will consider this a health problem. It isn’t, but it is still a problem for me. It is freckles. They cover my face in the summer, and they really bother me. How do I stop them? I am 16, and freckles are ruining my life. — L.M.

ANSWER: Sunlight causes freckles. In the winter, when the sun is less intense, they fade. In summer, the stronger sunlight activates skin cells to produce melanin, the dark pigment responsible for tanning – and for freckles.
Sunscreens with an SPF — sun protection factor — of 15 or higher afford a good defense against the sun’s ultraviolet rays. You shouldn’t go outside without applying it, and you should reapply it as often as the label directions say. If you can find it, get a sunscreen with protection against both ultraviolet A and B.
A hat provides shade for the face and is another protection against freckles.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.