Q. I took bioidentical hormone replacement therapy (BHRT) to handle my horrible hot flashes. After taking it for three months, I started having pains in my breasts. A mammogram did not show any problems, but the recommendation was made that I stop taking the compounded HRT. The pain went away when I did so.

I did feel better while on BHRT. My doctor told me, though, that even compounded bioidentical HRT still counts as hormone treatment. Any thoughts?

A. For more than 50 years, physicians prescribed traditional hormone replacement therapy (HRT) for menopausal symptoms with the expectation that it would protect the cardiovascular system and the bones as well. The Women’s Health Initiative (WHI) in 2002 revealed that HRT could increase the risk for heart attacks, strokes and breast cancer.

Bioidentical hormone therapy has not been subjected to the same careful scrutiny as the WHI, so its long-term safety is still a question. We believe that stopping your BHRT was smart. Data from the WHI show that women who experienced breast pain or tenderness while taking HRT were at substantially higher risk for invasive breast cancer (Archives of Internal Medicine, Oct. 12, 2009).

For more information on hormone pros and cons and other ways to deal with hot flashes, we offer our Guide to Menopause. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (61 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. W-50, P. O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our Web site:

www.peoplespharmacy.com

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Q. Milk of magnesia is great for blemishes. I started using it six months ago, and it really helped clear up my skin. It was better than the things my dermatologist prescribed.

I got lazy and stopped using it, and my face began to break out again. Now I apply the milk of magnesia every night before bed and leave it on all night. It can be a bit drying, but it works wonders for acne.

A. There are no studies of topical milk of magnesia for acne, but a letter in the Archives of Dermatology (January 1975) did mention this approach. Many readers also have shared their success with milk of magnesia to counteract blemishes.

Q. I am an anxious person and find that I don’t handle stressful situations very well. My doctor prescribed Lexapro, but it made me very nauseated. I woke up in a deep sweat with my heart racing.

I know there are other drugs as well, but I am concerned about their side effects. Are there any natural alternatives that won’t produce side effects?

A. Lexapro can cause nausea, sweating and palpitations. Drowsiness, headache and sexual difficulties also have been reported.

Finding a natural approach for anxiety may be a challenge. Physicians used to rely on a category of medications called benzodiazepines, which includes drugs like Ativan (lorazepam), Valium (diazepam) and Xanax (alprazolam). These medications can help reduce anxiety, but they also can be habit-forming.

Cognitive behavioral therapy is one approach that does not require medications. You may want to ask your physician for a referral. Herbs such as valerian and passionflower have sometimes been used to help control nervousness.