In a recent inquiry to Dr. Roach, a medical expert, a reader sought information about a possible correlation between celiac disease and restless legs syndrome (RLS). Dr. Roach shed light on this topic, offering insights into the relationship between these two conditions.

The reader shared concerns about her 72-year-old husband, who has been dealing with RLS for several decades. Despite taking medication such as gabapentin and pramipexole to manage his symptoms, he still experiences discomfort. In addition, he suffers from periodic limb movement disorder (PLMD) during sleep, which affects the quality of rest for both the husband and his wife, leading them to sleep in separate beds during severe episodes.

Dr. Roach clarified the terminology surrounding RLS and PLMD, emphasizing that PLMD is a separate issue that does not exhibit the characteristic uncomfortable sensation in the legs at rest, which prompts movement. However, most individuals with RLS do experience periodic limb movements during sleep.

The medical expert highlighted an increased risk of RLS among people with celiac disease. Iron deficiency is often a common factor linking these two conditions. Celiac disease, if not managed meticulously through dietary measures, can hinder the body's ability to absorb iron effectively.

Iron deficiency is frequently found among individuals with RLS, and it can exacerbate the symptoms. To accurately diagnose iron deficiency, Dr. Roach recommended conducting a ferritin level test instead of a blood count. If iron deficiency is confirmed, iron supplementation could potentially lead to a significant improvement in the nighttime symptoms associated with RLS.

In a separate inquiry, a 70-year-old woman sought Dr. Roach's opinion on the safety of using Estrace vaginal cream, which she had been using weekly for several years. Dr. Roach concurred with the patient's gynecologist, stating that using estradiol, the bioidentical hormone in Estrace, topically is beneficial for maintaining the health of vaginal tissue.

Without the use of estrogen, the tissues in the perineum area can become atrophic, increasing the risk of discomfort, infections, and incontinence. Dr. Roach noted that the recommendation to use Estrace after a Pap smear was justified since the procedure might have revealed signs of vaginal atrophy.

Addressing the patient's concern about her family history of cancer, Dr. Roach assured her that long-term use of topical estrogen results in minimal absorption into the body. However, in cases where there is a personal history of estrogen-sensitive tumors like endometrial cancer or certain types of breast cancer, Dr. Roach advised discussing options with both the patient and their oncologist.

In conclusion, Dr. Roach's insights shed light on the correlation between celiac disease and RLS, emphasizing the role of iron deficiency and the potential benefits of iron supplementation. Additionally, he addressed concerns about the use of Estrace vaginal cream, highlighting its importance for maintaining vaginal health while considering individual risk factors.