Think You’re Too Old for Hormone Therapy? Think Again!

After doing a podcast on bone health and hormone replacement therapy (HRT) otherwise known as menopausal hormone therapy (MHT), I was deluged with notes and calls from women over the age of 65 who wanted to know if it is too late for them to start. 

Current guidelines are that women receive the most benefit and the benefits outweigh the risks if HRT is started before the age of 60 within 10 years of menopause. So, of course older women or women whose became menopausal more than 10 years ago want to know…Is HRT right for me?  

The answer is not straightforward, and a lot depends on the type of hormone and route of administration such as by mouth (oral), through the skin (transdermal) or vaginally. It also depends on what you want to accomplish with HRT. Age is not the only factor. Your risk factors and genetics play a role. When starting hormones late, changes may be slower and less impactful, however they can still be beneficial.

A New Study Sheds Light

A few days ago, a comprehensive study was published in the journal Menopause: The Journal of The Menopause Society. This study sheds light on the benefits and nuances of menopausal hormone therapy (MHT) over age 65. It provided new insights that could influence healthcare decisions for millions of senior women.¹

The study analyzed health outcomes associated with different types, routes, and dosages of estrogen and progestogen as well as bioidentical progesterone using data from a massive cohort of over 10 million Medicare beneficiaries. 

Estrogen Alone Reduces Mortality!

One of the most encouraging outcomes of the study is the association between estrogen use and a notable reduction in mortality rates. Women who continued estrogen beyond 65 years exhibited a 19% reduction in all-cause mortality compared to those who never used hormone therapy or discontinued it post-65. 

The benefits extended beyond longevity. There were reductions in the risks of several major health conditions including breast cancer, heart failure, and dementia. Specifically, estrogen used alone was linked to reduced incidences of several cancers (breast, lung, and colorectal) and cardiovascular diseases. This was also found to be the case in the Women’s Health Initiative. The average age of women in that study was 63 and more than 10 years past menopause. Several newer meta-analyses of that study now consistently show reductions in heart disease and mortality when HRT is initiated soon after menopause. HRT also significantly decreases the incidence of various symptoms of menopause and the risk of osteoporotic fractures and improves quality of life.²

Adding Progesterone/Progestins is Nuanced

While estrogen therapy alone generally showed beneficial outcomes, the use of combined estrogen and progestogen (synthetic progestins) presented a more mixed picture. Although estrogen progestogen (synthetic) therapy was associated with reductions in risks for uterine and ovarian cancers, as well as some cardiovascular conditions, it also showed an increased risk of breast cancer.

While most studies showed synthetic progestins added to estrogen increased the risk of breast cancer, adding natural, bioidentical progesterone in the latest study showed a slightly increased risk of breast cancer and in other studies it did not. 

A 2018 study in Climacteric stated: “Estrogens combined with oral (approved) or vaginal (off-label use) micronized progesterone (natural, bioidentical) do not increase breast cancer risk for up to 5 years of treatment duration; (2) there is limited evidence that estrogens combined with oral micronized progesterone applied for more than 5 years are associated with an increased breast cancer risk.” ³

A 2021 study in Women’s Health stated: “Existing evidence from clinical studies on the use of micronized progesterone in MHT, for the most part, shows favorable outcomes, without deleterious effects. Micronized progesterone is able to prevent endometrial hyperplasia (growth of the uterine lining) in combination with estrogens, does not increase the risk of VTE (venous thromboembolism=clots that break off) and stroke when used with transdermal (topical through the skin) estrogens. Micronized progesterone does not seem to attenuate the cardiovascular benefits of estrogens and is likely safer than PGs (synthetic progestins). The breast cancer issue is of great concern, and according to observational studies, MHT regimens containing micronized progesterone are associated with a significantly lower risk of breast cancer than those containing PGs (synthetic progestins). ⁴

Type, Dose and Route of Administration Matters

Using low doses, vaginal or topical applications, and the use of bioidentical estradiol over synthetic conjugated estrogens (CEE) is safer. The preponderance of newer studies shows that natural, bioidentical progesterone is safer than the synthetic version and progesterone has many benefits such as anti-inflammatory, neuroprotective, muscle relaxation, helps build strong bones, and lowers anxiety and promotes sleep. Progesterone has been shown to lower rates of uterine and colon cancers and may also be useful in treating endometrial carcinoma (uterine cancer), ovarian cancer, melanoma, mesothelioma, and prostate tumors.⁵

This groundbreaking study not only provides reassurance about the safety and efficacy of continuing or starting hormone therapy after 65 but also highlights the critical need for personalized medical guidance. Are you wondering Is HRT Right for You? Take our course.  It will answer your burning questions, guide you through an assessment of the risk of taking or not taking bioidentical hormone replacement therapy, the studies that show the safety and benefits and what to expect of you decide to take hormone replacement. 

This course has helped many women have the courage, confidence, and knowledge to support their decision. Sharing the studies with your doctor can open a dialogue that is valuable to you and your practitioner.  Many practitioners may not be up to date on the latest studies. Always consult your healthcare providers to be sure if HRT is right for you. It may not be too late.

1. Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses. Menopause. Published online April 9, 2024. doi:10.1097/GME.0000000000002335
2. Lobo RA. Hormone-replacement therapy: current thinking. Nat Rev Endocrinol. 2017;13(4):220-231. doi:10.1038/nrendo.2016.164
3. Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric. 2018;21(2):111-122. doi:10.1080/13697137.2017.1421925
4. Hipolito Rodrigues MA, Gompel A. Micronized progesterone, progestins, and menopause hormone therapy. Women Health. 2021;61(1):3-14. doi:10.1080/03630242.2020.1824956
5. Nagy B, SzekerThis course has helped many women have the courage, confidence, and knowledge to support their decision. Sharing the studies with your doctor can open a dialogue that is valuable to you and your practitioner.  Many practitioners may not be up to date on the latest studies. Always consult your healthcare providers to be sure if HRT is right for you. It may not be too late.

es-Barthó J, Kovács GL, et al. Key to Life: Physiological Role and Clinical Implications of Progesterone. Int J Mol Sci. 2021;22(20):11039. doi:10.3390/ijms222011039