Menopausal Hormone Therapy Use Is Beneficial Beyond 65 Years

Menopausal hormone therapy's safety has been a topic of much debate for years, but now emerging data is showing its safety and benefits.

A recent article from the Menopause journal discusses the implications of continuing menopausal hormone therapy (HT) beyond the age of 65. It specifically examines the health outcomes associated with the use of estrogen monotherapy in older women. The study highlights significant reductions in risks for several major health issues when estrogen monotherapy is used beyond age 65 compared to discontinuing or never using HT. These health benefits include a 19% reduction in overall mortality, and notable decreases in the incidence of breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), dementia (2%), and the use of hormone optimization through bioidentical hormone therapy approved by the FDA. Additionally, estrogen monotherapy has been shown to protect against heart disease and stroke, increase bone density, reduce the risk of Alzheimer's disease, protect against vaginal atrophy, and help with urinary incontinence, hot flashes, mood swings, and night sweats.

What are the Benefits of Hormone Therapy for Women Beyond Age 65?
Types of Hormones Used in HRT
Forms of Hormone Therapy
Cyclical and Continuous Regimens
Considerations and Personalization
What Lab Tests Can Help Diagnose Menopause?
Follicle-Stimulating Hormone (FSH) Test
Estradiol Test
Luteinizing Hormone (LH) Test
Considerations and Limitations
Common Questions About HRT
Citations

The research also addresses the persistence of menopausal vasomotor symptoms in a substantial percentage of women aged 60–65 years, which supports the need for continued hormone therapy in some cases. In response to these findings, The Menopause Society updated their guidelines in 2022 to recommend that the decision to start or continue hormone therapy after age 65 should be personalized, taking into account the individual's specific needs, overall health, and medical history. The study also explored the effects of 40 different hormone therapy preparations on 13 health outcomes, finding significant variations depending on the type, route, and strength of the hormone therapy used [1]. For women experiencing menopause symptoms, it is important to note that hormone therapy should only be considered after consulting with a healthcare professional and discussing your current symptoms and medical history.

What are the Benefits of Hormone Therapy for Women Beyond Age 65?

The benefits of menopausal hormone therapy (HT) beyond age 65 have been the subject of various studies and discussions. The key takeaways from the sources provided are as follows:

Continuation of Symptom Relief: Menopausal symptoms such as hot flashes, mood disturbances, and sexual discomfort can persist well into the post-menopausal years, with moderate to severe vasomotor symptoms documented in 42% of women aged 60 to 65 years [1].
Bone Health: Loss of estrogen during menopause can lead to diminished bone density and an increased risk of osteoporosis. Hormone replacement therapy can offer protection against bone loss and help prevent osteoporosis [1].
Cardiovascular Benefits: Some studies suggest that hormone therapy started early in postmenopausal women can reduce heart failure and heart attacks significantly [2].
Cancer Risks: Estrogen therapy, either alone or in combination with progesterone, has been associated with a reduction in the incidence of certain cancers. For example, a study found significant reductions in the incidence of breast, lung, colorectal, and ovarian cancers among women using estrogen therapy [4].
Mortality: Hormone therapy may reduce overall mortality rates. A study analyzing data from the 2007–2019 records of more than 7 million women with Medicare coverage aged 65 and older found that rates of death occurred less often in women using hormone therapy [4].
Individualized Approach: The decision to start or continue hormone therapy after age 65 should be personalized, taking into account the individual's specific needs, overall health, and medical history [12].
Risks and Benefits: While there are undeniable benefits, some risks, such as blood clots and dementia, may increase with age or the duration of hormone therapy. The type of hormone therapy used also affects the risk profile [12].
Variations in Therapy: Different hormone therapy preparations have varied effects on health outcomes, and the choice of hormone type, administration route, and strength can influence the balance of risks and benefits [6].
Recent Research: A recent study provides reassurance regarding the safety of using hormone therapy after age 65, suggesting that with appropriate counseling and regular assessment of risks and benefits, continuing HT can be a reasonable option for healthy women with persistent vasomotor symptoms[6][16][17].

Menopausal hormone therapy (HT), also known as hormone replacement therapy (HRT), is used to alleviate symptoms of menopause by replacing hormones that are at a lower level as women go through this transition. Here’s a detailed look at the various options:

Types of Hormones Used in HRT

Estrogen Therapy: This involves the use of estrogen alone. It is typically prescribed to women who have had a hysterectomy (removal of the uterus) because they do not need progesterone to protect against uterine cancer [2].
Combination Therapy (Estrogen and Progestin): This is used for women who still have their uterus. Progestin is added to estrogen therapy to protect against the risk of uterine cancer, which can be increased by estrogen alone [2].
Estrogen and Testosterone: Sometimes, testosterone is added to help with specific symptoms, like a reduced sex drive [13].

Forms of Hormone Therapy

Oral Pills: These are perhaps the most common form of HT. Estrogen or combination hormone pills are taken daily [1] [4].
Patches: These are applied to the skin and release hormones into the bloodstream through the skin. They can be specific to estrogen or a combination of estrogen and progestin. Patches are changed once or twice a week, depending on the type [1] and [4].
Gels and Sprays: These are applied to the skin and allow hormones to be absorbed directly into the bloodstream. They are an alternative for those who may have issues with oral forms of HT [1] and [6].
Vaginal Creams, Tablets, and Rings: These are used primarily to treat vaginal and urinary symptoms of menopause. They provide hormones locally to the vaginal area with minimal absorption into the bloodstream, thus minimizing overall hormonal effects on the body [1] [3] [4].
Intrauterine Devices (IUDs): These devices release progestin locally and are used in combination with systemic estrogen therapy for women who need both hormones [4].
Nasal Sprays: This less common form delivers estrogen directly through the nasal membrane into the bloodstream [1].

Cyclical and Continuous Regimens

Cyclical HRT: This mimics the natural menstrual cycle. Estrogen is taken daily, and progestin is added for the last part of the cycle each month, which can lead to a withdrawal bleed similar to a period [5].
Continuous HRT: Both estrogen and progesterone are taken daily without a break. This method is often used for post-menopausal women and typically does not lead to a withdrawal bleed [5].

Considerations and Personalization

The choice of HT type and form depends on several factors, including a woman’s health history, her specific menopausal symptoms, whether she still has her uterus, and personal preferences. It’s important for women to discuss the benefits and risks of different HT options with their certified healthcare provider to determine the best approach tailored to their individual needs[2][4][5]. Each type of HT has its own benefits and potential risks, including the use of injections, and the decision to use hormone therapy should be made on an individual basis after thorough initial consultation with a certified healthcare provider.

Before starting combination therapy, several factors need to be considered to ensure the treatment is effective, safe, and tailored to the patient's specific needs. These factors include:

Adequacy of Monotherapy: Combination therapy is often considered when monotherapy does not adequately control the condition. It's important to assess whether the initial single-agent therapy was given in adequate doses and for a sufficient duration to determine its effectiveness1.
Patient's Health Profile: The presence of comorbid conditions can influence the choice of agents in combination therapy. For instance, certain drugs may be preferred or avoided depending on the patient’s other health issues like diabetes, heart failure, or kidney disease1 4.

Risk of Side Effects: Each medication in a combination therapy can have side effects, and their potential cumulative or interactive effects must be considered. It's crucial to choose drugs with non-overlapping adverse effects to minimize the risk to the patient3.

Drug-Drug Interactions: The potential for pharmacokinetic and pharmacodynamic interactions between the drugs used in combination therapy must be evaluated. This includes understanding how the drugs might affect each other’s metabolism and activity, which can alter their efficacy and safety3.
Patient Compliance and Convenience: Combination therapies, especially fixed-dose combinations, can enhance patient compliance by reducing the pill burden and simplifying the treatment regimen. However, individual patient preferences and their ability to adhere to the regimen should be considered1 2.
Cost and Access: The cost of medication and the patient’s access to it can affect adherence and the overall effectiveness of the treatment. It’s important to consider the financial impact on the patient when prescribing combination therapies4.
Guidelines and Evidence: Clinical guidelines and evidence from clinical trials should guide the choice of combination therapy. These guidelines are based on large studies and expert consensus, which help ensure that the combination chosen is effective and has a favorable risk-benefit profile1 7.
Initial Severity of the Condition: For conditions like hypertension or diabetes, the initial severity can dictate whether combination therapy should be started right away. For example, in patients with significantly high initial blood pressure or blood sugar levels, immediate initiation of combination therapy might be necessary to quickly achieve control1 2.
Goal of Therapy: The ultimate goal of the treatment, whether it is to control symptoms, prevent progression of a disease, or reduce the risk of complications, should be clearly defined and agreed upon with the patient. This helps in selecting the most appropriate therapy combination1 2.
Monitoring and Adjustment: Once combination therapy is initiated, regular monitoring is necessary to assess efficacy, side effects, and patient adherence. Adjustments may be needed based on the patient’s response and any new health developments1.

These considerations ensure that combination therapy is used effectively, maximizing benefits while minimizing risks and side effects for the patient.

What Lab Tests Can Help Diagnose Menopause?

Blood tests can be used to help diagnose menopause, although they are not always necessary or definitive on their own. The primary blood tests used to evaluate menopausal status measure the levels of follicle-stimulating hormone (FSH) and estradiol (a form of estrogen). Here's a detailed look at how these tests are used in the context of diagnosing menopause:

Follicle-Stimulating Hormone (FSH) Test

FSH is a hormone produced by the pituitary gland that plays a crucial role in the reproductive processes. During menopause, the ovaries begin to function less effectively, and in response, the levels of FSH typically increase as the pituitary gland tries to stimulate the ovaries to produce more estrogen. An elevated FSH level is often used as an indicator of menopause:

FSH Levels: After menopause, FSH levels are typically in the range of 25.8 to 134.8 mIU/mL5. However, FSH levels can fluctuate significantly, making a single test potentially misleading. Repeatedly high levels of FSH over time are considered a more reliable indicator of menopause6.
Testing Conditions: The timing of the test can affect FSH levels, as they can vary throughout the menstrual cycle. Women are often advised to have the test at a specific time, usually early in the menstrual cycle2.

Estradiol Test

Estradiol is the primary type of estrogen produced by the ovaries. During menopause, the levels of estradiol decrease as the ovaries reduce their hormone production:

Estradiol Levels: Lower levels of estradiol are associated with menopause. The specific threshold can vary, but generally, significantly reduced levels compared to the normal range for reproductive age indicate menopause8.

Luteinizing Hormone (LH) Test

LH is another hormone produced by the pituitary gland that works in conjunction with FSH to regulate the reproductive system. Like FSH, LH levels can also increase as the ovaries produce less estrogen:

LH Levels: High levels of LH can indicate menopause, especially when combined with high FSH levels and low estradiol levels7.

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Considerations and Limitations

Variability: Hormone levels can fluctuate greatly, making a single hormone test less reliable for diagnosing menopause. This is particularly true for women in perimenopause, where hormone levels can vary widely from day to day1 4.

Symptoms and Medical History: Diagnosis is often based on symptoms and medical history rather than solely on hormone levels. Common symptoms include changes in menstrual patterns and the onset of hot flashes3.
Other Tests: Sometimes, additional tests are conducted to rule out other conditions that could cause similar symptoms, such as thyroid disorders8.

In summary, while blood tests like those measuring FSH, LH, and estradiol levels can support the diagnosis of menopause, they are typically used in conjunction with a review of symptoms and medical history. Due to the variability in hormone levels, especially during perimenopause, these tests are not definitive on their own and may not accurately reflect hormone imbalance. Additionally, symptoms such as vaginal dryness, night sweats, which can greatly impact quality of life, may not be reflected in hormone levels and should be discussed with a healthcare provider. Bio-identical hormone replacement therapy (BHRT) for women is a potential solution for these symptoms and should be considered as a treatment option. Considerations and limitations should be taken into account when using hormone levels as a diagnostic tool for hormone imbalance.

Common Questions About HRT

How do I find hormone replacement therapy services near me?

To find hormone replacement therapy services near you, you can start by conducting a search online using search engines like Google. You can use search terms such as "hormone replacement therapy near me" or "HRT clinics in [your location]" to find relevant results. Additionally, you can check local directories, healthcare provider listings, or websites of medical centers in your area that specialize in hormone replacement therapy. Another option is to ask for recommendations from your primary care physician or seek referrals from friends or family members who may have undergone similar treatments. It's important to research the reputation and credentials of the providers you come across and consider factors such as their experience, reviews, and proximity to your location before making a decision.

You can also click on the following banner and fill out a form to have HRT clinics contact you:

What qualifications should I look for in a provider offering hormone replacement therapy near me?

When looking for a provider offering hormone replacement therapy near you, it is important to consider their qualifications and expertise in this area. Some qualifications to look for include:

1. Medical License: Ensure that the provider is a licensed healthcare professional, such as a doctor or nurse practitioner, who is authorized to practice in the field of hormone replacement therapy.

2. Specialization in Hormone Replacement Therapy: Look for providers who have specific training and experience in hormone replacement therapy and are knowledgeable about the latest treatment options and guidelines.

3. Board Certification: Providers who are board-certified in areas such as endocrinology or hormone therapy have demonstrated expertise in this field and adhere to high standards of care.

4. Experience: Consider providers who have extensive experience in hormone replacement therapy and have successfully treated patients with similar needs and conditions.

5. Positive Reviews and Patient Feedback: Check reviews and testimonials from other patients to get an idea of the provider's reputation, quality of care, and patient satisfaction.

By considering these qualifications, you can choose a provider who is well-equipped to provide safe and effective hormone replacement therapy tailored to your individual needs.

What questions should I ask during a consultation for hormone replacement therapy near me?

During a consultation for hormone replacement therapy near you, it is important to ask questions that will help you understand the treatment, its potential benefits and risks, and what to expect. Some questions you may consider asking include:

1. What are the different types of hormone replacement therapy available?
2. How will hormone replacement therapy benefit me specifically?
3. What are the potential side effects or risks associated with hormone replacement therapy?
4. How long do I need to be on hormone replacement therapy?
5. What monitoring or follow-up appointments will be necessary during the treatment?
6. Are there any lifestyle changes I should make while on hormone replacement therapy?
7. How soon can I expect to see results from hormone replacement therapy?
8. What happens if I miss a dose of my hormone replacement medication?
9. Are there any alternative treatments or therapies that I should consider?
10. How much will hormone replacement therapy cost, and does insurance cover it?

Asking these questions can help you make an informed decision about whether hormone replacement therapy is right for you and what to expect throughout the treatment process.

How long does it typically take to see results from hormone replacement therapy?

The timeline for seeing results from hormone replacement therapy (HRT) can vary depending on individual factors such as the type of hormones being used, the dosage, and the individual's response to treatment. Some people may start to notice improvements in their symptoms within a few weeks to a few months of starting HRT, while for others it may take longer. It is important to follow your healthcare provider's guidance and attend any follow-up appointments to monitor your progress and make any necessary adjustments to your treatment plan. If you have specific concerns about the timeline for seeing results from HRT, it is best to discuss them with your healthcare provider.

Do you need to chat with other women going through menopause and using HRT?

Please join a Facebook group with over 20,000 women from all over the world called : Women's Health and HRT

Citations

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