Absolutely not!
After you begin the transition into menopause, it never ends. And yet some providers often unceremoniously dump their patients off of hormone therapy after the age of 65, or some other arbitrary number. This is not evidence-based practice. Let’s delve into the evidence and recommendations from various medical societies to shed light on this important topic.
Understanding Menopausal Hormone Therapy (MHT)
Menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), involves taking estrogen, progesterone and/or testosterone to replace hormones that the body loses during menopause. It is commonly used to manage intense symptoms such as hot flashes, night sweats, vaginal dryness, and bone loss. However, the landscape around MHT has been marked by controversy and changing recommendations over the years.
The Controversy Surrounding MHT
In the early 2000s, a pivotal study called the Women’s Health Initiative (WHI) raised concerns about MHT. Preliminary results suggested that a combination of estrogen and progestin was associated with an increased risk of heart disease, stroke, blood clots, dementia, and breast cancer. As a result, many women and healthcare providers became hesitant to use MHT, especially after the age of 65.
However, subsequent research revealed flaws in the WHI study. For instance, the participants were older (average age 63) and had a higher baseline risk of heart disease and other conditions. The findings were not necessarily applicable to younger women experiencing menopausal symptoms.
What Do the Medical Societies Say?
Let’s explore the recommendations from key medical societies:
American College of Obstetricians and Gynecologists¹:
There is no definitive time limit for MHT use.
Treatment should be individualized based on benefits and risks for each woman.
The Menopause Society²:
"Because increasing risk is observed with advancing age and extended duration of use, women are advised to use the appropriate dose for the time needed to manage their symptoms."
"Because many women will experience bothersome VMS for many years, long-duration hormone therapy use may be needed, and an arbitrary age-based stopping rule is not clinically appropriate."
Endocrine Society³:
MHT should be prescribed for the shortest duration consistent with treatment goals and risk profile.
Individualized decision-making is crucial.
Recent Study: Use of MHT Beyond Age 65 Years
A new large-scale study based on the records of 10 million senior Medicare women from 2007 to 2020 suggests that the implications of MHT use beyond age 65 years vary by type, route, and dose (4). Specifically:
Estrogen Monotherapy: Use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction, and dementia.
Combination Therapy: The use of a combination of estrogen and progestogen therapy was found to increase the risk of breast cancer. However, this risk can be mitigated by using lower doses of transdermal or vaginal estrogen. There was a lower risk of heart failure with combined hormone therapy versus no hormone therapy. Of note, there was no increased risk of blood clot, heart disease, or dementia. Unless you've had a hysterectomy, a progestogen must be added to estrogen therapy to protect the lining of the uterus.
Reasons to Continue Hormone Therapy Beyond Age 65
If you are using hormone therapy with prevention in mind, you may need to remain on hormone therapy in order to continue reaping its benefits.
This is particularly true in the case of osteoporosis. If you are using hormone therapy to prevent osteoporosis and discontinue, your bone density will return to pretreatment levels within 1-2 years (2).
The Bottom Line
While these societies agree that MHT shouldn’t be used beyond necessity, there is no fixed age or treatment duration that mandates stopping MHT. Instead, it’s an individualized decision based on personal risks and goals.
Remember to consult your healthcare provider to tailor MHT to your specific needs. The goal is to maximize benefits while minimizing risks, considering your health history and preferences.
Sources:
ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms
The 2017 Hormone Therapy Position Statement of The North American Menopause Society
Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline
Seo H. Baik et al. (2024). Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses. Menopause, the journal of The Menopause Society. Read the full study here
Comments