Understanding Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) — also called Menopausal Hormone Therapy (MHT) or simply Hormone Therapy (HT) — has become an increasingly popular treatment for managing menopause symptoms. However, its use after age 65 has sparked debate, especially following the Women’s Health Initiative (WHI) study in 2002, which raised concerns about potential risks such as cancer and heart disease.
Since then, ongoing research has offered a more nuanced understanding of HRT’s risks and benefits, especially for women over 65. Let’s explore the latest findings and what they mean for your health.
Is It Safe to Use HRT After 65?
A recent study analyzing health records of 10 million senior women on Medicare from 2007 to 2020 has revealed important health benefits associated with continuing HRT beyond age 65. However, the effects vary depending on the type of therapy, method of delivery, and dosage.
This underscores the importance of an individualized approach. Regular consultations with a menopause-certified doctor can help you weigh the benefits and risks to make an informed decision that’s right for your unique health needs.
How Timing Influences Safety
Timing plays a critical role in determining the safety of HRT. Research suggests that starting HRT within 10 years of menopause onset or before the age of 60 has significantly lower risks compared to beginning treatment later. This “timing hypothesis” underscores the importance of early intervention to maximize the benefits of HRT while minimizing potential complications.
Additionally, new delivery methods such as transdermal patches and vaginal creams have been shown to carry fewer risks compared to oral HRT. These advancements allow for more targeted and safer treatment options, especially for women over 65.
Benefits of Taking HRT After 65
Despite declining usage rates among senior women, HRT offers several notable benefits:
- Bone Health: Long-term HRT use has been linked to a reduced risk of fractures by maintaining bone density. This is especially significant in preventing osteoporosis, a common condition among postmenopausal women.
- Colorectal Cancer reduction: Studies suggest HRT may lower the risk of colorectal cancer. This benefit contributes to improved long-term health outcomes for women.
- Cardiovascular Health: For women who start HRT soon after menopause, there’s generally a reduced risk of heart disease. While the relationship between HRT and cardiovascular health remains complex, emerging evidence highlights potential protective effects e.g. lower triglycerides, and less cholesterol plaque progression.
- Cognitive Function: Emerging research indicates potential cognitive benefits, including improved memory and reduced risk of dementia when HRT is started during perimenopause or early menopause. This area of study is particularly promising for addressing age-related cognitive decline.
- Improved Sexual Health: HRT can alleviate vaginal dryness and discomfort during sex, significantly enhancing sexual well-being. Improved sexual health can also lead to better emotional and relational well-being.
- Improved Sleep Quality: Many women experience disrupted sleep during menopause due to hot flashes and night sweats. HRT can help regulate these symptoms, leading to more restful and restorative sleep.
- Mood Stability: Hormonal changes during menopause can lead to mood swings, irritability, and even depression. HRT has been shown to stabilize hormone levels, which may improve mood and overall emotional well-being.
However, women who start hormone therapy at age 60 or older or more than 10 years after the onset of menopause, are at greater risk of blood clots, heart disease, and stroke. Always talk to a doctor or pharmacist to discuss the benefits and risks of the medication(s) you are taking.
HRT Risks
It’s crucial to understand that HRT risks can vary based on several factors, such as:
- Timing: Women who start HRT at age 60 or older or more than 10 years after menopause face a greater risk of blood clots, heart disease, and stroke.
- Type of therapy: Risks differ depending on whether estrogen is used alone or combined with progestins, as well as the dose and type of hormones (bioidentical vs. premarin (combination) .
- Personal health history: Family history, and medical conditions (e.g., breast cancer, blood pressure, high cholesterol, heart disease, liver issues, and osteoporosis) play a significant role.
Other potential risks include:
- Gallbladder Issues: HRT has been associated with an increased risk of gallbladder problems, mainly with oral hormone therapy.
- Blood Clots: The risk of blood clots is higher with oral estrogen compared to transdermal options like patches or gels.
Consulting with a menopause-society-certified doctor is essential to weigh these risks against the potential benefits and determine the best course of action for your health.
Reducing Risk
To minimize risks associated with HRT, consider these strategies:
- Start ASAP, ideally within 10 years of your last menstrual period (menopause)
- Use Local not systemic estrogen: local vaginal estrogen cream is not absorbed systemically so the risk of cancer, blood clots is minimal/none.
- Choose the right product and delivery method: Options include pills, patches, gels, vaginal creams, or vaginal rings. For genitourinary symptoms, low-dose vaginal treatments may be preferable.
- Discuss non-hormone alternatives: Non-hormonal options may be effective for specific symptoms and worth exploring with your doctor.
- Make sure you are up to date on your health maintenance visits: Annual physical check-ups with your doctor to make sure you have your health screenings specifically colonoscopy and mammograms. As well as regular follow ups on your menopause treatment plan with your healthcare provider to ensure it remains effective and safe over time.
- Adopt a healthy lifestyle: Combining HRT with a balanced diet, regular exercise, and stress management can further enhance its benefits while reducing risks.
Is It Safe to Start HRT After 65?
Generally, doctors will be hesitant to start anyone more than 10 years after their last menstrual period. However, if you have a clean bill of health (normal mammogram, no BRCA gene, normal colonoscopy, ideally normal cardiac coronary calcium CT scan) then the doctor might consider starting the system HRT.
Is HRT Right for Me?
Every woman’s menopause journey is unique, and HRT is not a one-size-fits-all solution. Here’s why HRT might be right for you:
- Effective symptom relief: From hot flashes to sleep disturbances, estrogen can alleviate common menopause symptoms and improve your quality of life and is more effective than any supplements.
- Bone and heart health: HRT helps maintain bone density and lowers the risk of cardiovascular disease when started early.
- Sexual well-being: Treating vaginal dryness and discomfort enhances vaginal health and pleasure.
- Improved quality of life: By managing menopause symptoms effectively, HRT can help you feel more comfortable, confident, and energized.
Exploring Non-Hormonal Alternatives
For women who cannot take HRT due to medical contraindications, several non-hormonal options are available to help relieve menopausal symptoms. These include:
- Medications: Selective serotonin reuptake inhibitors (SSRIs) and other drugs may help manage hot flashes and mood swings.
- Vaginal moisturizers and lubricants: These can address vaginal dryness and discomfort without systemic hormones.
- Lifestyle changes: Regular exercise, a healthy diet (more plants, whole grains, mediterranean diet), and stress reduction techniques like yoga or meditation can alleviate some menopause symptoms.
Why Choose Pandia Health?
At Pandia Health, our doctor specialize in hormonal care and with our menopause society-certified practitioner (MSCP) doctors tailor safe and FDA-approved menopause treatment to your unique needs. With convenient asynchronous online consultations, you can receive expert guidance from the comfort of your home!
Our approach ensures:
- Expert care from experienced specialist, menopause trained doctors
- Access to the latest advancements in menopause hormonal treatment
- A supportive, patient-centered experience designed for your well-being and ease
If you’re considering HRT, don’t navigate the journey alone. Start your consultation today and take the first step toward better health and well-being.