Older Women and HRT

EMBARGOED UNTIL 12:01 A.M. EST
WEDNESDAY, APRIL 10, 2024
Contact:
The Menopause Society
Ella Adams (eadams@fallsandco.com)
Phone: (216) 696-0229
Women Aged Older Than 65 Years May Be Able to Safely Continue Taking Hormone Therapy
New study suggests the benefits and risks of women aged older than 65 years taking hormone therapy
differ greatly depending on type, route, and dose prescribed

CLEVELAND, Ohio (April 10, 2024)—After the Women’s Health Initiative (WHI) in 2002, many
women have resisted taking hormone therapy (HT), especially after age 65 years, because of fears of
increased risks for various cancers and heart disease. A new study shows that those fears may be
unfounded, depending on the type, route, and dose of HT. Results of the study are published online today
in Menopause, the journal of The Menopause Society.
Despite the conflicting results of a follow-up WHI study in 2004 and dozens of other studies since that
time, a percentage of healthcare professionals and their middle-aged female patients continue to believe
that HT, especially when taken past the age of 65 years, can increase the occurrence of invasive breast
cancer, stroke, and coronary heart disease. Such fears have prevented many menopausal women from
getting relief from such symptoms as hot flashes because HT is today recognized as being the most
effective treatment option for managing an array of bothersome symptoms associated with the menopause
transition.
A new large-scale study based on the records of 10 million senior Medicare women from 2007 to 2020,
however, suggests that the implications of HT use beyond age 65 years vary by type, route, and dose.
These findings are in line with the 2022 HT Position Statement of The Menopause Society that states
there is no general rule for stopping HT in a woman based on age alone. The statement goes on to say
that, for healthy women with persistent hot flashes, continuing HT beyond age 65 years is a reasonable
option with appropriate counseling and regular assessment of risks and benefits. Moreover, the mitigation
of risks through the choice of low-dose and nonoral routes of administration becomes increasingly
important as women age.
A challenge, to date, has been that information on the effects of different HT formulations, doses, and
routes of administration is lacking. That’s why the researchers in this latest study specifically sought to
assess the use of HT beyond the age of 65 years and its health implications by the type of estrogen and
progestogen, route of administration, and dose.
Based on the results of the study, the researchers concluded that, compared with never use or
discontinuation of HT before the age of 65 years, the 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. The use of a combination estrogen and progestogen therapy was found to increase the risk of
breast cancer, but such risk can be mitigated using low doses of transdermal or vaginal estrogen plus
progestin. In addition, progestin usage resulted in significant risk reductions in endometrial cancer,
ovarian cancer, ischemic heart disease, congestive heart failure, and venous thromboembolism.
Study results are published in the article “Use of menopausal hormone therapy beyond age 65 years and
its effects on women’s health outcomes by types, routes, and doses.”
“This large observational study of women in Medicare provides reassurance regarding the safety of
longer-term hormone therapy use and even potential benefits, particularly in women using estrogen alone.
It also offers important insights into variations among different hormone therapy doses, routes of
administration, and formulations that could facilitate individualization of treatment,” says Dr. Stephanie
Faubion, medical director for The Menopause Society.
For more information about menopause and healthy aging, visit www.menopause.org.
The Menopause Society (formerly The North American Menopause Society) is dedicated to empowering
healthcare professionals and providing them with the tools and resources to improve the health of women
during the menopause transition and beyond. As the leading authority on menopause since 1989, the
nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for
healthcare professionals, researchers, the media, and the public and leads the conversation about
improving women’s health and healthcare experiences. To learn more, visit menopause.org.