Benefits of HRT After 65

November 19,2021

In their postmenopausal years, most women continue to experience an array of disruptive symptoms, thus compromising their functionality, overall health and quality of life. Additionally, there’s an ever-increasing risk of osteoporosis and bone density loss. 

Hormone replacement therapy (HRT) was not recommended for women over 65 years or even 60 because it was believed that symptoms of menopause subside over time, and HRT carried too many risks and far few benefits for women at that age. But now, it’s all changing.

While it’s true that most of the disruptive symptoms seem to disappear or reduce with age and older women are not ideal candidates for HRT due to the risk factors, but for many women at age 65 and above, HRT has been a truly transformative and positive intervention.

With this new understanding, more women at 65 and above can witness the benefits of HRT and live a good quality of life as they age.

Do You Need Hormone Replacement Therapy After 65?

Although age 65 marks the end of middle age, not all women need hormone replacement therapy. The decision of whether you need HRT or not depends on your overall health and your need for hormones. Until recently, many believed that women don’t need hormones after menopause. This is because the symptoms often subside in the years following menopause. But the symptoms persist in some women even after 65 or above, and they need to be addressed.

Your doctor may start you off with a low dose of hormones if you:

  • Are experiencing moderate to severe hot flashes and night sweats
  • Understand the potential risks of HRT
  • Have a high risk of bone fractures and can’t afford to have the side effects of other osteoporosis-fighting medications

Types of HRT Medication

There are more than 50 types of hormone replacement therapy available that can be administered orally, transdermally subcutaneously or vaginally.

  • Local estrogen: For treating urogenital conditions such as bladder problems, vaginal dryness, irritations, and infections, vaginal creams, tablets, or rings are administered. Some of the medications prescribed are Elleste Solo MX and Estradot.
  • Cyclical HRT: This therapy imitates the normal menstrual cycle. Estrogen is taken every day and progestogen for only 12 to 14 days. After the course of progestogen is completed, some bleeding occurs as the body “withdraws” from the hormone and the womb lining is shed. Progestogen regulates bleeding and protects the endometrium (womb lining) from harmful pre-cancerous changes. Commonly prescribed medicines include Elleste Duet and Evorel Sequi.
  • Estrogen-alone HRT: This therapy is usually prescribed to women who have had a hysterectomy (uterus removal). The benefits of HRTs are derived from estrogen; progestogen is only required to protect the uterus lining. Elleste Solo and Premarin are commonly prescribed HRT medicines.
  • Continuous combined therapy HRT (CCT): A combination of estrogen and progestogen such as Evorel conti is prescribed continuously for achieving period-free HRT.
  • Tibolone: This synthetic form of period-free HRT, such as Livial is continuously taken in tablet form. It has similar benefits to CCT.

Benefits of HRT After 65

Loss of estrogen in menopause not only cause symptoms like mood disturbances, hot flashes, and sexual discomfort, it reduces bone density and increases the risk of osteoporosis. This increases the risk of injury and affects the overall quality of life. 

When estrogen is introduced via HRT, it not only takes care of postmenopause symptoms, it offers protection against bone loss and help prevent osteoporosis. 

These benefits are very important once you turn 65. Women who start HRT in their 50s can continue with it beyond age 65 for a better quality of life and prevention of osteoporosis. But this decision has to be taken after proper evaluation and counselling of benefits and risks. 

Evaluating Risks

For most women, turning 65 doesn’t have to mean that HRT is no longer an option. The truth is there are some risks, such as blood clots and dementia, that may increase with the increase in age or duration of HRT. While HRT is not for every woman, the adverse effects may also depend on the type of hormone therapy and its mode of administration. In some cases, the risks can be minimised by using lower hormones levels and avoiding certain administration methods. In a study conducted on Finnish women, it was found that HRT use for over 10 years increases the risk of Alzheimer’s. But it was found that not all administration methods elevated that risk. Taking vaginal estrogen appeared to have no risk.