Since the Women’s Health Initiative (WHI) study in 2002, concerns about hormone therapy have lingered, especially among women over 65.
However, a recent study published in Menopause, the journal of The Menopause Society, challenges these fears, suggesting that the risks associated with hormone therapy (HT) may be dependent on factors like type, route, and dosage.
Despite ongoing debate and conflicting study results, many healthcare professionals and menopausal women have hesitated to consider HT past the age of 65 due to worries about increased cancer and heart disease risks. This reluctance has left some women without effective treatment for symptoms like hot flashes, for which HT is known to be the most effective option.
However, a new large-scale study based on Medicare records of 10 million senior women from 2007 to 2020 offers a more nuanced perspective. The findings align with The Menopause Society’s 2022 position statement, which emphasises that age alone shouldn’t dictate the cessation of HT. The statement suggests that, for healthy women experiencing persistent hot flashes, continuing HT beyond 65 may be reasonable with proper counseling and risk assessment.
One challenge has been the lack of information on how different HT formulations, doses, and administration routes affect health outcomes. To address this gap, researchers analysed HT use after 65 and its impact on various health factors, including mortality, cancer risk and heart disease.
The study found that, compared to never using or discontinuing HT before 65, continuing estrogen-only therapy beyond 65 was associated with reduced risks of mortality and several cancers. On the other hand, estrogen combined with progestogen therapy increased the risk of breast cancer, but this risk could be mitigated with low doses of transdermal or vaginal progestin.
Overall, the study underscores the importance of personalised treatment, considering factors like hormone type, route of administration, and dosage. Dr Stephanie Faubion, medical director for The Menopause Society, emphasises the significance of these findings in guiding individualised HT decisions.
“It also offers important insights into variations among different hormone therapy doses, routes of administration, and formulations that could facilitate individualization of treatment,” Dr Faubion said.
