There Is No Absolute Age Cutoff for Hormone Therapy
A timely Substack essay challenging outdated age-based limits for HRT and advocating for a personalized approach to hormone health.
It's time to debunk the myth that hormone therapy is only for younger women.
Older women, especially those beyond the so-called 'ideal' window, can still
benefit from treatment. Let's shift the focus from age prohibition to the
potential benefits of hormone therapy.
It's time to stop pretending that there's some magical age where hormone
therapy (HT) suddenly becomes too dangerous to consider. The science doesn't
support that fear-based messaging, and in fact, it tells a very different story.
For decades, women who were more than 10 years past menopause were told they were
'too late' for hormones (this usually means estrogen, implying that progesterone
and testosterone don’t matter). You are too old. Past the window. Told that hormone
therapy was 'only for young menopausal women' and 'not safe after age 60.' But let's
be clear: those warnings were based on broad, outdated interpretations of the WHI
study - a study that used oral conjugated equine estrogens and synthetic progestins
(no longer the gold standard) in women who were already decades into menopause,
many with underlying conditions. As the years went on in that study, the 'risks'
didn't hold up - most strikingly, the risk of stroke.
The actual truth? It tells a different story. A safer, more nuanced one.
Especially when discussing transdermal estradiol, the other hormones, and
individualized care.
What to read next
There’s no doubt that menopause can be tough, but support is out there. We asked Dr Naomi Potter, menopause specialist and co-author of the book Menopausing, for her expertise on navigating your body and mind through this transformative time.
An evidence-based article outlining how estrogen decline contributes to joint pain, muscle loss, and osteoporosis in menopause.
Every year, about 1.3 million American women enter menopause—the stage of life when
your estrogen levels diminish and your periods stop completely. It’s a natural part
of aging and nothing to fear.
That said, the symptoms of menopause—including hot flushes, low sex drive, trouble
sleeping, weight gain, UTIs and vaginal dryness, brain fog, heart palpitations, muscle
and joint aches, and mood changes—can be miserable and debilitating. You also lose the
health benefits of estrogen itself, like heart and brain protection, says Avrum Z.
Bluming, MD, a hematologist and medical oncologist who has spent decades investigating
the benefits of estrogen. Women can avoid many of these problems with one treatment:
hormone replacement therapy, or HRT. Alternatively called MHT, for menopausal hormone
therapy, HRT refers to the combination of estrogen and progesterone given to women who
still have their uterus; estrogen alone is given to women who have had a hysterectomy.
Unfortunately, HRT remains controversial, due mostly to the results of the decades-old
Women’s Health Initiative, the largest study done on the health of postmenopausal women
in the United States. In 2002, findings from the WHI were released suggesting that women
on HRT had greater risks of heart disease, stroke, dementia, and, scariest of all, breast
cancer; as a result, millions of women of menopausal age either quit or avoided it at all
costs. Subsequent studies have walked back these claims, but many women remain gun-shy
about taking estrogen. The fallout has been enormous: Among menopausal women in the
United States, just under 5 percent are currently on HRT, and it’s been estimated that
between 2002 and 2012, over 90,000 American women died prematurely, mainly from heart
disease, as a result of avoiding HRT.