A real world study has confirmed that women ages 65 and older who have been on hormone therapy for menopause symptoms can usually continue to take it safely into their seventies and even eighties.
To arrive at this conclusion, Canadian researchers examined the characteristics, safety, and motivations of older women who had been using hormone therapy for 18 years on average. Results of the analysis will be presented at the 2024 Annual Meeting of the North American Menopause Society in Chicago September 10 to 14. (The study has not yet appeared in a peer-reviewed medical journal.)
“We wanted to look at this group of patients because we have a lot of them at our clinic, many that we’ve been following for years,” says senior author Wendy Wolfman, MD, director of the Menopause Clinic and the Premature Ovarian Failure Clinic at Mount Sinai Hospital in Toronto.
In the past, many doctors believed that women needed to stop hormone therapy after five years, even though menopause symptoms might worsen and many women felt much better while on these medications, says Dr. Wolfman.
“This study can reassure providers that as long as patients are otherwise well and don’t have any absolute contraindications to the medication, that they actually do very well continuing on hormone therapy,” she says.
Many Women Can Benefit From Taking Hormone Therapy Long-Term
“These findings aren’t surprising. They do show, again, that it is not only perfectly safe to continue your hormone therapy long term, but that there are benefits,” says Lauren Streicher, MD, a professor of obstetrics and gynecology at Northwestern Medicine in Chicago and the author of several books on women’s health, who was not involved in the study.
Women going through menopause can have hot flashes for seven years on average, and for some of them it’s 10 years or longer, Dr. Streicher points out. In fact, up to 40 percent of women in their sixties and 10 to 15 percent in their seventies still experience hot flashes.
For these women, long-term hormone therapy can deliver continuing relief from hot flashes, and also improve bone health, aches and pains, and quality of life, Streicher says.
Many Women Took Hormone Therapy for More Than 20 Years
The study was a retrospective analysis (looking back on information already gathered) of 110 women ages 65 and older who were currently using hormone therapy. About 8 percent were 80 or older.
The women were 50 years old on average when they went through menopause, and 52 on average when they started hormone therapy.
Most of the women were taking hormone therapy for hot flashes. Other reasons were vaginal dryness, night sweats and other sleep disturbances, mood swings, and decreased sexual desire.
About 2 out of 3 of the women had never tried to stop taking hormone therapy because of ongoing symptoms or for better quality of life. Most who did attempt to go off hormone therapy restarted because their symptoms came back.
When the researchers looked at the long-term health of these women, they noted no increase in reported incidents of strokes, heart attacks, or uterine cancers. Postmenopausal bleeding was the most common negative effect of hormone therapy.
Older Women’s Desire to Remain on Hormone Therapy Should Be Respected
The findings provide important validation that hormone therapy can continue to provide relief of menopause symptoms and improve quality of life in older women, says Wolfman.
“For women who can safely continue to take hormone therapy, we should respect her wishes as she gets older and not deny her the benefit of continuing a therapy which really has no huge risk,” she says.
There are many benefits to hormone therapy that go beyond reducing hot flashes, and the idea that women should only take this treatment for a few years was never based on data, says Streicher.
“Can you imagine giving guys testosterone for three to five years and then saying, ‘Now you’ve got to stop?’ It wouldn’t happen,” she points out.
The Decision to Remain on Hormone Therapy Should Be Individualized
Extending hormone therapy beyond five years might not be the best option for all women, says Stephanie Faubion, MD, medical director for the North American Menopause Society and director of Mayo Clinic Center for Women’s Health in Jacksonville, Florida.
“It is important that each woman has an individualized risk assessment in collaboration with their primary care provider and that they consider factors such as risk for cardiovascular disease and breast cancer and the need for ongoing therapy, taking into account personal preferences.”
These discussions should occur regularly, understanding that the risk-benefit balance may shift as a woman ages, adds Faubion.
But age alone shouldn’t force a woman off hormone therapy. “For most women, it’s not necessary to discontinue hormone therapy simply because they’ve reached a predetermined age. Some women may still benefit,” says Dr. Faubion, who was not involved in the research.
Women in Their Seventies Shouldn’t Start Hormone Therapy for the First Time
These findings don’t mean that starting hormone therapy is safe, effective, or recommended for all women over 65, says Wolfman.
- Breast or endometrial cancer
- Stroke
- Heart attack
- Blood clots
- Liver disease
Existing evidence suggests that for older women who went through menopause a decade or longer ago, the risks of starting hormone therapy for the first time outweigh the benefits.
“It’s not a study to say that women in their seventies can start hormone therapy,” says Wolfman. “It’s important to make the distinction, because there are women who are older who don’t feel well and were denied the opportunity to take hormone therapy because of the results of (earlier research) and are now seeking help,” she says.
