The age of 65 is really no different than 64 or 66. It’s not a magical door or moment of profound transformation. But it is often treated as such.
Women turning 65 might notice a lot of changes, subtle and overt. You could be retiring. You are eligible for more discounts than you thought possible. And you might be denied medical care you feel is needed. This is especially true when it comes to menopause hormone therapy. For years, hormone replacement therapy (HRT) after 65 was thought to be a no-go for reasons ranging from the medically-sound to the prejudiced. This was true for both women who were already receiving hormone therapy and for women who have never started it. Now, that is changing due to a growing body of evidence suggesting that HRT can have significant benefits for women over 65.
It is true that some women don’t need or aren’t appropriate candidates for HRT due to individual risk factors. But if you do need or want hormone therapy, that door shouldn’t be closed by a largely arbitrary number. Today, hormone replacement therapy after 65 is a possibility accepted by the world’s leading medical bodies and can help you preserve your quality of life as you age.
Do You Need Hormone Replacement Therapy After 65?
If 65 seems like a random number on which to base health decisions, it’s partially because it is. Until recently, it was the official full retirement age. It also typically marks the end of middle age and the beginning of being an older adult. But everyone is different. There’s no reason taking hormones the day before your 65th birthday is fine, but as soon as the candles are blown out: no more. However, it isn’t completely arbitrary. There are legitimate medical reasons why 65 is the shorthand date for a cutoff. Ultimately, it comes down to two things: your overall health and your need for hormones.
The last one is very important for a few reasons. Until recently, many people both inside and outside the medical community believed that women didn’t need hormones for much after menopause, which generally happens in your 50s. Because symptoms often subside in the years after menopause, it was sometimes thought that there were simply no serious symptoms left to address after 65—despite countless women knowing otherwise.
Today, however, the medical community is increasingly recognizing that symptoms can and often do persist in women 65 and older. As noted by the North American Menopause Society (NAMS) in 2012:
[V]asomotor symptoms persist for an average of 7.4 years and for more than a decade in many women. Moderate to severe vasomotor symptoms have been documented in 42% of women aged 60 to 65 years. Thus, many women will continue to have vasomotor symptoms after age 65, and these symptoms can disrupt sleep and adversely affect health and quality of life.
This recognition is significant for both women who are already on HRT and want to continue after the age of 65 and those who are interested in starting HRT for the first time after 65. It acknowledges the very real struggles women continue to face in their postmenopause years—struggles that are known to be alleviated by hormone therapy.
The Multiple Benefits of HRT After 65
Postmenopause symptoms like hot flashes, mood disturbances, and sexual discomfort can be devastating and are typically what spurs women to seek HRT. However, the loss of estrogen that triggers menopause also diminishes bone density and increases the risk of osteoporosis—a major cause of injury and overall degraded quality of life for older women. Introducing exogenous estrogen via HRT therefore not only addresses more overt postmenopause symptoms, it can offer protection against bone loss and help you prevent osteoporosis.
These benefits are no less important once you reach the age of 65. In fact, a 2014 study by researchers at the University of Southern California found that “women who start HRT when in their 50s and continued for 5-30 years [experienced] an increase of 1.5 quality-adjusted life-years.” Research like this led to NAMS’ 2017 hormone replacement therapy position paper, which states:
Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent [vasomotor], [quality of life] issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
This updated understanding of the experiences of women and the role of HRT means that there is no longer a general rule about when to discontinue HRT. A one-size-fits-all approach simply doesn’t make sense. Rather, each woman can work with her health care practitioner to determine whether HRT is the best option to address her symptoms and reduce her risk of osteoporosis.
Evaluating Risks and Creating an Individualized Plan
For many women, the benefits of hormone replacement therapy after 65 are undeniable, and you may take great comfort in the knowledge that turning 65 doesn’t mean HRT is no longer an option. However, the truth is that some risks, such as blood clots and dementia, may increase with age or duration of hormone therapy. While adverse events seem to depend on what type of hormone therapy is used, it also means that HRT isn’t appropriate for everyone. Using lower hormone doses and avoiding certain administration methods may minimize these risks. For example, a large-scale study on Finnish women found that HRT use of over 10 years was associated with an increased risk of Alzheimer’s, but not all administration methods appeared to elevate risk. More specifically, no increase was observed in those taking vaginal estrogen. (It’s also important to note that some research suggests that HRT may lower Alzheimer’s risk if taken earlier in life.)
Ultimately, HRT may not be right for every woman after 65. But it might be right for you. The best way to find out is to consult a practitioner who specializes in hormone replacement therapy and discuss your symptoms, your health history, your treatment options, and your personal preference. Don’t assume that you must discontinue hormone replacement therapy at a certain age or that it’s too late to start. Attitudes are changing rapidly on this subject; based in part on NAMS’s updated policy position, more practitioners are now open to prescribing HRT for older women and some insurance companies have even begun covering HRT for those over 65.
Listen to your body. Listen to your health care practitioner. Live the life you deserve.
If you are wondering if hormone replacement therapy after 65 is right for you, BodyLogicMD can help you find answers. The BodyLogicMD network is comprised of top medical professionals specializing in hormone health and integrative medicine. These practitioners are dedicated to helping women address postmenopause symptoms through personalized treatment plans designed to promote optimal health and enhance quality of life. Contact a local practitioner near you to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz today.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.