Stop Short: Do You Really Need to Stop HRT at 65?

By Kathleen Murphy

New research challenges the idea that age alone should determine when women stop hormone therapy

For years, many women were led to believe that hormone replacement therapy (HRT) was something they could use for a limited time in midlife – but something they should certainly reconsider after age 65. 

The source was the 2002 Women’s Health Initiative – one of the largest studies ever conducted on women’s health. Its early findings about HRT prompted widespread concern about breast cancer, heart disease, and other risks – dramatically changing how doctors and patients viewed HRT.  

But a more recent, large-scale study published in the journal Menopause suggests the picture may be more complex – especially for women using lower-dose or non-oral forms of hormone therapy.

The Menopause study analyzed 10 million records from women on Medicare who continued using HRT past 65, women who stopped, and women who never started. The researchers looked at what happened to them over time across 13 different health outcomes – including cancers, heart conditions, and dementia.  

The striking results

HRT is generally administered in one of two ways. Women who have had a hysterectomy may take estrogen alone (known as estrogen monotherapy). But to protect against endometrial cancer, women who still have a uterus must use estrogen plus a progestogen (known as combined hormone therapy).

For each type, the results of the Menopause study were striking – and sometimes surprising.

Compared to women who stopped or never used estrogen monotherapy, researchers found that women in the study who were taking it after age 65 were associated with a 19% lower risk of dying from any cause. There were also significant risk reductions for numerous conditions – including breast cancer (16%), lung cancer (13%), colorectal cancer (12%), and congestive heart failure (5%).

Combined hormone therapy showed a more complicated story. Depending on the formulation, women taking estrogen plus a progesterone had a 10-19% higher risk of breast cancer.

But the bigger story may be the potential benefits of combined HRT. Researchers found it resulted in significant risk reductions of endometrial cancer (45%), ovarian cancer (21%), and ischemic heart disease (5%). 

The most favorable associations were seen when HRT was taken at a lower dose rather than a higher dose, and when it was delivered vaginally or through the skin (such as through a patch), rather than through pills. In other words, how hormones are taken can be just as important as whether they are taken at all. 

“This large observational study of women on Medicare provides reassurance regarding the safety of longer-term hormone therapy use and even potential benefits, particularly in women using estrogen alone,” said Stephanie Faubion, MD, medical director for the Menopause Society. “It also offers important insights into variations among different hormone therapy doses, routes of administration, and formulations that could facilitate individualization of treatment.”

There is an important caveat: This was an observational study, not a randomized clinical trial. The researchers could identify associations between HRT usage and health outcomes, but they couldn’t prove that the hormones themselves caused those outcomes.

A new, reasonable option

The study’s findings are in line with The Menopause Society’s long-standing assertion that there is no definite “rule” for stopping HRT based on age alone. For a healthy woman with persistent menopause symptoms who has consulted with her doctor, continuing or even starting HRT beyond age 65 may be a reasonable option.

It may also be reasonable for an older woman who is still struggling with sleep disruption, bone loss, and quality of life issues. These concerns aren’t minor. 

For some women, the question isn’t simply whether they continue to suffer from hot flashes. It may be whether continuing treatment helps them sleep, protects their bone health, or improves their quality of life. Those are legitimate considerations, but they have to be weighed against each woman’s individual risk.

HRT isn’t risk-free for everyone. But the idea that turning 65 should trigger an automatic stop is too simple. Medicine is moving, albeit slowly, toward a more nuanced view of aging. That includes the recognition that age 65 isn’t a biological cliff. That shift – from blanket rules for all older women to individualized care for each different woman – is long overdue.

So what should a woman actually take away from this? Not that everyone over 65 should be taking hormones. It’s that the number on your birthday cake shouldn’t make the decision for you.

The more important questions are: What hormones are you taking? At what dose? How are you taking them? Why are you taking them? And what are your individual risks?

The real takeaway from this massive study is that after age 65, hormone therapy isn’t either  “good” or “bad.” For some women, the benefits of controlling persistent symptoms and maintaining quality of life may outweigh the risks. For others, they won’t.

The decision is personal, conditional, and – when done thoughtfully – potentially life-changing. The bigger shift may be recognizing that when you’ve reached 65, you may have reached a milestone age…but that age is definitely not an expiration date.

Kathleen Murphy has always been a writer – for newspapers, magazines, companies, and nonprofit organizations. Today, as an independent journalist, she writes about physical health, emotional wellness, and successful aging. She’s living her dream through her creative projects and her adventures in the great outdoors. You can explore all of Kathleen’s published works here. We are thrilled to welcome Kathleen as a new feature writer for agebuzz!