Is it too late to start HRT at 60? — Ask Dr Jean

Question

Is it too late to start Hormone replacement therapy (HRT) (now known as menopausal hormone therapy) at 60? I take calcium and vitamin D 120mg daily. My bone density is diminishing, I am now osteopenic lumbar spine. My GP has been reluctant to commence HRT as my blood pressure is borderline high. I would like to start HRT to assist stasis in bone density. Does biomedical HRT work? Would this raise my blood pressure?

Answer

Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.

It is not common to start hormone therapy for bone health at or after the age of 60. By the age of 60, arteries are generally stiffer and women at this age are more at risk of cardiovascular disease, hence commencing hormone therapy may increase their risk of cardiovascular disease or events. High blood pressure would increase this risk as well. Bioidentical custom-compounded hormone therapy probably confers the same risks as conventional hormone therapy, but lacks safety data, so is not recommended (read our article on bioidentical hormone therapy).

The general recommendations for bone health at age 60 years include maximising weight-bearing exercise, calcium within the diet around 1300mg per day, and maintenance of vitamin D levels around 75nmol/L, plus avoidance of risk factors such as alcohol excess and smoking. A specialist referral may be useful to discuss this further, in terms of aiming for prevention of osteoporosis and fracture.

There is excellent information on the Australasian Menopause Society website about hormone therapy for bone health up to the age of 60 years.

You can also learn more about HRT and other menopause management options.