Taking HRT post 60 — Ask Dr Jean

Question

I am 62 years old. I have been taking HRT for probably 10 years. My doctor reassures me that there are minimal risks. I want to keep taking HRT if it is safe. I sleep well, and have a good libido, which is why I started taking it in the first place. What is your opinion? Can I take HRT until I am 80 or 90?

Answer

There is considerable controversy about the amount of time that a woman can safely use menopausal hormone therapy. The past few years have seen menopause experts closely examine the scientific studies of hormone therapy so that health practitioners can guide women as to the benefits and risks of hormone therapy.

The most important consideration about hormone therapy use is that it depends on a woman's individual situation – her medical history and other medical problems she may have, her family medical history, other medications or supplements she may be taking, her general health, smoking and alcohol use, and weight. Some women are extremely healthy and have few risk factors, hence they may be deemed safe to continue hormone therapy, if necessary for bothersome symptoms, for some years. Other women may have many risk factors or a family history of breast cancer (for example) – this makes a decision about hormone therapy use more challenging. Guidance from a health practitioner with women's health and menopause expertise is definitely recommended in this regard.

In terms of general advice about the risk of breast cancer associated with hormone use, although this in itself is a complicated issue, depending on hormone therapy type and other factors, the general consensus is that there is a slight increase in breast cancer risk associated with combined oestrogen and progestogen hormone therapy after five years of use.

The extra challenge with hormone therapy provided by increasing age include a general tendency for arteries to 'stiffen' and this is associated with an increase heart disease and stroke risk, and this will be a consideration for women who are using hormone therapy beyond the age of 60 years, or within 10 years of the menopause. The risk for venous clots (DVT) also increases with age.

If hormone therapy use is to continue past this age, it would be advisable to reduce to the lowest dose necessary for symptom control, and if possible to use a non-oral approach (such as a skin patch or gel), which avoids the liver having to process the hormones.