Is it too late for hormone therapy?

The benefits of hormone replacement therapy are well-established. For the right candidates, research notes fewer hot flashes and night sweats, and better sleep, mood, and cognitive function. There are even perks for long-term health like protection against bone fractures, heart disease, and diabetes.

All that’s great — but what if you’re over 60? Is it too late?

The short answer is a resounding no. Hormone replacement therapy (HRT), also known as hormone therapy or menopausal hormone therapy (MHT), can be an option for some women to stay on for many years. Here’s what you should know about starting — or restarting — HRT after 60, and how to weigh the benefits and risks with your healthcare provider.

Treating symptoms when you’re over 60

By the time you hit 60, you will have almost certainly have reached menopause — but that doesn’t always mean your symptoms will have stopped. While some symptoms may let up over time, others continue for many more years and can even cause ongoing problems over time if left untreated.

“Even though some symptoms of menopause like hot flashes or night sweats may subside, changes like urination urgency or frequency, vaginal dryness, painful sex, and propensity for UTIs are progressive and do not resolve without treatment,” says Dr. Ashley Winter, M.D., urologist, sexual medicine specialist, and certified menopause practitioner. They can also be dangerous in certain scenarios. For example, UTIs can cause kidney infections and sepsis if they aren’t properly treated.

So, can women over 60 use hormone therapy?

According to The Menopause Society, hormone therapy can be beneficial for controlling menopause symptoms like hot flashes. And they recommend you start when you’re under 60, or within 10 years of the onset of menopause. This timing represents the safest risk-benefit ratio for HRT. Risks associated with HRT include stroke, blood clots, and uterine and breast cancer, and some of these risks can increase with age.

However, in some circumstances, it may be beneficial and safe to start a little later. “The idea that the door has to slam shut just because you’re 60 is so illogical. No matter your age, this is an individual decision to make with a knowledgeable clinician,” says Dr. Heather Hirsch, M.D., M.S., NCMP, author of The Perimenopause Survival Guide.

Examples of HRT use after 60

According to Dr. Lauren Streicher, M.D., medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, there are a few potential scenarios:

• If you went on hormone therapy at age 45 to 50, you may be able to remain on these medications if you continue to have significant symptoms that require these therapies. The Menopause Society says that many women older than age 65 can stay on hormone therapy, noting that as many as 15% of women have hot flashes into their 70s and treatment can continue to benefit them. What’s more, according to 2024 research, using HRT beyond age 65 was associated with reduced mortality risk, and reduced risk of breast, lung, colorectal cancer, dementia, and cardiovascular conditions like congestive heart failure.

• If you want to go off of HRT and you are over 60, your clinician might have you do a trial run and monitor your symptoms. Women have various reasons for wanting to stop, from side effects to fear of long-term risks, though more research needs to be done. If symptoms such as hot flashes return, then your clinician may recommend restarting.
  
  
• If you went on HRT at age 50 to 60, stopped, and have been off of it for six or seven years, you’re in a unique group because you’re not new to treatment, but not in the “continuing” category either. You may still receive HRT. “We treat them like a new start because we don’t have data,” says Streicher.
  
  
• If you are over 60 but went through menopause less than 10 years ago, current recommendations are that you can start hormone therapy if needed as long as you don’t have other health issues that make HRT unsafe.

What works best for you should be determined by you and your doctor. The Menopause Society’s position is that you can stay on hormone therapy, but if you’re newly starting after 60, “the advice is individualized and depends on your goal,” says Streicher.

For example, if you’re 65 and have menopause-related symptoms like joint issues and hot flashes, clinicians will look at your cardiovascular health (such as calcium score, lipid levels, presence of diabetes, smoking status, and your other medications) and then decide if they should start you on HRT — and if so, also consider the type and form best for you.

Types of HRT for women over 60

When it comes to hormone therapy, there are two main types:

• Systemic, which means that hormones get into the blood stream. This addresses menopausal symptoms such as hot flashes and night sweats.
  
  
• Local/low dose, which means that hormones are mostly given through the vagina to address vaginal and urinary symptoms such as vaginal dryness, pain with intercourse, and recurrent urinary tract infections.

Experts are concerned about increased cardiovascular risks (like blood clots) that can be associated with HRT in women who start on hormones in postmenopause, says Hirsch. But the form the estrogen is delivered through can make a difference. Systemic hormone therapy is available in pills, patches, sprays, gels, or as a vaginal ring. In women who are postmenopausal — especially those more than 10 years postmenopause — and are good candidates for HRT, Hirsch might recommend transdermal MHT (meaning hormones are administered through the skin via a patch, spray, or gel), as this form is less likely to cause inflammation and clotting, Hirsch says, noting “we also individualize the dose.”

Treating genitourinary syndrome of menopause symptoms over 60

The genitourinary syndrome of menopause (GSM) is a collection of symptoms related to declining estrogen in menopause that leads to pain with intercourse, vaginal dryness and discomfort, painful urination, overactive bladder, and more. GSM affects up to 84% of women in postmenopause.

For women with GSM, local estrogen to the vagina can be extremely impactful. “For women with these symptoms, I’d say it’s safer to start it than not, since as women get older, GSM is a progressive condition,” says Winter.

“Local vaginal estrogen is safe to begin at any age. Local treatment does not raise blood levels above postmenopausal ranges,” adds Dr. Barbra Hanna, D.O., OB/GYN. That's because vaginal estrogen remains in vaginal tissues, with some traveling up to the bladder, urethra, and ureters (the ducts urine uses to pass from the kidney to the bladder).

Research suggests that vaginal estrogen is not linked to a higher risk of heart disease or cancer. That said, vaginal estrogen won’t treat vasomotor symptoms, support bone health, or promote heart, brain, or longevity, says Hirsch. “But it will keep your pelvic floor happy.”

Hanna also states that local treatment should be used for life. If your symptoms improve and you stop treatment, says Hanna, you can expect that your symptoms will return.

How to talk to your doctor about hormone therapy when you’re over 60

If you’re interested in HRT for symptoms in postmenopause, consult a menopause-trained clinician where you can get a personal assessment and discuss your individual benefits and risks of hormone therapy, Winter recommends.

One of the best things you can do going into your doctor appointment is to be educated about your symptoms and ask your clinician directly for what you want, says Winter. Be up front with your needs, such as “my hot flashes are still impacting my life, is hormonal therapy an option for me?” Or, “I’m pretty confident I have symptoms of GSM, and I understand that vaginal estrogen may be something that can help. What do you think?”

Whether you are continuing to experience hot flashes or are having symptoms of GSM (or both), the reality is that you need individualized options tailored to you. Your next step? Talk to a menopause-trained clinician like one at WeightWatchers Clinic for Menopause. These clinicians take time to learn about you and your health history, talk to you about your wants and needs for therapy, and provide a comprehensive overview of options to create a personalized care plan.

Options beyond HRT

Hormone therapy may offer longevity benefits in cognitive, heart, and bone health, but it’s not the only option for staying healthy in postmenopause. Research shows that lifestyle habits — the foundation of the WeightWatchers for Menopause program — are hugely important in preventing disease. And, as you can see, there is a lot of overlap in these behaviors. Here’s what to focus on:

Bone health

To help preserve bone health, follow these habits:

• Get enough calcium and vitamin D. (Recommendations are 1,200 mg of calcium through your diet and supplements and 600 to 800 IU of vitamin D daily.)
• Seek out sun exposure (15 minutes outside daily)
• Limit alcohol consumption to a maximum of one time per week
• Practice resistance or weight-bearing exercise (at least two hours per week)
• Maintain physical activity (150 minutes per week of moderate-to-vigorous activity)

Heart health

Research shows that you can reduce your risk of cardiovascular disease by following these six healthy habits:

• Follow a healthy whole food-based diet

• Get 2.5 hours of moderate or 75 minutes of vigorous exercise per week
• Avoid smoking
• Maintain a healthy weight
• Get 7 to 9 hours of sleep per night
• Manage your blood sugar, blood pressure, and cholesterol

Cognitive health

To maximize cognitive health as you age, the Centers for Disease Control and Prevention recommends:

• Staying physically active (20 minutes per day)
• Prevent or manage diabetes
• Control blood pressure
• Prevent or correct hearing loss
• Limit or avoid drinking alcohol and smoking