Do You Really Have to Stop HRT at 65?

For years, many women were told that hormone therapy had to stop at 60 or 65. Full stop.

But newer research suggests that this conversation may need to be far more nuanced.

A 2024 study looking at more than 10 million senior Medicare women examined hormone therapy use beyond age 65 and found that the outcomes were not all the same. They varied depending on the type of hormone used, the dose, and the route of administration.

This was a large observational study, not a randomized trial, so it shows association rather than proof of cause and effect. Even so, it offers meaningful real-world data and raises an important point: age alone should not be the only reason a woman is told to stop hormone therapy.

One of the most important takeaways from the study was this: estrogen-only therapy beyond age 65 was associated with significant reductions in several important health outcomes, including a 19 percent lower all-cause mortality risk.

The authors also reported that the more favorable patterns were generally seen with estradiol rather than conjugated estrogens, and with lower-dose, vaginal, or transdermal approaches rather than higher-dose oral therapy.

That does not mean hormone therapy is right for everyone.

It also does not mean every woman should stay on it indefinitely.

What it does mean is that menopause care deserves better than blanket rules. It deserves clinical context, individualized risk assessment, and thoughtful decision-making based on a woman's symptoms, health history, whether she has a uterus, and her treatment goals.

Too many women in perimenopause and menopause are still receiving outdated messaging around HRT, menopause treatment, and hormone replacement therapy. When that happens, women may either stay on a treatment that is not ideal for them, or stop a treatment that may still be appropriate and helpful.

The better question is not, “How old are you?”

The better question is:

• What kind of hormone therapy are you using?
• At what dose?
• By what route?
• And is it still appropriate for your body and your current stage of life?

This is exactly why individualized menopause care matters.

If you are navigating perimenopause, menopause, HRT, or hormone therapy decisions, the details matter more than most women have been led to believe.

PMID: 38595196