When Is It Too Late To Start Hormone Replacement Therapy?
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I have women come to see me from 40 to 70 years of age asking about Hormone Replacement Therapy (HRT). Yet, hormones are not the right solution for every woman and not appropriate for all ages. Though every case must be treated individually (e.g. by exploring family history, personal history, and blood work results), there are some general guidelines for initiating HRT.
Window of Opportunity
A woman officially enters menopause when she has gone an entire year without a menstrual period. At this time, she is now considered to be one year into menopause. The window of opportunity to start hormone therapy is at 9 to 10 years after the official start of menopause. In other words, after a woman’s period stops she has a decade to consider hormone therapy. Starting HRT after this window comes with risks that outweigh the benefits for most women. Research suggests that women who used HRT have a lower dementia and cardiovascular disease risk BUT only if they started the HRT in the “window of opportunity”. If a woman started HRT outside this window the studies suggest that women have an increased risk of dementia and cardiovascular disease. So starting HRT later in life actually caused negative health outcomes, where starting it earlier was found to be protective.
The Women Health Study in 2010 found that HRT caused an increased risk of cardiovascular incident. These findings caused an upheaval in hormone medicine and seemingly overnight, millions of women were told to stop their HRT. We now understand that one of the issues with this landmark study was the age of the participants. The average age of women in this study just starting HRT was 63 years. The vast majority of them were outside the “window of opportunity” and hence the negative consequences became apparent.
Best Time to Start Hormone Replacement Therapy
So the best practice guidelines currently state that the ideal time to start HRT is within 10 years of the initiation of menopause, or under the age of 60. Keep in mind that for women who go into early menopause (before the age of 40), or medical menopause (due to surgery or chemotherapy), the benefits of starting HRT are even higher and in most cases highly recommended.
If you are considering starting HRT, I highly recommend connecting with a menopause knowledgeable health provider, ideally one that is certified by NAMS. The misunderstandings and misconceptions around hormone therapy still exist today, which leaves women confused about their options. If hormone therapy is something you are considering, you want to make sure you do not miss your “window of opportunity” to start. Having someone who can help you evaluate your personal risk and benefits is essential.
Dr. Angela Hunt is a Naturopathic Doctor and NAMS Certified Menopause Practitioner. She manages the Bioidentical Hormone Program at KIHC and facilitates the popular Menopause Group Classes, designed for current naturopathic patients.
*Photo by Ashkan Forouzani on Unsplash.
