Should a 70 year old woman take hormones? A Guide to Hormone Therapy in Later Life

As many as 15% of women in their 70s continue to experience debilitating menopause symptoms like hot flashes. So, should a 70 year old woman take hormones? The decision is not a simple one and requires a personalized approach, balancing potential benefits against evolving risks.

Quick Summary

The question of whether a 70-year-old woman should continue or start hormone therapy is highly individual and depends on her specific health profile, symptoms, and risk factors. Age alone is no longer a definitive barrier, but careful medical evaluation is essential.

Key Points

• Age is Not a Hard Limit: The decision to continue hormone therapy after age 70 depends on an individual's health profile, not just their age.

• Risks and Benefits are Highly Personal: A thorough medical evaluation is necessary to weigh the benefits of symptom relief against increasing age-related health risks, including cardiovascular issues.

• Consider Transdermal over Oral: For older women, transdermal (patch, gel) hormone delivery may be a safer option than oral pills by potentially reducing risks of blood clots and stroke.

• Individualized Treatment is Key: Treatment plans should be tailored to address persistent symptoms and prioritize quality of life, with regular monitoring by a healthcare provider.

• Ongoing Symptoms Justify Treatment: For women experiencing significant hot flashes or other menopausal symptoms that disrupt their daily life, continued HT can be a reasonable and effective option.

• Shared Decision-Making with a Doctor: Discussing your specific medical history, symptoms, and lifestyle with a knowledgeable healthcare professional is crucial for making an informed choice.

Understanding Hormone Therapy in Later Life

Historically, it was standard practice to stop hormone therapy (HT) after age 60 or 65, influenced by initial findings from the Women's Health Initiative (WHI) study concerning risks like certain cancers and cardiovascular issues. However, newer research and re-evaluations offer a more complex view. The current medical approach emphasizes tailoring HT decisions to a woman's health, symptom severity, and treatment duration, moving away from age as the primary factor.

The Evolving Medical Perspective on Long-Term HT

Recent analyses, including a study of over 10 million senior Medicare women, suggest that the benefits and risks of continuing HT after 65 are significantly influenced by hormone type, delivery method (like oral vs. transdermal), and dosage. Low-dose transdermal estrogen, for instance, may have a better risk profile than higher-dose oral options. The Menopause Society's 2022 stance supports that age alone shouldn't mandate stopping HT. Continuing for persistent, bothersome symptoms can be appropriate with proper counseling and risk assessment.

Benefits of Considering Continued HT

For some women over 70, continuing HT can significantly improve their quality of life, often by managing persistent hot flashes.

Benefits may include:

• Symptom Management: Relief from hot flashes and night sweats.
• Improved Quality of Life: Better sleep and overall daily function by reducing disruptive symptoms.
• Bone Health: Estrogen can help maintain bone density, reducing osteoporosis and fracture risk.
• Vaginal and Urogenital Health: Localized estrogen effectively treats vaginal dryness and related urinary issues.

Assessing Risks and Mitigating Factors

HT risks generally increase with age and duration, making a detailed medical evaluation essential.

Key risks include:

• Cardiovascular Risks: Older women may have higher risks of stroke and blood clots, particularly with oral HT. Transdermal methods might be safer alternatives.
• Breast Cancer Risk: Combined estrogen and progestin therapy is linked to increased breast cancer risk, varying by specific formulation.
• Other Health Conditions: Existing conditions like high blood pressure, cholesterol, or a history of blood clots or breast cancer must be considered.

Key Considerations: Oral vs. Transdermal HT

Hormone delivery method impacts risk. The table below compares oral and transdermal HT.

Feature	Oral Hormone Therapy	Transdermal Hormone Therapy
Administration	Pills taken by mouth	Patches, gels, or sprays applied to the skin
Liver Metabolism	Processed through the liver; can affect clotting factors	Bypasses the liver; avoids some potential risks
Cardiovascular Risk	Possibly higher risk of blood clots and stroke	Possibly lower risk of blood clots compared to oral
Dosage Control	Systemic dose, impacts entire body	Can be more localized or systemic, depending on application
Convenience	Easy to remember daily pill	Requires consistent application and skin integrity

Transdermal delivery is often preferred for older women due to potentially reduced cardiovascular risk, but the choice requires consulting a healthcare provider.

How to Discuss HT with Your Doctor

Discussing HT with a doctor is crucial. Be prepared to cover:

1. Symptom Severity: Describe how symptoms affect your daily life.
2. Medical History: Share your personal and family medical history.
3. Risk Assessment: Understand your individual risks.
4. Treatment Options: Discuss types and delivery methods of HT.
5. Ongoing Monitoring: Plan for regular follow-ups.

This shared decision-making helps determine the best path for your health needs.

Conclusion: A Personal, Informed Decision

There's no single answer to should a 70 year old woman take hormones. Current guidance favors an individualized approach based on persistent symptoms, quality of life, and a careful risk-benefit analysis. For women with significant ongoing symptoms and a suitable health profile, continuing or starting HT under medical care can be a valid option. A key resource for more information is The Menopause Society.

The Menopause Society

Frequently Asked Questions

Is it safe for a 70 year old woman to start hormone therapy?

Starting hormone therapy at age 70 is less common than continuing it from an earlier age. The risks, especially for cardiovascular events, are generally higher when initiated later in life. However, a healthcare provider can assess your individual health and risk factors to determine if it is a safe option for you, particularly if you have persistent, debilitating symptoms and a favorable risk profile.

What are the main risks for a 70 year old woman taking hormones?

Primary risks include an increased chance of blood clots, stroke, and possibly certain cancers like breast cancer, especially with combination therapy. These risks tend to increase with age. A full assessment of your personal and family medical history is critical.

Can hormones help with persistent hot flashes in older women?

Yes, hormone therapy is the most effective treatment for hot flashes. For some women, these symptoms can persist well into their 70s. Continued HT can be a valuable tool for managing these symptoms and improving quality of life, especially for 'super flashers'.

Are there different types of hormone therapy for older women?

Yes, there are various forms of HT, including oral pills, transdermal patches, gels, and sprays. Transdermal administration, which bypasses liver metabolism, is often preferred for older women due to a potentially lower risk of blood clots.

How often should a 70 year old woman be monitored if she continues HT?

Regular monitoring is essential. This typically involves periodic evaluations with a healthcare provider to assess symptoms, review potential side effects, and re-evaluate the overall risk-benefit balance of the treatment. There is no one-size-fits-all answer, and the frequency will be determined by your doctor.

Can hormone therapy prevent aging-related diseases?

While estrogen has protective effects on bone density and may have cardiovascular benefits for certain populations, HT is not a treatment for general aging. The main purpose in later life is to manage persistent menopausal symptoms and improve quality of life, not to prevent age-related diseases broadly.

What non-hormonal alternatives exist for menopausal symptoms?

Non-hormonal options include lifestyle changes like diet and exercise, as well as certain medications such as SSRIs and SNRIs that can help manage hot flashes. Consulting a doctor about these alternatives is a good first step, especially for those with contraindications for HT.