HRT Over 65: Dispelling Myths and Understanding Benefits

Menopause symptoms don’t magically disappear as women get older; in fact, many older women I’ve talked with still struggle 10 or even 20 years after going into menopause. Family practice physicians, OB/GYNs, and primary care doctors often hesitate to prescribe hormone replacement therapy (HRT) to women over 65. Healthcare providers think of age as a primary barrier to HRT use. However, emerging studies suggest that we need to reevaluate this outdated thinking. In this post and in the featured video, I’ll be sharing both scientific findings and some heartbreaking personal stories to paint a fuller picture of HRT’s role for women over 65. I’ll also be taking a close look at a giant new study that was just released, looking at HRT in older women.

Understanding HRT and Its Long-standing Taboos

Hormone Replacement Therapy has been a controversial topic, especially concerning its use in older women. Despite the benefits HRT can offer in reducing both symptoms and health risks, many find themselves denied this option purely due to age. A recently published study involving over 10 million women over 65 has shed light on this issue, offering fresh perspectives that challenge outdated views.

The Impact of HRT on Persistent Menopause Symptoms

Once a woman goes through “the change,” her menopause symptoms, for the most part, are here to stay. Symptoms like hot flashes, night sweats, and more can persist for 10, 15, even 20 years, impacting quality of life significantly. Carol, age 59, suffers from osteoporosis and other menopausal symptoms. Finding a provider willing to prescribe HRT has been a futile three-year journey for her. The misconceptions surrounding the risks and benefits of HRT in older age contribute heavily to Carol’s and other women’s challenges.

The Realities of Menopause Beyond 65

Many women continue to experience menopausal symptoms well into their 60s, 70s, and beyond. Unlike the common belief that these symptoms taper off, for many, they remain just as intense, if not worsen, as they age. This persistence can lead to significant distress, impacting mental health, physical health, and overall well-being. Hot flashes and night sweats may . . . or may not gradually decline in severity over time. Insomnia, weight gain, anxiety, depression, and many other symptoms remain constant over time. Vaginal, sexual, and urinary symptoms are very likely to get much worse as the years go by.

Breaking Down the Latest Research

A groundbreaking study of HRT in 10 million women, all over age 65, was recently published in the journal ‘Menopause‘. This study has broken new ground by analyzing the effects of HRT on women aged 65 and older, highlighting not only the potential benefits but also the minimal risks associated with continued HRT use.

Key Findings from the Study

The study’s findings are quite revealing:

    • Women taking estradiol alone (mostly women who have had a complete hysterectomy – removal of uterus and ovaries) experienced a 21% decrease in “all-cause mortality” (death for ANY reason) compared to those not on HRT. That means women on estradiol died at a rate 21% less than women not taking hormones – an absolutely huge finding.

    • Comparing 31 different types of HRT showed that 29 out of 31 types were associated with either neutral risk (neither increased or decreased) or significantly reduced risk for all-cause mortality.

    • The 2 types of HRT (out of 31) which showed increased risk for all-cause mortality were women taking only progestins and women taking a vaginal combination of estrogen+progestin. These groups represent women with major health conditions that fall outside the norm that can be set aside.

Study Limitations

It’s important to keep in mind several limitations of this study, including:

    • This was an “observational study” which looked at health records and prescriptions of women over a long period of time. That’s different than an “interventional study” where patients are divided into a group that receives treatment and a group that receives a placebo and the two groups are compared.

    • Observational studies are less helpful in terms of determining whether HRT “causes” diseases or death. Rather, it shows “associations” between HRT and disease or death, either negatively or positively.

    • There’s no information about how long women took HRT in this study. In fact, it appears that a single prescription (whether a woman actually took it or not) would qualify a woman to be in the “HRT” group. Here’s a direct quote: “We considered women to be exposed to [hormones] if they ever had a prescription for that drug . . .

Puzzling Breast Cancer Risks

One of the most sensitive aspects of HRT is its association with breast cancer risk. The study, surprisingly, showed that some types of HRT were associated with small increased risks for breast cancer. This segment of the research calls for a nuanced understanding of hormone therapy, encouraging personalized medical approaches.

Navigating HRT After 65: Real Women, Real Stories

The voices of women who have lived through menopause without adequate support are compelling. Stories from individuals like Denise and Emily, who struggle to find understanding and support from their healthcare providers, highlight the urgent need for more informed, compassionate care practices.

The Challenge of Finding HRT-Friendly Providers

Finding a healthcare provider who understands and supports the use of HRT in older age remains a significant barrier. Hormone optimization specialists, like the ones I refer patients to, have a nuanced understanding of hormones and health risks. I have relationships with experienced hormone specialists all over the world with the largest concentration in the US and Canada.

What Does This Mean for Women Over 65?

The recent findings offer hope and a possible paradigm shift in how menopause is treated in older women. With more informed discussions, women over 65 might finally receive the support and recognition they need to manage their symptoms effectively.


Women over 65 are still experiencing hot flashes and many other menopause symptoms. Having a 65th birthday does not magically mean these women are suddenly symptom-free and do not need to have their hormones optimized. Going without hormones from the onset of menopause for 10-15 years or longer may allow serious health risks to increase, especially for cardiovascular disease and osteoporosis. This is the exact reason that women, especially those over 65, should seek a trained, experienced hormone optimization specialist to help with hormones. Women over 65 need help from experienced practitioners who understand the nuances of hormones and health risks and how to navigate those risks.


What is hormone optimization? Hormone optimization is the process of assuring that hormone levels aren’t too high or too low but they’re “just right,” especially in the years following menopause. Just right hormone levels reduce or eliminate menopause symptoms (some of which can persist for decades) and reduce long-term health risks (like heart disease and osteoporosis) at the same time.

Is it safe to start HRT after 65? A recently published study of 10 million women on HRT showed that HRT past 65 is much safer than the conventional wisdom has maintained.

The Menopause Solution!

Confused about whether HRT is right for your  menopause? My digital course helps you gain the confidence and clarity to make your HRT decision . . . in about 2 hours.

Hormone Practitioners: Find out how you can use The  Menopause Solution to simplify your hormone practice.

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