Everyone is aware of hormonal health and what the drop in estrogen and progesterone can do. Anyone on social media, I am sure, has seen testimonials, talks, discussions, and memes on what perimenopause and menopause can do.
But what about those ladies who have never taken hormones and are very much deep into menopause?
Can you start HRT in your 60’s?
- Is it too late? Or just different?
Because of the WHI study (which made its sweeping debut in 2002), there is a whole generation of women who were either pulled off their HRT or never given the opportunity to take HRT.
Back even just a few years ago, doctors would say HRT was just for symptoms and not to take for longer than 4-5 years.
Now we know that HRT is not just about symptom relief but about long-term health. We now know that hormones have a huge impact on our bones, heart, and brain health, not to mention our well-being.
I’m not saying we can't live amazingly great lives without HRT. But it's good to have the option to use HRT as a tool to support our daily well-being and long-term health.
For a woman deep into menopause, we are talking about women who might not have had a period for 15+ years.
What are they experiencing daily, and what are they at higher risk for long-term?
- Bone density diminishes/declines
- Cardiovascular health: high blood pressure, high cholesterol
- Visceral adipose tissue (fat accumulated around the organ = highly inflammatory)
- Osteoarthritis
- Increased risk of Alzheimer’s
- Insulin resistance with a higher risk for diabetes
- Weight gain
- Hair and skin thinning
-
GSM: genitourinary syndrome of menopause
- Vaginal dryness
- Increase in UTIs and vaginal infections
- Urinary leakage and urinary stress incontinence
Usually, by the time a woman is deep into menopause, we are already seeing the manifestations of long-term hormonal decline affecting nearly every system in the body, from bone and cardiovascular health to metabolism, cognition, skin, hair, and the genitourinary tract.
While the goals in early and middle menopause are to prevent these so-called ‘age-related’ conditions, the goal in deep menopause is to try to reverse and prevent further damage.
To further explain, let’s meet Denise. Because those of you who know me know I love a good story.
‘Hi, I’m Denise,
I’m not saying I don’t have a great life. But how did I get here this fast?
I’m 64 years old and worrying about my health, my memory, my bones, my sleep, my body. I miss feeling sharp, energetic, confident, and comfortable in my own skin.
I just did another bone scan, and my bones are getting too thin.
This scares me, I don’t want osteoporosis like my mom had.
I hear so many opinions, and there is so much information from everywhere. I hear this is normal, just part of getting old. Others say it’s menopause and your hormones. Take hormones, you can’t take hormones… Hormones are good for everything, and some people say it’s a waste of $ or it will make you gain weight, lose weight, make you sick…I just don’t know, am I even a candidate for HRT at 64?
Flashback to 2013 or maybe it was 2012. I know this started when I was around 50, when I went through menopause. I was getting hot flashes, gaining weight (not a lot, like 15lbs), brain fog, sleepless nights, and was so tired.
So I went to see my gynecologist and my GP. All of my testing looked great. I asked both of them about hormones and hormone therapy. They both looked at me, horrified, and told me it would give me cancer and that women have been going through menopause “naturally” since the beginning of time.
I was made to feel like I was being dramatic, like I was acting like a big baby and simply needed to tough it out.
Now here I am worried about my bones. And I have to admit, I would love to improve my sex drive, help my hair and skin, and energy. Can hormones help with that?
And now, suddenly, I’m hearing conversations about hormones everywhere and being told that HRT can actually be safe and helpful for many women. And I can’t help but wonder… where was this conversation when I was 50?
And now that I’m finally hearing it, am I too old to even consider HRT?’
What Can Denise Do?
Can she take HRT past 60?
The short answer is yes.
The longer answer is that HRT should be individualized and tailored to her specific needs. That means considering:
- Type of hormones used
- Dose
- Health history
- Symptoms and goals
- It’s best to start low and adjust slowly over time based on how she responds.
There is no one-size-fits-all approach to HRT after 60. The goal is to balance symptom relief, quality of life, and long-term health while carefully weighing benefits and risks for the individual woman.
So let’s get into the nitty-gritty for Denise.
HRT for a woman 60+ years old who has never had HRT or hormones after menopause?
- Progesterone is often a yes.
- While estrogen is a maybe or a slow introduction, or sometimes not appropriate at all.
- What about testosterone? That depends too. Some women benefit tremendously with improvements in muscle mass, motivation, libido, mood, cognition, and overall vitality, while others may be more sensitive to side effects.
-
Other hormones to consider?
- Possibly DHEA and pregnenolone, especially in women with low adrenal reserve, fatigue, poor stress tolerance, low libido, or cognitive decline.
But again, this is where individualized medicine matters. Deep menopause is not the time for a “one size fits all” hormone plan.
So, where do we begin with introducing HRT to a woman like Denise?
- What types of hormones should be considered?
- What doses?
- What delivery methods?
- How slowly should hormones be introduced in a woman deep into menopause?
So, is Denise too old for HRT?
Maybe. Maybe not.
The real answer is that menopause medicine is rarely black and white, especially in women deep into menopause. It requires listening to the woman, understanding her health history, respecting her physiology, reviewing the risks, and thoughtfully deciding what her body may or may not need at this stage of life.
For some women, that may mean no hormones at all. For others, it may mean cautiously introducing progesterone, DHEA, pregnenolone, estriol, estradiol, testosterone, or a combination of these.
Because the goal is not to make Denise 25 again.
The goal is to help her feel stronger, clearer, healthier, more comfortable in her body, and supported as she moves through this next phase of life.
In the paid version of this newsletter, we are going to dive much deeper into how I personally approach HRT in women over 60 who have never previously used hormones.
We’ll discuss:
- where I typically begin
- why I often layer hormones slowly
- DHEA and pregnenolone dosing and testing
- oral vs transdermal progesterone
- estriol vs estradiol
- Biest ratios
- testosterone dosing in women
- blood testing and interpretation
- why “low and slow” matters in deep menopause
Because for women like Denise, hormone therapy is rarely black and white.
Thank you for reading, DrValorie
