"Is It Too Late to Start HRT in My 60s"
Is starting HRT in your 60s too late? New research suggests it might still offer big benefits—if it’s the right fit for you.
“I'm 65. Is it too late for me to start HRT or MHT?”
This question landed in my Instagram DMs last week (you can send me your questions right here) and my answer is: Absolutely not!
While timing does matter with hormone replacement therapy (HRT)—with most consensus guidelines recommending initiation within 10 years of menopause—starting in your 60s can still offer significant benefits, especially for bone health, brain function, and quality of life.
The key isn’t your age: It’s individualized care and assessing your personal health risks with a knowledgeable healthcare provider.
Speaking of knowledgeable healthcare providers? I’m lucky to know an incredible one: Dr. Avrum Bluming. I first met Dr. Bluming when I was a little girl as my father and he were old medical school friends. Today, Dr. Bluming is a leading expert on HRT and co-author of Estrogen Matters.
His research, along with data from The Women’s Health Initiative (WHI), suggests that estrogen therapy may be protective well into a woman’s 60s and beyond, particularly for bone density and cognitive function.
Here’s what HRT can help with:
- Bone Health & Osteoporosis Prevention – HRT remains one of the most effective ways to prevent fractures and osteoporosis, which accelerate after menopause (Bluming & Tavris, 2018). If you’re in your 60s and experiencing bone loss, joint pain, or fractures, estrogen therapy could be valuable.
- Brain Health & Alzheimer’s Risk – Estrogen has neuroprotective effects. Some studies suggest that women who use HRT may have a lower risk of Alzheimer’s disease, especially if started early post-menopause, though research is ongoing (JAMA Neurology, 2021). Even in later years, estrogen may still support cognition, memory, and mood stability.
- Quality of Life & Symptom Relief – Still battling hot flashes, sleep disturbances, or vaginal dryness? HRT can offer substantial relief, improving daily function and overall well-being (Menopause Journal, 2022).
What About Risks?
Worried about HRT’s potential negative side effects? I totally get it. In 2002, a WHI study threw many women and their doctors on high alert with its possible correlation between hormone therapy and heart disease.
However, researchers re-evaluated this study and found it overstated the risks for the majority of women. Current research now shows that HRT does not increase heart disease risk in healthy women and may actually reduce it if started within 10 years of menopause (Circulation, 2020).
So what happened? The complications for women in their mid-60s and beyond are simple statistics—cardiovascular risks (e.g. heart disease, stroke, etc) naturally increase with age.
For this reason, women who start HRT in their 60s should have a personalized approach that considers factors such as heart health, cancer history, and stroke risk.
As I always say, ask your health provider four key questions:
- What is the risk of taking HRT?
- What is the risk of NOT taking HRT?
- What is the benefit of taking HRT?
- What is the benefit of NOT taking HRT?
Important Note
The Menopause Society is not quite as enthusiastic about HRT as Dr. Bluming. Their official statement on their consensus report reads:
"For women who initiate hormone therapy more than 10 years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable (than women who are in their 50s or within 10 years of menopause) because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.
Longer durations of therapy should be for documented indications such as persistent VMS, (hot flashes) with shared decision-making and periodic reevaluation. For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended."
I’m sharing both perspectives with you because medicine rarely offers clear-cut answers. (And if someone claims it does? They might be trying to sell you something.) As always, your decision should be informed by multiple viewpoints and tailored to your specific needs.
One last thing: Talk to your doctor about the route of administration. Transdermal (patch) estrogen and micronized progesterone are often recommended for women starting later, as they minimize clotting risk compared to oral forms.
Bottom Line
It’s not too late to consider HRT in your 60s! But it does require a personalized discussion with your doctor and an evaluation of YOUR risks of heart disease and stroke.
If your primary concerns are bone density, cognitive health, or symptom relief, HRT may still be a safe and effective option—especially when guided by evidence-based medicine rather than outdated fears.
This question came directly from a member of the Ajenda community.
