How Old Is Too Old for HRT?
Anyone who knows me knows I don’t particularly like the word “old.” Perhaps I’m in denial. After all, at 56, I’m getting much closer to 60 and if I’m honest, I find that thought absolutely horrifying.
But it got me thinking…
Too old for what?
Too old for holidays? Too old for romance? Too old to start something new?
Or, when it comes to menopause, are we sometimes told we’re simply “too old” for HRT?
So, How Old Is Too Old for HRT?
One of the most common messages women hear is that HRT should be started before the age of 60 or within 10 years of menopause. That is generally considered the time when the benefits are most favourable for many women.
But this doesn’t automatically mean that HRT cannot be considered after 60.
The decision should be individual, considering your symptoms, medical history and choice.
I’ve been studying menopause, HRT and women’s health since 2017. When I first
started to “join the dots” between menopause, declining hormones and long-term
health, I began to understand so much more about the women I had nursed over the
years and why so many had struggled with their physical and psychological health.
My Student Nurse Experiences
When I was a student nurse, hysterectomies were common. I saw middle-aged women prescribed medications such as Diazepam during the day to calm them and Temazepam at night to help them sleep.
Women were often described as “ditzy, forgetful” or very emotional.”
These medications would reduce their anxiety and help them sleep but they also carried significant risks, including dependence and side effects. Most importantly, they didn’t address the underlying cause of the symptoms which was lack of female hormones.
Memories from the Ward
I hadn’t been taught very much about menopause or HRT during my nurse training and I don’t remember seeing many women being prescribed it.
This was also a very different era of HRT. Oral HRT was prescribed and the hormones used were synesthetic, very from what we prescribe today. We now have a much greater understanding of how different routes and formulations of HRT how risks such as blood clots.
At the time, many women were smokers and after surgery, we encouraged prolonged bed rest which also increased the risk of blood clots.
As I look back, I can’t help wondering how different things might have been if women had received better menopause education, appropriate treatment and earlier support.
Nearly 40 Years of Nursing Later…
Yes…I really have been nursing for nearly 40 years!
And thankfully, our understanding of menopause and HRT has changed enormously.
We now have decades of research helping us understand the role of hormones in women’s health.
One area I’m particularly passionate about is cardiovascular health.
Cardiovascular disease is a major cause of illness and death in women, yet menopause and the decline in oestrogen are not always discussed when we talk about women’s long-term cardiovascular health.
During the menopausal transition, a few changes can occur. Cholesterol levels can change, blood pressure can increase, body fat distribution can shift towards the midriff and blood vessels can become less flexible.
This is one reason why the timing of HRT matters.
Why Starting HRT Earlier Is Beneficial
For many women, starting HRT during perimenopause or within the first 10 years after menopause, particularly before the age of 60 is most beneficial.
HRT can be extremely effective at treating menopausal symptoms, improving quality of life and helping protect bone health. There is also evidence that starting HRT around the time of menopause may have cardiovascular benefits, although HRT is not prescribed solely to prevent cardiovascular disease.
For many women, feeling better can have a positive knock-on effect on everyday life.
When you have more energy and fewer debilitating symptoms, you may find it easier to exercise, socialise, work, sleep better and enjoy life again.
And surely that matters?
But What If You’re Over 60?
This is where I think we need to move away from the idea that there is a magical birthday when you suddenly become “too old” for HRT.
Being over 60 does not mean HRT is off the table. In-fact I prescribe HRT to lots of women over 60.
My menopause consultations are in-depth and we come to a joint decision together as to have HRT or not. In my experience very few women can’t have HRT.
The type of HRT, the dose, the route of administration and your individual health history all matter.
This is why a personalised consultation with a menopause specialist is so important.
What About Dementia?
Dementia is understandably a concern for many women.
An article in The British Menopause Society journal states “Menopause Hormone Therapy does not appear to impact dementia risk either positively or negatively”.
I often refer to this a being a neutral risk.
What I’ve Learnt
After almost four decades of nursing and many years specialising in menopause,
one thing has become very clear to me:
Women deserve better menopause support.
We deserve to understand what is happening to our bodies.
We deserve to have our symptoms taken seriously.
And we deserve to have conversations about HRT that go beyond simply- “You are too young or too old”
Your health history, your symptoms, your risk factors, your choice all need to be considered.
Have You Been Told You’re “Too Old” for HRT?
If you’ve been told you’re “Too old” for HRT, don’t assume that means the
conversation must end there.
As a Senior Nurse Practitioner and British Menopause Society Registered Menopause Specialist, I’m passionate about helping women understand their options and make informed decisions about their menopause care.
Symptoms can and do last years.
However, being prescribed the right HRT can and is lifechanging.
You should never be denied HRT due to your age
You should never be told you have to stop HRT after 5 years of taking it
Have you been advised or had your HRT reduced due to your age
If you’ve been told nothing else can be prescribed to help you
Get in touch with me Diane!
For Expert Menopause Support and HRT please email-
