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If you could reduce your risk of overall mortality (what will kill you) by 19%, your risk of breast cancer by 16%, of lung cancer by 13%, colorectal cancer (12%), congestive heart failure (5%), acute myocardial infarction (11%), venous thromboembolism (3%), atrial fibrillation (4%), and dementia (2%), would you hesitate?
A recent 13-year study using records of 10 million senior Medicare women from 2007-2020 examined the “effects of different preparations of menopausal hormone therapy on all-cause mortality, five cancers, six cardiovascular diseases, and dementia.”
And the results they published in The Journal of The Menopause Society earlier this month will change women’s healthcare forever.
What makes this report unique is that it studies the use of menopausal hormone therapy (MHT) beyond the age of 65, which has been a topic of ongoing debate in the medical community. For decades we’ve had clinical guidelines to consider when providing hormone replacement therapy to women under age 65. For example, if a young woman experienced menopause due to surgical removal of her ovaries, or her ovaries failing to function, we provide MHT. But there was mixed information available about hormone use over the average age of menopause (51 years old), and especially after age 65. Those of us who specialize in hormone therapy have long suspected, thanks to global research and case studies, that MHT beyond 65 could be imperative to women’s health. But this study confirms that the use of estrogen monotherapy beyond age 65 was associated with significant risk reductions in mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction, and dementia.
These findings suggest that MHT has a protective effect on women’s health in the long term, particularly in terms of preventing chronic diseases like heart disease and cancer.
Moreover, the study highlights the importance of considering different types, routes, and doses of MHT when evaluating its risks and benefits. Women deserve a full evaluation of their peri/menopause, and a nuanced discussion regarding risks and benefits. This underscores why personalized approaches to MHT may be more effective in maximizing its benefits and minimizing its risks.
The study’s findings are particularly relevant for women’s health care providers, as they can inform clinical decision-making regarding the use of MHT in older women.
Beyond health care providers, the study’s findings have implications for public health policy and guidelines regarding MHT use in older women. The study’s results suggest that MHT may have a role in preventing chronic diseases in older women, which could inform the development of Global guidelines and policies aimed at promoting women’s health and reducing health disparities.
In a country where cardiac disease is the leading cause of mortality in women over 65. And “the number of Americans ages 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 (a 47% increase), and the 65-and-older age group’s share of the total population is projected to rise from 17% to 23%,” this kind of disease prevention is more important than ever. And the repercussions of this study simply can’t be overstated.
Sadly, even younger women aren’t aware of the health benefits of hormone replacement therapy, even with the data we’ve had for decades about MHT before 65.
Women have been neglected and dismissed regarding peri and menopause and simply have been robbed of information, of appropriate and available care, and of an improved quality of life. It’s time we as a healthcare community address these imbalances, highlight the importance of personalized approaches to MHT.
This study highlights why menopause care should be individualized, patients should be able to have a nuanced discussion regarding risks and benefits, and, alongside their healthcare provider, they should be a partner in the decision-making. If you have questions about peri menopause, menopause, or MHT after 65, let’s chat. We can discuss your questions and goals and help decide whether hormone therapy is right for you as an individual.
