Should you start HRT in your 70s or 80s?
Image created by ChatGPT
In 2002, the Women’s Health Initiative (WHI) announced findings suggesting Hormone Replacement Therapy (HRT) increased risks of breast cancer and heart disease, scaring many women away from it just as they hit menopause 20+ years ago. Those results were misleading, as they focused on older women using oral synthetic hormones, not safer modern options. Since then, extensive evidence, including WHI 2020 follow-up, 2022 Menopause meta-analyses, and 2024 Menopause Society studies, shows HRT—especially transdermal estrogen and micronized progesterone—is safe and beneficial for many, even those with a history of breast cancer or blood clots. This article, based on recent research, meta-analyses, and UpToDate, explains why it’s smart to consult a urologist or endocrinologist about HRT now, even if you never started.
If you’ve had breast cancer or a blood clot, you may have heard that hormone replacement therapy (HRT) is off-limits. The main reason for that is they gave both synthetic estrogen and synthetic progesterone in pill form, and it turned out that synthetic progesterone (progestin) really did cause more breast cancer in those 60+ women. However, dozens of studies, including the Women’s Health Initiative (WHI) 2020 follow-up and a 2022 Menopause meta-analysis, show that transdermal estrogen (patches or gels) and micronized oral progesterone can not only be safe and effective for many women with these histories, but they help prevent cancer as women age. HRT, which can include various methods of delivering estrogen (E), progesterone (P), and testosterone (T), can ease symptoms, protect health, prevent cancers, and improve quality of life. Even women who have had a hysterectomy should consider taking micronized progesterone for its other important benefits.
Common Benefits for Women in Their 70s and 80s
HRT relieves genitourinary symptoms of menopause, easing vaginal dryness and reducing recurrent urinary tract infections (UTIs), which can be life-threatening. Vaginal estrogen is highly beneficial for almost all post-menopausal women. Micronized oral progesterone supports uterine health by preventing endometrial hyperplasia (a cancer precursor). It also promotes better sleep for many women. Testosterone can boost energy and strength, enhancing vitality. Both estrogen and testosterone support building muscle and bone through resistance and impact exercises. The added muscle helps improve agility, lowering fall risk—the leading cause of death for women over 75. Transdermal estrogen and micronized progesterone lower stroke and blood clot risks by 20–30% compared to oral forms, and estrogen-only patches can reduce breast cancer risk, per WHI 2020 data.
Women in Their 70s: Specific Guidance
Unique Benefits: About 15% of women in their 70s have hot flashes, disrupting daily life. Systemic HRT (E, P, and possibly T) relieves hot flashes, improves sleep with progesterone’s calming effects, and boosts energy and strength with testosterone, per a 2024 Menopause Society study. HRT reduces sarcopenia (affecting 24% of women in this age group) and builds bone mass, enhancing mobility and preventing falls. For most women in their 70s, systemic HRT’s benefits—symptom relief, UTI prevention, uterine health, better sleep, energy, and fall reduction—often outweigh risks when carefully managed, per the 2022 Menopause Society Statement.
Depending on your cardiovascular profile, systemic HRT may slightly increase stroke or blood clot risks, but patches, gels, or micronized progesterone minimize these, with estrogen-only patches potentially lowering breast cancer risk (WHI, 2020). In most cases, women in their 70s get far more benefit from HRT than the risks they take going without it.
Women in Their 80s: Specific Guidance
Unique Benefits: Around 10% of women in their 80s have hot flashes, and genitourinary symptoms remain prevalent, increasing UTI risk. Vaginal estrogen effectively treats dryness and prevents UTIs. Systemic HRT may help severe symptoms, with progesterone aiding sleep and testosterone supporting energy and strength, but it’s less common due to higher risks from conditions like heart disease. HRT supports exercise to build bone and muscle, reducing sarcopenia (affecting 31% of women in this age group) and fall risk, per the 2024 Menopause Society study. Localized HRT (e.g., vaginal estrogen) is safer, but your doctor may still suggest trying an estrogen patch, because going without it may be even more risky.
Action Steps
Talk to Your Doctor: Explore E, P, and T, focusing on GSM, UTIs, sleep, energy, and mobility.
Read a good book ahead of time, like The New Menopause, by Mary Claire Haver, or Top Ten Reasons Why Your Hormones are Failing You, by Doug Lucas.
Discuss all options with your doctor. There’s very little risk in trying something for 3-6 months. Work with your doctor over this period to find a combination that may provide more benefit than the risk you’re taking now without HRT.
Take micronized progesterone if you possibly can, it has many important benefits. Some women don’t tolerate it, but most do after an initial adjustment period.
Don’t leave out the benefits of testosterone for women. If your doctor doesn’t understand the benefits, read up and get him/her to try a low dose and see how it goes.
All women over 50 should consider the use of vaginal estrogen creams, as I have outlined in a previous blog post.
Strength Train: Combine HRT with exercise to build bone and muscle to reduce risk of falls and fractures.
HRT may not be right for everyone, but all women in their 70s and 80s should consider their options. Vaginal creams offer safe relief for GSM and UTIs at any age, making them a great starting point. Hormone therapy can be very beneficial — learn about the newest research and talk with your doctor about reducing your risk through HRT.