It’s no secret that hormone replacement therapy is making a comeback. This treatment for symptoms of menopause fell out of favor in the early 2000s after a study suggested it could do more harm than good (researchers later discovered that data was flawed). But an arsenal of research since then has found that hormone therapy in menopause can be a game-changer for women in this phase of life.Still, you’re not taught the ins and outs of hormone replacement therapy in school, and it’s not even commonly discussed in the doctor’s office. With that, it’s understandable to wonder if it’s too late to start hormone replacement therapy, especially if you’re in perimenopause or menopause. The answer is slightly complicated. “It’s never too late,” says Dr. Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. But there is research to suggest that there’s an ideal window of time to start hormone therapy for menopause. “There is a timing benefit on long-term outcomes,” says Dr. Jessica Shepherd, MD, an ob/gyn in Texas and author of Generation M: Living Well in Perimenopause and Menopause. So, what does this mean for you, and what is the ideal timing for hormone therapy in menopause? Here’s what doctors who prescribe this treatment want you to know. ?SIGN UP for Parade’s health newsletter with expert-approved tips, healthy eats, exercises, news & more to help you stay healthy & feel your best self?
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Hormone replacement therapy, also known as menopause hormone therapy, is a treatment for menopausal women that’s designed to ease uncomfortable symptoms like hot flashes and insomnia. Hormone replacement therapy supplements the estrogen and progestin that’s lost during the menopausal transition, when the ovaries stop producing those hormones. There are different types of hormone therapy options for women, including topical localized treatments like estrogen creams and patches, and oral forms that are systemic, meaning they send these hormones throughout your body. (Remember that for later.)
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As we mentioned above, hormone therapy has a controversial past. Preliminary results released from the Women’s Health Initiative (WHI) clinical trial, which were released in 2002, linked hormone replacement therapy with a higher risk of serious health issues, including heart disease and stroke. The trial was abruptly stopped for safety reasons, and many women avoided menopause hormone therapy as a result.
However, subsequent research has since found that the original findings were flawed. Among other things, the original analysis lumped older women who already had a higher risk of heart disease in with younger women. It also didn’t tease out when women started hormone therapy, which can make a difference in outcomes. The original authors of the study came out with a follow-up study that was published in JAMA in 2024, which concluded that hormone therapy is a safe option for women, but a lot of the damage had been done.
Research since the original study has found that hormone therapy in menopause can have a slew of potential benefits, including supporting heart health and bone density in women. Research has also suggested that hormone therapy may lower the risk of dementia in women, depending on when they start the treatment.
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When Do Doctors Recommend Starting Hormone Replacement Therapy?
Every woman is different, making it important to have a conversation with your healthcare provider if you’re interested in hormone therapy. But doctors generally recommend starting the treatment before age 60 or within 10 years of menopause, if you have uncomfortable symptoms like hot flashes, night sweats or mood changes, says Dr. Ashley Parr, DO, an ob-gyn at MemorialCare Medical Group at Saddleback Medical Center’s Women’s Health Pavilion in Laguna Hills, CA.
“Research shows that starting hormone therapy during this window offers the most favorable balance of benefits and risks,” she explains. “Hormone therapy is the most effective treatment for menopausal symptoms and is primarily used to improve quality of life, not to prevent disease or extend lifespan.”
Starting estrogen therapy early can help support the cardiovascular system as women age, says Dr. Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine and founder of Madame Ovary. (It helps to keep blood vessels open and prevents thickening of the walls of the blood vessels, she points out.) “However, if we go out a while from menopause, when we don't have estrogen protecting our vessels as it did before menopause, clots can build up in the blood vessels, and estrogen later on can actually lead to some clots breaking off,” she says. That can then raise the risk of heart attack and stroke.But it’s important to point out that this is the guidance that doctors consider when it comes to systemic hormone therapy (meaning, oral medication that’s distributed throughout your body), Dr. Streicher says. “You can start localized hormone therapy any time,” she adds.
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Keep this in mind, per Dr. Shepherd: “There is no perfect age to start hormone therapy.” However, doctors typically conduct a risk-benefit analysis to determine if it might be a suitable option.
“Between 60 and 69 it might not be great—it won't help prevent heart disease, but it's not terrible,” Dr. Minkin says. “But if we get to 70 and beyond, it actually can be detrimental to heart health. So, in general, we like to give estrogen relatively soon after menopause.”
Dr. Streicher stresses that it’s never too late to start hormone replacement therapy, “but the benefits decrease, and the risks increase as time goes on.”
Dr. Parr agrees. “As women age, baseline risks for conditions such as heart disease, stroke, blood clots and cognitive decline increase, and starting hormone therapy later may carry more risk than benefit,” she says. “This doesn’t mean hormone therapy is automatically off the table, but initiation at this stage requires careful, individualized discussion with a clinician.”
Ultimately, Dr. Streicher says it’s best to talk to a healthcare provider, and ideally one who specializes in menopausal care. “Talk to a menopause expert and take it from there,” she recommends.
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Sources:
Dr. Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of MedicineDr. Jessica Shepherd, M.D., an ob/gyn in Texas and author of Generation M: Living Well in Perimenopause and MenopauseDr. Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine and founder of Madame OvaryDr. Ashley Parr, D.O., an ob-gyn at MemorialCare Medical Group at Saddleback Medical Center’s Women’s Health Pavilion in Laguna Hills, CAHence then, the article about is it too late to start hormone replacement therapy was published today ( ) and is available on Parade ( Saudi Arabia ) The editorial team at PressBee has edited and verified it, and it may have been modified, fully republished, or quoted. You can read and follow the updates of this news or article from its original source.
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