Q&A: Is HRT okay for women over 60?

Question:

“I have just turned 62 and have been off HRT (hormone replacement therapy) now for ten months, after about nine years on several types of HRT; the last was Premique® Low Dose (about four years). I didn't 'wean' myself off HRT (my doctor didn't tell me to do this and was pretty clear about my stopping therapy because of my age). However, I have been reading so many conflicting reports about aged 60 plus’s on HRT and I feel I would like to resume it as I am now suffering sleepless nights and sweats. Any advice?
I suppose I want some conclusive evidence that HRT is ok for 60 plus women. The list of postmenopausal health problems - thinning vagina, osteoporosis, deeper wrinkles, less hair - is horrific. Would therapy appear to help all this?”

– Eileen

Answer:

Dr Sarah Jarvis says: “ HRT has been the subject of huge controversy in the last 15 years or so. Until 2002, many doctors thought there were virtually no down sides, and recommended it for almost every woman after the menopause. Then in 2002, an American study called the Women’s Health Initiative study raised the possibility that HRT increased the risk of heart attack and stroke. A year later, the UK Million women study linked HRT with an increased risk of breast cancer and earlier this year, another study suggested a higher likelihood of ovarian cancer among women taking HRT.

But since then the pendulum has swung back – partly because we’ve got the risks into perspective. For instance, HRT tablets increase the risk of deep vein thrombosis and pulmonary embolism (clot on the leg and the lung respectively), but HRT given in patch form doesn’t appear to increase the risk compared to someone not taking HRT. For ovarian cancer, an extra one in 1,000 women are likely to develop ovarian cancer, and an extra one in 1,700 to die from it, as a result of taking HRT for five years. The NICE (National Institute for Health and Care Excellence) states that HRT ‘does not increase cardiovascular disease risk when started in women aged under 60 years and does not affect the risk of dying from cardiovascular disease’. Again, while HRT tablets slightly increase the risk of stroke, HRT patches do not increase the risk.

Taking combined HRT containing oestrogen and progesterone (the recommended form for any woman who hasn’t had a hysterectomy) may increase your risk of breast cancer. The best-guess estimate we have is that for every 200 women taking combined HRT for 5 years, and for every 50 women taking combined HRT for 10 years, one will get cancer who wouldn’t have got it otherwise. This risk does drop after you stop HRT, but taking it for longer does increase your risk.

When it comes down to it, the decision about whether these risks outweigh the benefits of HRT should be yours. However, there are alternatives you could consider to control the hot flushes you are getting. For instance, NICE mentions St John’s wort, isoflavones or black cohosh. However, they do stress that different preparations may vary, that there have been some safety concerns with complementary therapies and that they may interact with other medicines.

Some of the symptoms you describe can be treated without HRT. For instance, topical vaginal oestrogen creams/vaginal rings/pessaries can relieve vaginal dryness and carry a very low risk. Stopping smoking, cutting down alcohol, taking weight-bearing exercise and if necessary tablets called bisphosphonates can protect against osteoporosis. As for the wrinkles, are they really so noticeable to anyone else?”

̶ Dr Sarah Jarvis