Too old for hrt?

Despite the loosening of medical stance about hrt in general as the early panic over the Women's Health Initiative Study has waned, many women have encountered the seemingly hard stop-date of 65 on their HRT prescriptions despite being in surgical menopause and still experiencing considerable hormone supplementation need.

Recent research has, however, begun to validate (because goodness knows they couldn't believe us about it) the persistence of hot flashes well beyond the conventional "just a few months" and in fact into years if not decades post-menopause. This has, in turn, led to reappraisal of that upper limit for treatment.

The North American Menopause Society (NAMS) has taken this research into account in their latest position statement, NAMS Supports Judicious Use of Systemic Hormone Therapy Even After Age 65. Here are the money quotes from that release:
“The official position of NAMS is that there shouldn’t be hard and fast rules against hormones after age 65,” said Wulf Utian, MD, medical director for NAMS. “Yes, there may be safety concerns, and the Society does recommend that a woman use the lowest dose of hormones for the time appropriate to meet her needs. But we know that, under some circumstances, hormone therapy can be appropriate for women over age 65, such as those instances when the benefits of treating hot flashes outweigh the risks or when a woman has a high risk of bone fractures and can’t take other bone drugs or can’t withstand their side effects.”
“The use of hormone therapy should be individualized and not discontinued solely based on a woman’s age,” said Dr. Utian. “NAMS encourages all women bothered by their menopause symptoms to seek the help they need and consider all of their options with the guidance of their clinician.”
What does this do for us? If our doctor suddenly decides to cut us off despite our work to keep our HRT dose reduced to reflect our decreasing needs as we age, providing them with a copy of this statement may help them find their way to updating their understanding of the current standards for HRT use. And if we're interviewing a new doctor, asking if they are familiar with this new recommendation and are willing to prescribe accordingly can help us make sure we're working with a doctor who shares our interest in maintaining our menopausal health. While not all of us in surgical meno will need to supplement our estrogen past the age of 65, it's wonderful to finally have explicit medical guidance that we may do so if we need it.