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Is it too late to start HRT at 60? — Ask Dr Jean

Ask Dr Jean 3 Sep 2018
Ask dr jean envelope pink

When it comes to women's health, there is no such thing as a silly question. Do you have a question you want answered, but have been too afraid or embarrassed to bring it up with your GP? Or you forgot to ask while you were in the doctor's surgery? Now, you can 'Ask Dr Jean'.


This question has been answered by Jean Hailes endocrinologist (hormone specialist) Dr Sonia Davison (pictured).

Dr Sonia Davison

Question

Dear Dr Jean. Is it too late to start HRT at 60? I take calcium and vitamin D 120mg daily. My bone density is diminishing, I am now osteopenic lumbar spine. My GP has been reluctant to commence HRT as my blood pressure is borderline high. I would like to start HRT to assist stasis in bone density. Does biomedical HRT work? Would this raise my blood pressure? Many thanks

Answer

Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.

It is not common to start hormone therapy for bone health at or after the age of 60. By the age of 60, arteries are generally stiffer and women at this age are more at risk of cardiovascular disease, hence commencing hormone therapy may increase their risk of cardiovascular disease or events. High blood pressure would increase this risk as well. Bioidentical custom-compounded hormone therapy probably confers the same risks as conventional hormone therapy, but lacks safety data, so is not recommended (read our recent article on bioidentical hormone therapy here).

The general recommendations for bone health at age 60 years include maximising weight-bearing exercise, calcium within the diet around 1300mg per day, and maintenance of vitamin D levels around 75nmol/L, plus avoidance of risk factors such as alcohol excess and smoking. A specialist referral may be useful to discuss this further, in terms of aiming for prevention of osteoporosis and fracture.

There is excellent information on the Australasian Menopause Society website about hormone therapy for bone health up to the age of 60 years:

https://www.menopause.org.au/hp/information-sheets/622-osteoporosis