There is no right answer to the question about how long to take HRT for, and there is no arbitrary age cut-off. The benefits and risks will differ for every woman as they enter their 60s and beyond. That’s why it’s essential that you speak to a healthcare professional experienced in treating the menopause and in prescribing HRT - menopause management is not one size fits all!
HRT is effective in treating the symptoms of the menopause – important when around 5% of women continue to experience symptoms of the menopause for 15 years and longer. In other words, well into their 60s.
HRT is also beneficial in preventing osteoporosis and continuing the prevention of heart disease (if HRT was started early in the menopause.)
- If HRT is started within 10 years of the menopause or before the age of 60, there is evidence that it reduces the risk of heart disease.
- If HRT is started after the age of 60 or after 10 years, the evidence we have suggests that there should not be a significant increase in the risk of heart disease.
- However, there is also evidence suggesting that starting older oral forms of HRT in older age may increase the risk. It's always best to discuss your case and your risk factors for heart disease with a doctor.
The main risks of using HRT to consider are the increase in the risk of breast cancer diagnosis and the increased risk of blood clots and stroke.
The risk of breast cancer increases with age and with the length of time you take HRT. (Other breast cancer risk factors include your weight, your alcohol intake, and whether you smoke. Regular exercise can reduce the risk).
If you have had a hysterectomy, you only need oestrogen-only HRT. This is associated with a lower risk of breast cancer than combined HRT containing oestrogen and progestogen, though the risk of breast cancer is also likely to increase with time if you take oestrogen-only HRT. If you have a womb, you need to take a progestogen to reduce your risk of cancer of the womb.
If you need to take a progestogen, taking Utrogestan™
with oestradiol, or taking Femoston™
oral HRT (which contains oestradiol and dydrogesterone) are likely to have a lower risk of breast cancer than synthetic alternative forms of HRT containing norethisterone. Utrogestan™
and the Mirena™
have never gone head-to-head in trials. The amount of progestogen released into the body from the Mirena™
is low but not zero.
The risk of blood clots – for example, in the leg (deep vein thrombosis), lungs (pulmonary embolism), or brain (stroke) - increases with age. HRT tablets increase the risk further. Having the oestradiol through the skin in the form of a patch, gel or spray will not further increase the risk. If you need to take a progestogen, Utrogestan™
and the Mirena™
should not significantly affect the risk of blood clotting. Older synthetic progestogens – such as norethisterone – do. So, heading into your 60s, it's safer to switch to transdermal oestradiol plus Utrogestan™
or the Mirena™
Studies have suggested that the risk of ovarian cancer diagnosis increases by a small amount, year on year, though there is no evidence that HRT actually causes this [Beral V, Million Women Study C, Bull D, Green J, Reeves G. Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet. (2007) 369:1703–10.]