Let me tell you what happened to my patients after 2002.
A study came out. It had flaws we did not fully understand for years. The headlines were terrifying. Breast cancer. Heart disease. Stroke. And overnight, doctors stopped prescribing hormone therapy to millions of women. Women who were doing well. Women whose symptoms had not stopped. Women who were protected.
They told them to stop. Or they scared them into stopping themselves.
Many of those women were over 60.
That decision, made in the wake of a deeply misinterpreted study, has consequences we are still measuring. And a new study published in the journal Menopause in 2024 adds to a growing body of evidence that what we did to older women in the name of caution was, in many cases, the opposite of safe.
One clarification before we go further. Everything in this piece is about systemic hormone therapy: patches, pills, gels, creams, and injections that circulate estrogen throughout the body. Vaginal estrogen is a different category entirely. It stays local. It is absorbed into the bloodstream in amounts so small they do not raise systemic estrogen levels meaningfully. Virtually every woman can use vaginal estrogen for as long as she needs it, including women with a history of breast cancer. There is no age limit on vaginal estrogen. There is no controversy. If your doctor stopped your vaginal estrogen along with your systemic therapy, that deserves a separate conversation.
What the research actually shows
Researchers from the National Library of Medicine analyzed prescription records from more than 10 million women on Medicare, aged 65 and older, between 2007 and 2020. These are women who kept using hormone therapy past 65, women who stopped, and women who never started. The researchers looked at what happened to them over time across 13 health outcomes: all-cause mortality, five cancers, six cardiovascular conditions, and dementia.
The findings for estrogen monotherapy, estrogen used alone, are striking.
Women who continued estrogen after age 65 had a 19 percent lower risk of dying from any cause compared to women who stopped or never used it. They had a 16 percent lower risk of breast cancer. A 13 percent lower risk of lung cancer. A 12 percent lower risk of colorectal cancer. An 11 percent lower risk of heart attack. A five percent lower risk of congestive heart failure. A four percent lower risk of atrial fibrillation. A three percent lower risk of blood clots. A two percent lower risk of dementia.
Read those numbers again. Because your doctor may never have told you any of them.
The picture is more nuanced for combination therapy, estrogen plus a progestogen. When synthetic progestins are involved, breast cancer risk does increase by 10 to 19 percent. That is real and it matters. But here is what also matters: That risk can be substantially mitigated by using low-dose, transdermal or vaginal formulations rather than oral preparations. The data also showed that women using estrogen plus a progestin had a 45 percent lower risk of endometrial cancer, 21 percent lower risk of ovarian cancer, and meaningful reductions in cardiovascular risk.
There is also an important distinction between synthetic progestin and natural progesterone. Progesterone monotherapy was associated with a 22 percent reduction in mortality and a 10 percent reduction in breast cancer risk. Synthetic progestin monotherapy was associated with an 11 percent increase in mortality and a 21 percent increase in breast cancer risk. These are not the same molecule. They are not interchangeable. The type of hormone you are on matters.
In plain terms
The best outcomes in this study came from three things: lower doses, transdermal or vaginal delivery rather than oral pills, and estradiol rather than conjugated equine estrogen. That is not a coincidence. It is the direction that the clinical evidence has been pointing for years.
What the guidelines actually say
Here is something many women over 60 do not know. The Menopause Society, the leading professional organization for menopause medicine in North America, does not specify an age at which hormone therapy must stop. Their 2022 position statement is explicit: The decision to continue hormone therapy should be individualized, based on a woman's symptoms, quality of life, personal health history, and her own informed preferences in consultation with her clinician.
There is no expiration date written into the guidelines.
The clinical principle is this: If hormone therapy was appropriate for you at 52, the reason to stop it is not that you turned 60. The reason to stop it is a documented change in your health risk profile that outweighs the benefits, or the resolution of symptoms you were treating in the first place, or your own decision that you no longer want it.
Age alone is not the answer.
Why this matters so much right now
The same study that showed these protective effects also showed something else. The proportion of women over 65 using any hormone therapy dropped from 11.4 percent in 2007 to 5.5 percent in 2020. Women are not stopping because their doctors evaluated their individual risk and concluded the benefits no longer outweighed them. Women are stopping because their doctors were taught that 65 is the cutoff. Or because their pharmacists flagged a warning. Or because a family member looked it up and got scared. Or because no one ever told them it was still an option.
That is not individualized medicine. That is a blanket policy applied to millions of women based on a fear response to data that has been substantially reinterpreted in the years since.
The women in this study who were still on estrogen after 65 were living longer, getting less cancer, having fewer heart attacks, and developing less dementia than the women who stopped.
That is the conversation your doctor should be having with you.
A note on vaginal estrogen specifically
If you are using vaginal estrogen for dryness, discomfort, recurrent urinary tract infections, or any of the symptoms of genitourinary syndrome of menopause, do not stop it. Do not let anyone tell you that you need to stop it because of age. Vaginal estrogen is local therapy. The systemic absorption is minimal. The major medical societies, including the North American Menopause Society and the American College of Obstetricians and Gynecologists, have stated that vaginal estrogen is safe for the vast majority of women, including most women with a history of breast cancer. It does not carry the risks associated with systemic therapy. Every woman who needs it can and should use it for as long as she needs it.
What you can do
If you are over 60 and on systemic hormone therapy and your doctor has suggested you stop because of your age, ask them what specific clinical finding in your health history supports that recommendation. "You're 60" is not a clinical finding.
If you stopped systemic hormone therapy because of the 2002 headlines and have wondered ever since whether that was the right call, it is worth revisiting. The evidence has continued to evolve. You are allowed to ask the question again.
If you have a mother, an aunt, a friend in her 60s who was told her symptoms just have to be tolerated now because she is too old for hormone therapy, please share this with her. She deserves to know what the research actually shows.
Menopause is inevitable. Suffering is not. Neither is accepting an arbitrary age cutoff in place of actual clinical reasoning.
