I got started on E, P, T at the end of “the window.” By end, I mean photo finish - ten years post-meno and 59 yo. I’ve reaped all the benefits - like the full menu. My parents lived until 95 (dad) and 102 (mom). So I’d like to think that at 59, I am just hitting middle age. ;)
They used oral estrogen (CEE), and progestins, That's why I have them as unsafe option for late-starters in my charts. No studies have ever shown that late start transdermal estradial with micronized progesterone increases dementia risk.
HI, great, clean and clear writing. Thank you! Are there studies done on late start women aside from the WHI? We know that was a failure with the CEE and Progestins but do we have data that is clear on the safety of starting HRT (transdermal E2 with progesterone) after 60? I feel like it's still a data free zone but I would love to find data to share with my patients! I keep getting asked and I feel like I'm in a tough spot when NAMS says after 60 is dangerous. HELP!
Data Free Zone is a good way of describing it. Or, at least, Less Data Than We'd Like Zone. We don't have RCTs on late-start TD estradiol and micronized progesterone. In ELITE, late-start oral E2 + progesterone didn't accelerate or slow CIMT plaque accumulation. In mechanistic studies, TD E2 doesn't increase MMP or clotting factors (so unlikely to increase plaque rupture or VTE). I did a recent Substack on Stroke risk and discussed late-starters there. But, yes, no RCT's to point to here - just observational studies and mechanistic studies.
Great article. Would love to share it with my wife but she won't read it because she'll think I just want sex from her. She's missing out on great health advice because of her stubbornness.
Thank you for all of this! Two years ago, at 68 and 15 years past menopause, I took the small bits of knowledge I could gather and got on MHT. Your fabulous guide will help so many of us "older women". I plan to share it often, most importantly, to my PCP who told me it was too late! Thanks again. 🩵
Thank you. I appreciate the feedback. I hope it's helpful. P.S. Make sure you take my original Substack on Late-Start HRT (my very first Substack) with you to see your doctor as it has more details about risks/benefits with links to key studies.
I'm 68 yo. I've been on 0.05 MG oral delivery estrogen for at least 15 years. I had cervix and uterus removed in 1989. I also take Lipitor (going to ask GP about Azetamide).
Should I change my delivery method of estrogen to cream?
Help I was on a HRT until I was taken off by my Family MD and supposed hormone specialist CNP.
I was taken off due to my age 71.
No provider in my western Colorado region will prescribe. They will only help with tapering off at age 65.
I have contracted long covid . I have been developing difficulty with remembering nouns. I have developed mild stress incontinence. I have lots of joint pain. More importantly, my metabolism has been affected.
Insulin resistance. Weight gain in the middle, hypertension, etc.
I’m off HRT because of hear attack risks. Now I have developed significant heart attack risks.
Where can I find a provider to write a prescription for HRT in Colorado? Help!!!
Transdermal estradiol does not increase CV disease risk. I just did a Substack on stroke risk, which is similar to myocardial infarction risk. Check it out.
I just wrote an entire Substack articles with many references about stroke. It's not a single reference - it's looking through many articles and understanding what they are saying and not saying.
I got started on E, P, T at the end of “the window.” By end, I mean photo finish - ten years post-meno and 59 yo. I’ve reaped all the benefits - like the full menu. My parents lived until 95 (dad) and 102 (mom). So I’d like to think that at 59, I am just hitting middle age. ;)
Thank you for always sharing useful information! Also, the calendar numbers and days of the week killed me.
You're welcome!
Very interesting topic. Can you comment on the WHIMS study showing that women starting HRT decades after menopause face an increased risk of dementia?
They used oral estrogen (CEE), and progestins, That's why I have them as unsafe option for late-starters in my charts. No studies have ever shown that late start transdermal estradial with micronized progesterone increases dementia risk.
HI, great, clean and clear writing. Thank you! Are there studies done on late start women aside from the WHI? We know that was a failure with the CEE and Progestins but do we have data that is clear on the safety of starting HRT (transdermal E2 with progesterone) after 60? I feel like it's still a data free zone but I would love to find data to share with my patients! I keep getting asked and I feel like I'm in a tough spot when NAMS says after 60 is dangerous. HELP!
Data Free Zone is a good way of describing it. Or, at least, Less Data Than We'd Like Zone. We don't have RCTs on late-start TD estradiol and micronized progesterone. In ELITE, late-start oral E2 + progesterone didn't accelerate or slow CIMT plaque accumulation. In mechanistic studies, TD E2 doesn't increase MMP or clotting factors (so unlikely to increase plaque rupture or VTE). I did a recent Substack on Stroke risk and discussed late-starters there. But, yes, no RCT's to point to here - just observational studies and mechanistic studies.
Thank you for taking time to confirm! We press onward!!
Thanks for sharing!
Great article. Would love to share it with my wife but she won't read it because she'll think I just want sex from her. She's missing out on great health advice because of her stubbornness.
Tell her I don't mention sex at all in this article!
Thank you for all of this! Two years ago, at 68 and 15 years past menopause, I took the small bits of knowledge I could gather and got on MHT. Your fabulous guide will help so many of us "older women". I plan to share it often, most importantly, to my PCP who told me it was too late! Thanks again. 🩵
Thank you. I appreciate the feedback. I hope it's helpful. P.S. Make sure you take my original Substack on Late-Start HRT (my very first Substack) with you to see your doctor as it has more details about risks/benefits with links to key studies.
I'm 68 yo. I've been on 0.05 MG oral delivery estrogen for at least 15 years. I had cervix and uterus removed in 1989. I also take Lipitor (going to ask GP about Azetamide).
Should I change my delivery method of estrogen to cream?
Help I was on a HRT until I was taken off by my Family MD and supposed hormone specialist CNP.
I was taken off due to my age 71.
No provider in my western Colorado region will prescribe. They will only help with tapering off at age 65.
I have contracted long covid . I have been developing difficulty with remembering nouns. I have developed mild stress incontinence. I have lots of joint pain. More importantly, my metabolism has been affected.
Insulin resistance. Weight gain in the middle, hypertension, etc.
I’m off HRT because of hear attack risks. Now I have developed significant heart attack risks.
Where can I find a provider to write a prescription for HRT in Colorado? Help!!!
What about patients with previous myocardial infarctus? 64 years old.
Transdermal estradiol does not increase CV disease risk. I just did a Substack on stroke risk, which is similar to myocardial infarction risk. Check it out.
Do you have a medical reference for this?
I just wrote an entire Substack articles with many references about stroke. It's not a single reference - it's looking through many articles and understanding what they are saying and not saying.
Does the vaginal estrogen help bones? What about women who have had breast cancer? Any new evidence there?
No. It only works on the pelvic floor.
No risk for breast cancer woman, no effect on bones
Sorry, I mean other methods for BC not vaginal. But was curious about vaginal in bones since some does go systemic.
Love this and LOVE the hed. :)
Thanks Liz!