From the Research
There is no specific upper age limit for starting hormone therapy (HT) for postmenopausal hot flashes, but it's generally recommended to initiate treatment within 10 years of menopause or before age 60 for optimal benefit-risk ratio.
Key Considerations
- The decision to start hormone therapy later in life requires careful individualized assessment of cardiovascular risk, breast cancer risk, bone health, and symptom severity 1.
- Women over 60 may face higher risks of cardiovascular events, stroke, and breast cancer with HT, so non-hormonal alternatives like certain antidepressants (venlafaxine, paroxetine), gabapentin, or clonidine might be safer options for older women with hot flashes.
Treatment Options
- Common hormone therapy options include estrogen-only therapy (such as oral estradiol 0.5-1mg daily, estradiol patch 0.025-0.05mg/day, or vaginal estrogen) for women without a uterus, or estrogen plus progestogen (such as oral estradiol with medroxyprogesterone acetate 2.5mg daily or micronized progesterone 100-200mg daily) for women with an intact uterus to prevent endometrial cancer 2.
- Treatment should use the lowest effective dose for the shortest duration needed to manage symptoms, typically reassessing every 3-6 months.
Recent Guidelines
- A recent review suggests that hormonal replacement therapy, selective serotonin, and norepinephrine reuptake inhibitors, in addition to lifestyle modification, are the mainstay of treatment for menopausal hot flashes 1.
- Another study found that conjugated estrogens combined with the selective estrogen receptor modulator bazedoxifene is a new progestin-free HT option for alleviating estrogen deficiency symptoms in postmenopausal women with a uterus 3.