Risks of Hormone Patches in a 68-Year-Old Woman
Hormone patches such as Estraderm (estradiol) are NOT recommended for a 68-year-old postmenopausal woman due to increased risks of stroke, dementia, and venous thromboembolism that outweigh potential benefits at this age. 1, 2, 3
Key Risks for a 68-Year-Old Woman
Cardiovascular Risks
- Stroke: Significantly increased risk (HR 1.36) with estrogen therapy 1
- Venous thromboembolism: 1.92-fold increased risk compared to placebo 4
- Pulmonary embolism: 1.81-fold increased risk 4
- The absolute risk increase for stroke is 6 per 1000 women, for venous thromboembolism 8 per 1000 women, and for pulmonary embolism 4 per 1000 women 4
Cognitive Function Risks
- Dementia: Women over 65 years have a 2.05-fold increased risk of probable dementia with hormone therapy 3
- The absolute risk of probable dementia increases by 23 cases per 10,000 women-years 3
Cancer Risks
- Breast cancer: Increased risk, particularly with combined estrogen-progestin therapy 2
- Ovarian cancer: Meta-analysis shows 1.41 relative risk with hormone therapy 3
Other Risks
- Gallbladder disease: 2-4 fold increased risk requiring surgery 3
- Visual abnormalities: Risk of retinal vascular thrombosis 3
Age as a Critical Factor
Age significantly impacts the risk-benefit ratio of hormone therapy:
- Women who start hormone therapy more than 10 years after menopause (like a 68-year-old) have:
Route of Administration Considerations
While transdermal estradiol may have some advantages over oral administration:
- Lower risk of venous thrombosis compared to oral routes 2, 5
- Avoidance of first-pass hepatic metabolism 6
However, these advantages do not outweigh the overall risks for a 68-year-old woman, as the FDA boxed warning applies to all forms of estrogen therapy 3.
Important Caveats
- The Women's Health Initiative Memory Study specifically demonstrated increased dementia risk in women 65+ years old 3
- The USPSTF and European Society of Cardiology recommend against hormone therapy for women in this age group 2
- The FDA boxed warning emphasizes that estrogens should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals 3
Alternative Approaches
For a 68-year-old woman with menopausal symptoms, consider:
- Low-dose vaginal estrogen for genitourinary symptoms only (minimal systemic absorption) 2
- Non-hormonal options such as SSRIs/SNRIs, gabapentin, or clonidine for vasomotor symptoms 2
The evidence clearly shows that for a 68-year-old woman, the risks of systemic hormone therapy via patches significantly outweigh potential benefits, and safer alternatives should be considered.