From the Guidelines
Hormone replacement therapy (HRT) is not recommended for a 75-year-old postmenopausal woman due to the increased risks of cardiovascular events, stroke, blood clots, and breast cancer. The Women's Health Initiative study, as referenced in the USPSTF recommendations 1, demonstrated that the harms of estrogen-progestin therapy are likely to outweigh the chronic disease prevention benefits for most women. The absolute increase in risk from HRT is modest, but it becomes more pronounced with advancing age.
Risks and Benefits
The study found that 10,000 women taking estrogen and progestin for 1 year might experience 7 additional coronary heart disease (CHD) events, 8 more strokes, 8 more pulmonary emboli, and 8 more invasive breast cancers, but would also have 6 fewer cases of colorectal cancer and 5 fewer hip fractures 1. However, these benefits do not outweigh the risks for most women, especially at the age of 75.
Alternative Treatments
If the woman is experiencing menopausal symptoms like hot flashes or vaginal dryness, alternative treatments should be considered. For hot flashes, options include certain antidepressants like venlafaxine or paroxetine at low doses, gabapentin, or lifestyle modifications. For vaginal symptoms, low-dose vaginal estrogen preparations (creams, rings, or tablets) may be appropriate as they have minimal systemic absorption.
Decision Making
Any decision regarding hormone therapy should be made after a thorough discussion with her healthcare provider, taking into account her specific health history, risk factors, and quality of life concerns. Clinicians should develop a shared decision-making approach to preventing chronic diseases in perimenopausal and postmenopausal women, considering individual risk factors and preferences in selecting effective interventions for reducing the risks for fracture, heart disease, and cancer 1.
From the FDA Drug Label
The Women’s Health Initiative Memory Study, including 4,532 women 65 years of age and older, followed for an average of 4 years, 82% (n = 3,729) were 65 to 74 while 18% (n = 803) were 75 and over. Women treated with conjugated estrogens plus medroxyprogesterone acetate were reported to have a two-fold increase in the risk of developing probable dementia. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greatest frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy
Hormone Replacement Therapy (HRT) is not recommended for a 75-year-old postmenopausal woman due to the increased risk of dementia and other potential adverse effects. The Women's Health Initiative Memory Study found a two-fold increase in the risk of developing probable dementia in women treated with conjugated estrogens plus medroxyprogesterone acetate 2. Additionally, the drug label recommends cautious dose selection for elderly patients, starting at the low end of the dosing range, due to the potential for decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy 2.
From the Research
Hormone Replacement Therapy (HRT) for a 75-year-old Postmenopausal Woman
- The decision to use HRT in a 75-year-old postmenopausal woman should be based on individual assessment of benefits and risks 3, 4, 5.
- HRT is effective in relieving menopausal symptoms, such as vasomotor symptoms and genitourinary syndrome of menopause, and can also prevent osteoporotic fractures 3, 5.
- However, HRT is associated with an increased risk of stroke and breast cancer, particularly with long-term estrogen-progestin use 3, 6, 4.
- The risk-benefit ratio of HRT differs by age, with younger postmenopausal women (less than 60 years old) likely to benefit more from HRT than older women 4, 5.
- For women over 70 years old, HRT should not be used for the prevention of chronic diseases due to the increased risk of stroke and breast cancer 4.
Considerations for HRT in Elderly Women
- Counseling about HRT should be given to all postmenopausal women, taking into account their personal history, attitudes, and risk factors 7.
- The potential benefits of HRT, such as improved quality of life and reduced risk of cardiovascular disease and osteoporosis, should be weighed against the potential risks 3, 7.
- Transdermal routes of HRT administration and natural progesterone may be preferred due to their lower impact on coagulation and breast cancer risk 3.
- Regular reassessment of the woman's health status is mandatory to determine whether the benefits of HRT continue to outweigh the risks 3.