10 Million Elderly Women HRT Study: Does HRT Benefit the Elderly? by Jeffrey Dach MD

I frequently get this question on HRT for the elderly: What about HRT for women older than 65? Is there a benefit? And what is the risk? Should doctors offer the elderly woman over 65, menopausal hormone replacement (HRT)? Lucky for us, the answer was published in 2024 by Dr. Seo H. Baik in the Journal, Menopause. Dr. Baik examined Medicare records for 10 million senior Medicare women from 2007-2020.

Estrogen Monotherapy After Age 65

The use of estrogen monotherapy after age 65 was compared to never use or discontinued use.  Estrogen use was associated with almost 20% risk reduction in mortality. Other risk reductions in  percentages were: breast cancer 16%, lung cancer 13%, and colorectal cancer 12% risk reduction. These benefits are seen in women aged 65 to 79 using low-dose transdermal or vaginal estrogen for managing menopausal symptoms like hot flashes and night sweats. (1)

Combined Estrogen/Progestin

The use of estrogen and progestogen combo-therapy exhibited significant risk reductions in endometrial cancer (45%) and ovarian cancer (21%).

So, yes, there is a benefit.

Adverse effects are related to excessive estrogen dosage, which may cause breast tenderness, fullness, or pain. These symptoms are obvious to the patient, who will then take a few days off from the topical hormone product, and once symptoms have resolved, then resume at a lower dosage.

In 2025, Dr. Panagiotis Anagnostis writes:

However, low or ultra-low dose (25 or 12.5 μg of 17β-E2), preferably by the transdermal route, conveys the safest option for postmenopausal women in this age group who have troublesome VMS (vasomotor symptoms), in the absence of contraindications (e.g. history of hormone-sensitive cancer. (2)

Other Benefits of Estrogen

In 2024, Dr. Chengmei Zhang studied the benefits of estrogen in the elderly, finding estrogen has potent neuroprotective properties. Estrogen plays an important bioenergetic role in mitochondrial metabolism in skeletal muscle in prevention of sarcopenia, a form of muscle wasting seen in the elderly. Dr. Zhang writes:

The deficiency of estrogen in menopause has been linked to changes in brain structure, connectivity, energy metabolism. Therewith, these are crucial factors in cognitive function and the risk of Alzheimer’s diseases. Besides, it leads to endocrine and metabolic dysfunction, resulting in osteoporosis, metabolic syndrome, and a tendency toward decreased muscle mass and strength. Estrogen’s influence on mitochondrial function is particularly relevant to aging, as it affects the production of ATP and the overall metabolic health of the brain. Estrogen decline in women skeletal muscle mass is usually related to sarcopenia, a prevalent disease observed in vulnerable elderly individuals.  (3)

Conclusion: Yes, there is considerable benefit for the over-65 age group, and my office will provide these women HRT using bioidentical hormone formulas.

If you liked this article, you might like my new book, Bioidentical Hormones 101 2nd Edition (2025) paperback and ebooks on Amazon. 

Click Here for link to ebook Bioidentical Hormones 101 Second Edition (2025) by Jeffrey Dach MD. This is a Three Volume Series e-book

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Bioidentical Hormones for Breast Cancer Survivors  Video Presentation

Articles with Related Interest:

Hormone Replacement for Breast Cancer Survivors Part One

Hormone Replacement for Breast Cancer Survivors Part Two

Estrogen Metabolism, Iodine, 2MEO Part Three

Testosterone for Breast Cancer Prevention and Treatment

All Bioidentical Hormone Articles

Header Image: Courtesy of Wikimedia Commons. Portrait of Aline Pasquiou-Quivoron, Mère de l’artiste, 1860, oil on canvas Source/Photographer Artbook – Impressionism and its overlooked Woman 2024. Public Domain.

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
my blog: www.jeffreydachmd.com 

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
my blog: www.jeffreydachmd.com 
Bioidentical Hormones 101 Second Edition
Menopausal Hormone Replacement, Health Benefits
Natural Thyroid Toolkit by Jeffrey Dach MD
Cracking Cancer Toolkit by Jeffrey Dach MD
Heart Book by Jeffrey Dach MD

References:

1) Baik, Seo H., Fitsum Baye, and Clement J. McDonald. “Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses.” Menopause (2024): 10-1097.

Objectives: The study aims to assess the use of menopausal hormone therapy beyond age 65 years and its health implications by types of estrogen/progestogen, routes of administration, and dose strengths.

Methods: Using prescription drug and encounter records of 10 million senior Medicare women from 2007-2020 and Cox regression analyses adjusted for time-varying characteristics of the women, we examined the effects of different preparations of menopausal hormone therapy on all-cause mortality, five cancers, six cardiovascular diseases, and dementia.

Results: Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%). For the use of estrogen and progestogen combo-therapy, both E+ progestin and E+ progesterone were associated with increased risk of breast cancer by 10%-19%, but such risk can be mitigated using low dose of transdermal or vaginal E+ progestin. Moreover, E+ progestin exhibited significant risk reductions in endometrial cancer (45% or adjusted hazards ratio, 0.55; 95% CI, 0.50-0.60), ovarian cancer (21%), ischemic heart disease (5%), CHF (5%), and venous thromboembolism (5%), whereas E+ progesterone exhibited risk reduction only in CHF (4%).

Conclusions: Among senior Medicare women, the implications of menopausal hormone therapy use beyond age 65 years vary by types, routes, and strengths. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with E2 rather than conjugated estrogen.

A recent study analyzing data from 10 million senior Medicare women between 2007 and 2020 found that hormone therapy (HT) use beyond age 65 may be safe and even beneficial for managing menopause symptoms like hot flashes. The study suggests that age alone should not be a reason to discontinue HT, but that the type, route, and dose of therapy matter. It also found that estrogen monotherapy beyond age 65 was associated with reduced mortality and other health benefits.

2) Anagnostis, Panagiotis, et al. “Can menopausal hormone therapy be considered in postmenopausal women who are older than 60 years?.” Gynecological Endocrinology 41.1 (2025): 2468957.

However, low or ultra-low dose (25 or 12.5 μg of 17β-E2), preferably by the transdermal route, conveys the safest option for postmenopausal women in this age group who have
troublesome VMS, in the absence of contraindications (e.g. history of hormone-sensitive cancer.

3) Zhang, Chengmei, et al. “Research progress on the correlation between estrogen and estrogen receptor on postmenopausal sarcopenia.” Frontiers in endocrinology 15 (2024): 1494972.

Estrogen is a necessary sex steroid and potent neuroprotective hormone. It plays a multifaceted role beyond the reproductive system, extending its influence to the brain, skeletal muscle, and other organs. Estrogen’s role in cognition, mood, autonomic regulation, and neuroprotection involves interactions with neurotransmitters, neuromodulators in a distributed manner. Notably, the
impact of estrogen on mitochondrial metabolism in skeletal muscle is particularly significant due to a unique modulated bioenergetic profiles, synaptic plasticity, and neuronal health. The deficiency of estrogen in menopause has been linked to changes in brain structure, connectivity, energy
metabolism. Therewith, these are crucial factors in cognitive function and the risk of Alzheimer’s diseases. Besides, it leads to endocrine and metabolic dysfunction, resulting in osteoporosis, metabolic syndrome, and a tendency toward decreased muscle mass and strength. Estrogen’s influence on mitochondrial function is particularly relevant to aging, as it affects the production of ATP and the overall metabolic health of the brain. Estrogen decline in women skeletal muscle mass is usually related to sarcopenia, a prevalent disease observed in vulnerable elderly individuals. Therefore, estrogen is considered to play a crucial role in skeletal muscle homeostasis and motor ability, although the exact mechanism remains unclear. This paper reviews the literature on the impact of estrogen on postmenopausal skeletal muscle diseases and the underlying molecular mechanisms, especially in terms of mitochondrial metabolism. In summary, estrogen plays an important role in the health of skeletal muscle in postmenopausal women, and its impact on mitochondrial function and homeostasis offers potential targets for the development of new strategies to treat sarcopenia

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Published on September 8th, 2025 by Jeffrey Dach MD