Red Hot Mamas In Charge of Change.
By: Red Hot Mamas
Published: February 8, 2026
Initiation of Hormone Therapy After Age 65 Remains Risky but Still Works for Some Women
New large-scale study concludes that older women should receive individualized risk-benefit assessment and close monitoring before continuing or initiating hormone therapy
CLEVELAND, Ohio (Feb 4, 2026)—Hormone therapy (HT) has proven effective for managing hot flashes and other common menopause symptoms, but questions remain about long-term safety, especially in women aged older than 65 years. A new study evaluated the health outcomes of HT in women aged 65 years and older, including women who initiated therapy after age 65 years. Results of the study are published online today in Menopause, the journal of The Menopause Society.
Despite current guidelines that recommend the initiation of HT before age 60 or within 10 years of menopause onset, a notable proportion of older women continue or begin HT later in life. This is not surprising, given that a number of more recent studies show that some women continue to experience hot flashes and other bothersome menopause symptoms after the age of 65. In 2015, more than a third of HT prescriptions in the United States were written for women aged older than 60 years.
The risks and benefits of HT have been debated in numerous studies over the years, which has led to an evolving understanding of HTT and the importance of individualized risk-benefit assessments for each woman. The Menopause Society recognizes that there is no universal age limit for discontinuing HT. For healthy women with persistent bothersome symptoms, continuing HT after 65 years may be a reasonable option, provided it is undertaken with careful risk-benefit assessment, judicious selection of HT dose and regimen, and ongoing counseling.
In this latest retrospective cohort study from Israel, more than 83,000 women aged 50 years and older were evaluated over a 22-year span. They were categorized by age at time of HT initiation. Outcomes included malignancies, cardiovascular events, osteoporosis, and dementia.
Hormone therapy use was associated with increased risk of several malignancies (especially breast cancer). In crude analyses, women initiating HT aged 50 to 65 years had lower ischemic heart disease or myocardial infarction prevalence but higher hypertension. In adjusted Cox models, initiation at 65 years or older was associated with increased hazards of any cancer, cerebrovascular accident, and ischemic heart disease or myocardial infarction. The crude cardiovascular advantage was not observed after adjustment. Increasing duration of HT use was accompanied by higher morbidity, reinforcing the cumulative burden associated with advancing age and prolonged HT exposure.
Given that a percentage of women aged older than 65 years are continuing to safely and effectively use HT, despite the added risks, the researchers believe these findings reinforce the importance of individualized risk-benefit assessment for HT use, especially in older women, along with ongoing, regular assessment and consideration of nonhormone alternatives.
Study results are published in the article “Health outcomes of hormone therapy initiated or continued after age 65.”
“Although these findings are limited by a lack of information about the formulation (including concomitant use of a progestogen), dose, and route of administration of hormone therapy used and subject to the usual limitations of an observational study, the study authors reinforce current recommendations for a personalized approach to hormone therapy use with regular reassessment of risks and benefits for women as they age,” says Dr. Stephanie Faubion, medical director for The Menopause Society.
Karen Giblin’s Hot Take:
HT May Still Be Reasonable for Some After 65…Key Facts for Women…
Still Having Hot Flashes After 65? You’re Not Alone
At Red Hot Mamas®, we know that the conversation about hormone therapy (HT) doesn’t end after 60. Many women continue to struggle with bothersome menopause symptoms later in life — and decisions about HT can feel complicated. This month, we’re spotlighting a new large-scale study that looks closely at the effects of starting or continuing hormone therapy after age 65 and what it means for women today.
Hormone Therapy After 65: What This New Study Means for You
Many women are surprised to learn that menopause symptoms don’t always stop right at 60 or 65. Hot flashes, night sweats, and sleep problems can continue for years — even decades — after menopause. Because of this, some women choose to start or stay on hormone therapy (HT) later in life to get relief and improve their quality of life.
A new large study published in Menopause, the journal of The Menopause Society, looked at the health outcomes of more than 83,000 women aged 50 and older over a 22-year period. The researchers wanted to better understand how starting or continuing hormone therapy after age 65 affects health risks like heart disease, cancer, and dementia.
Here’s what they found in plain language:
- Women who began HT at age 65 or older had a higher risk of certain health problems, including cancer and heart-related conditions, compared with younger women.
- The longer women stayed on HT, the more those risks tended to increase — likely because both age and time on hormones can add to overall risk.
- But for some healthy women who continue to have bothersome menopause symptoms, staying on HT after age 65 can still be reasonable, as long as decisions are made carefully and reviewed regularly.
Experts like Dr. Stephanie Faubion of The Menopause Society emphasize that there’s no one-size-fits-all age to stop or start hormone therapy. Instead, it’s about finding a balance that’s right for you. That means working closely with your healthcare provider to regularly review your personal risks and benefits, the type and dose of hormones used, and whether nonhormone options might also help.
The bottom line: this study reinforces what many women already know — menopause is not the same for everyone. If you’re over 65 and still dealing with symptoms that affect your comfort or daily life, don’t assume HT is automatically “off-limits.” A thoughtful, individualized plan with your healthcare provider can help you make the safest and most effective choice for you.
Karen’s Takeaway
- Talk with your healthcare provider. Ask how your personal and family health history might affect your risks or benefits from hormone therapy.
- Review regularly. If you’re already using HT, check in with your doctor at least once a year to reassess your dosage, delivery method, and ongoing need.
- Explore all options. Some women find relief from nonhormone medications, lifestyle changes, or complementary therapies.
- Stay informed. Research continues to evolve. What matters most is tailoring treatment to you — your body, your symptoms, and your quality of life.
Let’s Keep the Conversation Going
Have you continued or started hormone therapy after 65? What helped you make your decision? Share your experience or questions with me at kgiblin@redhotmamas.org — your story may help another woman feel informed and less alone.
