Estrogen therapy, also known as menopausal hormone therapy (MHT), replaces the estrogen a woman’s body no longer produces after menopause. This treatment addresses menopausal symptoms and related health concerns. For women aged 70, the decision to pursue estrogen therapy is complex and highly individualized, requiring careful consideration of personal health history, potential risks, and benefits.
Estrogen Therapy in Later Life
Estrogen therapy replaces hormones that decline during menopause, primarily estrogen. Traditionally, it was initiated around menopause to alleviate symptoms like hot flashes and vaginal dryness. Medical understanding has evolved, with recent research refining guidelines, particularly regarding age and duration of use.
Considerations for older women differ from those starting therapy closer to menopause. The timing of initiation significantly impacts the risk-benefit profile. Current guidelines do not recommend hormone therapy for preventing chronic conditions in postmenopausal women. The decision remains highly individual, depending on each woman’s unique health and circumstances.
Weighing the Decision at 70
Deciding whether a 70-year-old woman should take estrogen therapy involves a careful assessment of potential benefits against associated concerns. This evaluation is deeply rooted in an individual’s health history, existing medical conditions, and specific menopausal symptoms. The type of estrogen, its delivery method (e.g., oral, transdermal), and the duration since menopause also influence the risk-benefit balance.
For some women, estrogen therapy might be considered for severe vasomotor symptoms like hot flashes and night sweats, which can significantly affect quality of life. Estrogen is considered the most effective treatment for these symptoms. Another potential benefit is addressing genitourinary syndrome of menopause (GSM), which includes symptoms like vaginal dryness and discomfort. Low-dose local estrogen treatments, such as vaginal creams, tablets, or rings, are often effective for GSM with minimal systemic absorption, leading to fewer risks.
Estrogen therapy can also help maintain bone density and reduce the risk of fractures due to osteoporosis, particularly if started earlier in menopause. However, for women over 70, its role in bone health is typically a continuation of prior therapy, as significant bone protection is closer to menopause.
Concerns associated with estrogen therapy increase with age and duration since menopause. For women aged 60 or older, or more than 10 years past menopause, the risk of serious complications from systemic estrogen therapy tends to increase. Cardiovascular health is a significant consideration; while estrogen therapy may have a cardiovascular benefit when initiated early, studies indicate an increased risk of heart disease and mortality for women in their 70s who start therapy. Oral estrogen therapy can increase the risk of blood clots, including deep vein thrombosis and stroke, because it is metabolized in the liver. Transdermal forms bypass the liver, potentially carrying a lower risk of blood clots and stroke.
Specific cancer risks also require attention. Combination therapy with estrogen and progestin can increase breast cancer risk, with the risk rising the longer it is taken and with increasing age. Estrogen-only therapy, however, has been associated with a decreased risk of breast cancer in some studies, particularly in women who have had a hysterectomy.
For women with an intact uterus, taking estrogen alone can increase the risk of endometrial cancer, necessitating the addition of a progestin to protect the uterine lining. Both estrogen-only and combined estrogen-progestin therapies have been linked to an increased risk of gallbladder disease and the need for gallbladder surgery. The risk of gallstones appears higher with oral estrogen compared to transdermal forms.
Consulting Your Healthcare Provider
Engaging in a thorough discussion with a qualified healthcare provider is important when considering estrogen therapy at age 70. This consultation should involve a gynecologist, endocrinologist, or primary care physician. The discussion should cover the woman’s complete personal health history, including pre-existing medical conditions and family history of diseases like cancer or cardiovascular issues.
Women should discuss the severity and impact of their menopausal symptoms on daily life, along with their treatment goals. This helps the provider assess whether potential benefits outweigh risks in her specific situation. Shared decision-making is a core component, integrating the woman’s values and preferences with medical evidence. The healthcare provider may recommend diagnostic tests, such as bone density scans, mammograms, and cardiovascular risk assessments, to inform the decision.
Exploring Non-Hormonal Options
For women aged 70 not suitable for or not wishing to use estrogen therapy, several non-hormonal approaches can help manage menopausal symptoms. Lifestyle modifications can alleviate symptoms like hot flashes. Adjustments include dressing in layers, keeping the bedroom cool, and avoiding triggers such as spicy foods, caffeine, and alcohol. Regular exercise, maintaining a healthy weight, and quitting smoking also contribute to overall well-being and may reduce symptom severity.
Various over-the-counter remedies and prescription medications address specific symptoms. For vaginal dryness, non-hormonal vaginal moisturizers and lubricants provide relief. For hot flashes, prescription non-hormonal options include certain antidepressants (SSRIs, SNRIs), gabapentin, or pregabalin. Fezolinetant, a newer medication, blocks specific nerve pathways involved in hot flash production. Mind-body techniques like cognitive behavioral therapy (CBT) and hypnosis also show promise in reducing the impact of vasomotor symptoms.