After 60, many patients believe that menopausal hormone therapy (MHT) is no longer an option, or that it inevitably becomes risky. This idea deserves some nuance, because the answer mainly depends on when treatment is started and on each woman's individual situation.

The myth

"After 60, hormone therapy is simply too late and too dangerous."

What the science says

Learned societies distinguish between starting treatment and continuing it. The French National Authority for Health (Haute Autorité de Santé) notes that treating symptomatic menopause is worthwhile when women are significantly troubled by their symptoms, and that the benefit-risk ratio needs to be carefully assessed for each individual woman.

The North American Menopause Society sets out this reasoning by age group: for women under 60, or within 10 years of the start of the menopause, with no contraindications, the benefit-risk balance is favourable for treating bothersome hot flushes and preventing bone loss. However, for those starting hormone therapy more than 10 years after the onset of the menopause, or after the age of 60, the balance appears less favourable, because of higher absolute risks of coronary heart disease, stroke, venous thrombosis and dementia.

This does not mean that a woman already on treatment should stop on her 60th birthday. A recent study published by the same society points out that, despite current guidelines recommending that treatment be started before 60 or within 10 years of the menopause, a significant proportion of older women continue treatment, or start it later in life. The authors stress the importance of a personalised approach, with regular reassessment of risks and benefits as women grow older.

Why it matters

Setting an automatic age cut-off at 60 ignores two realities: some women still have bothersome symptoms well beyond this age, while others tolerate very well a treatment started earlier. Conversely, assuming that age makes no difference at all would overlook the genuine increase in risk seen when treatment is started later in life. So the right question is not "how old am I?" but "what are my symptoms, my medical history and my risk factors today?"

What to remember

Key takeaway

There is no single, automatic age limit: the value and safety of hormone therapy should be reassessed on a case-by-case basis with your doctor, taking into account when the menopause began, your symptoms, and your personal medical history.

Do not hesitate to discuss your specific situation with your doctor: this is the best way to find out whether starting, continuing, or stopping hormone therapy is right for you.