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.
For more information about menopause and healthy aging, visit www.menopause.org.
The Menopause Society is dedicated to empowering healthcare professionals and providing them with the tools and resources to improve the health of women during the menopause transition and beyond. As the leading authority on menopause since 1989, the nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for healthcare professionals, researchers, the media, and the public and leads the conversation about improving women’s health and healthcare experiences. To learn more, visit menopause.org.