Doctors often refrain from prescribing Hormone Replacement Therapy (HRT) to women over the age of 60 or advise stopping HRT after five years due to concerns about blood clots and breast cancer. This caution is based on findings from the Women’s Health Initiative (WHI) study, which observed a slight increase in breast cancer risk at the five-year mark among women who began HRT at an older age, specifically those who used synthetic progesterone and oral estrogen. The synthetic progesterone was identified as the main contributor to the increased breast cancer risk, and oral estrogen, metabolized in the liver, was linked to a higher risk of blood clots.

In the 20+ yrs since the Women’s Health Study, HRT practices have evolved which mitigates these risks. First, modern HRT avoids synthetic progesterone associated with increased risks. We use bio-identical micronized progesterone.  Second, modern HRT does not prescribe oral estrogen to women over 55 or those at risk. Instead, we use transdermal estrogen (the patch), which bypasses liver metabolism and does not carry the same risk of blood clots as pills.

Recent studies, such as the E3N French Study, indicate that using transdermal estrogen and micronized (bio-identical) progesterone does not increase the risk of blood clots and is associated with a lower incidence of breast cancer.

Additional workup for women who want to start HRT after age 60 (or more than 10 years after last period):

It is important to assess your risk for blood clots, which can lead to stroke and heart attack. Unfortunately, the necessary screening tests listed below are not covered by insurance. They generally cost around $60-$120 each. We can provide the prescriptions for these tests for a small fee, or you can request them from your primary care doctor before joining Bloom. Some states do not require a prescription to get the test. Check with the testing facility first.

• Coronary Calcium CT Scan
• Carotid Intima-Media Thickness (CIMT) Test

• Known heart disease
• Smoking
• Obesity
• Inactivity
• Diabetes3
• Uncontrolled blood pressure
• High triglycerides
• High cholesterol
• Known clotting disorder
• History of stroke
• History of blood clots
• History of heart attack

Starting HRT after age 60 requires careful consideration and thorough medical evaluation. While modern HRT practices have mitigated some of the risks associated with synthetic hormones, potential hazards like blood clots and breast cancer still necessitate caution. The above tests will give us real data to assess your actual risk.  We’ll take that along with your history, lifestyle and other risk factors to evaluate your candidacy for HRT.

Cancer Risks

If your concerned about the use of HRT and your risk of cancer there are a few things we can do.  First, if you’ve ever had DNA done by services like Ancestry.com or 23 and me.com take a look at your genes and evaluate certain SNP’s linked to breast cancer, ovarian and how your liver and body detoxifies hormones.  Next, after being on HRT for a few months we can do a DUTCH test to evaluate how your body is metabolizing your hormones. Some people metabolize them down pathways which can increase cancer risk.  This again can be due to your genes so it’s helpful to know what your DNA says.  This can also be due to lifestyle, obesity, metabolic syndrome, and nutritional deficiencies to name a few.  Lot’s of things impact your pathway. If you are metabolizing hormones down the bad pathway we can use supplements and lifestyle changes to alter the pathway and encourage it to take the safer pathway.  The DUTCH test is not covered by insurance and runs $399.  It’s a simple test done at home using dried urine samples taken thorough out the day.  I even recommend young menstruating women obtain this test to look at how their own natural hormones are being metabolized so they can take steps to prevent cancer as they age.  If you have a daughter or granddaughter and want assistance obtaining and interpreting this test reach out to [email protected] and we can help. Why insurance does not cover it and why it’s not routine for all women is really disheartening as it can be so very helpful and a huge step towards prevention. I guess our health system is not set up for this kind of medicine–but I digress…