Hormone Therapy After 65: What Women Need to Know

This is my mom. And she's one of the reasons I believe we need to stop thinking about women's health in terms of arbitrary age cutoffs.

Women don't become less deserving of individualized care when they turn 65. Their needs simply evolve.

65 ISN'T A MAGIC EXPIRATION DATE.

A new large-scale study reinforces an important message: hormone therapy decisions should be individualized—not based on age alone.

If you’re approaching or over 65 and still using hormone therapy, you may have heard a familiar question:

“Aren’t you supposed to stop hormone therapy at 65?”

The answer is more nuanced than a simple yes or no.

A new large-scale observational study published in Menopause, the journal of The Menopause Society, looked at more than 83,000 women age 50 and older over a 22-year period. Researchers examined health outcomes in women who initiated hormone therapy at different ages, including women who started or continued hormone therapy after age 65. The findings deserve attention—but they also need context.

The bottom line: 65 is not a magic expiration date

The Menopause Society does not recommend that every woman automatically discontinue hormone therapy when she turns 65.

For some healthy women who continue to experience significant menopause symptoms, continuing hormone therapy beyond 65 may be reasonable when the benefits continue to outweigh the risks.

But that decision should be individualized and revisited regularly.

And importantly, starting hormone therapy after 65 is a different conversation from continuing therapy that was started earlier in menopause. That distinction matters.

What did the new study find?

The study found that women who initiated hormone therapy at age 65 or older had higher adjusted risks of several serious outcomes, including:

• Certain cancers

• Stroke

• Ischemic heart disease and myocardial infarction

  
  

The researchers also found that increasing duration of hormone therapy was associated with increasing morbidity. However, this was an observational study, which means it can identify associations but cannot prove that hormone therapy itself caused these outcomes.

There were also important limitations. The researchers did not have detailed information about the specific hormone therapy formulations, doses, routes of administration, or whether women were using a progestogen along with estrogen. Those details matter enormously when we're talking about hormone therapy.

Starting at 65 is not the same as continuing at 65

This is one of the most important takeaways.

Current recommendations generally favor initiating hormone therapy before age 60 or within 10 years of menopause onset, when appropriate.

Why?

Because the balance of benefits and risks tends to be more favorable when hormone therapy is started closer to the menopause transition. A woman who began hormone therapy at 52 because she was experiencing severe hot flashes, night sweats, sleep disruption, and other symptoms is not necessarily in the same situation as a woman considering starting hormone therapy for the first time at 67.

Timing matters.

So does the woman's overall health, medical history, symptoms, treatment formulation, dose, route, and personal risk factors.

What about women who still have symptoms after 65?

They absolutely exist.

Some women continue to experience vasomotor symptoms—such as hot flashes and night sweats—well beyond 65.

For some women, these symptoms significantly affect sleep, mood, quality of life, relationships, and daily functioning. For a healthy woman who has been benefiting from hormone therapy, automatically stopping treatment simply because she reached a certain birthday may not be the best approach.

Instead, the conversation should be:

What are the benefits I'm receiving?

What are my risks now?

Has anything changed about my health since I started treatment?

Is my current dose and formulation still appropriate?

Are there nonhormonal options that could work for me?

Those are much more useful questions than simply asking, “Am I too old?”

Hormone therapy should be reassessed as you age

One of the most important principles in menopause care is that hormone therapy isn't a “set it and forget it” treatment.

Your risk profile can change over time. Blood pressure can change. Family history can become more relevant. Medications can change. Your cardiovascular risk can change.Your breast health can change. Your symptoms can change. Your hormone therapy may need to change, too. That doesn't necessarily mean stopping.

It means reassessing.

There is no one-size-fits-all menopause patient

This is why blanket statements about hormone therapy can be so misleading.

“Everyone should take hormones.”

“Everyone should stop at 65.”

“Menopause is natural, so you shouldn't treat it.”

None of these statements captures the complexity of menopause care.

The right question is:

What is appropriate for this woman, at this stage of her life, given her symptoms, goals, health history, and individual risk profile?

That is the foundation of personalized menopause care.

What should you do if you're over 65 and taking—or considering—hormone therapy?

Don't make a decision based on your birthday alone.

Instead, have a thorough conversation with a qualified menopause healthcare professional about:

• Why you started hormone therapy

• Whether your symptoms are still affecting your quality of life

• Your cardiovascular and breast cancer risk

• Your blood pressure and other health factors

• Your current hormone formulation, dose, and route

• Whether your current treatment remains appropriate

• Nonhormonal alternatives

• Whether any changes should be made to your treatment

  
  

And if you've been feeling well on your therapy, don't stop abruptly simply because you've heard that 65 is the cutoff. The best menopause care is individualized, evidence-informed, and regularly reassessed.

At Follaine Health, we believe women deserve better than blanket rules.

You deserve to understand why a treatment may be right for you—or why it may no longer be.

Menopause care should evolve as you do.

Your age is one piece of the picture. It isn't the whole picture.

Ready for a More Personalized Approach to Menopause Care?

Your menopause journey doesn't come with an expiration date—and neither should your questions.

At Follaine Health, we help women navigate menopause, hormone therapy, nutrition, exercise, and healthy aging with a personalized, evidence-informed approach.

If you're wondering whether hormone therapy is right for you, whether your current treatment still makes sense, or simply want to better understand your options, let's talk.

Book a Call with Follaine Health

Take the first step toward understanding your options and creating a menopause health plan that makes sense for you.

Your health. Your hormones. Your next chapter.

This article is for educational purposes only and is not individual medical advice. Hormone therapy decisions should be made with a qualified healthcare professional who understands your personal medical history and risk factors.

Source: The Menopause Society, “Health outcomes of hormone therapy initiated or continued after age 65,” published in Menopause, February 4, 2026.