No! It is not too late. Just be sure to start low and go slow to avoid untoward effects as she has been deficient for a while. Only use oral estradiol if you want the best benefit for her. Oral estradiol will not cause dislodging of any plaque that may have been building in the cardiovascular system. It was Premarin that caused blood clots and that was seen in women over the age of 60 and only in the first year of use. Why? because Premarin produces an enzyme when metabolized that can dislodge clots. Fatty acid esters decrease the formation of hard plaque only seen in oral estradiol. However, start her at 1.0 mg, test in 1 month, and titrate by 0.25mg monthly until symptoms improve and/or a blood serum level between 75-100 pg/ml. However, if she has a history of blood clots or congenital thrombophilia you may want to use transdermal. Not because oral E2 causes clots, but because she will eventually have another and you will get blamed. There are actually very sound studies that show oral estradiol reduces intima-media thickness (IMT). Regardless if she has a uterus or not, she should also be put on oral micronized progesterone (not to be confused with progestin or medroxyprogesterone – not the same thing). If she has a uterus it is a must to give oral progesterone as transdermal will not get levels high enough to be protective. If you want breast protection (which you do) then look for serum levels of 3.5 or greater (Lab Corp) or 10 ng/ml. Then consider a low dose testosterone cream 2% start with 5 mg applied to the inner thigh daily. She will feel great!
Bernini Gp, Sgro M, Moretti A, et al. Endogenous androgens and carotid intimal-medial thickness in women. J Clin Endocrinol Metab.1999 Jun;84(6):2008-2112.
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