When to start HRT

[Denise Burroughs]

For women, is 10yrs still the cut off as when to start E2 therapy?  I was told not to start women on E2 therapy if it has been over 10 yrs since going though Menopause of having a Total Hysterectomy.  The reasoning behind this was that it would increase their chances of developing Breast CA.  Is this guideline still good to follow?

[Eric Fete]

No it is not too late.  Having surgical menopause puts her at higher risk of CAS, Osteoporosis, etc.
How old is she?  Symptoms?

I would start her now

 

Eric

[Denise Burroughs]

She’s 48 y/o and had her Total Hysterectomy in 2009 d/t heavy menses.  She was never placed on any HRT post surgery.

Is there a guideline to follow about starting age?  Say a 60 y/o woman was wanting to start HRT.  Would that be ok? Or is 60 a cut off age?

I’m also trying to find literature on how long it’s ok to leave women on HRT for? Any guidance on that?

Thank you so much for your reply!

[Eric Fete]

yes she is fine to start     no hard age- once menopausal can start.  can stay on indefinitely for optimal benefit.

Eric

[Abid Husain]

I agree with Dr Fete.  It is never too late to start BHRT.  My general policy with hormones is to start low and work up to avoid side effects.

Oral synthetic estrogens will stimulate metalloproteinases and that is what is implicated in cardiac events when starting BHRT.  That is where the concern about starting estrogens in older women comes from.  If they has risk factors for athersclerosis and get started on a commercial HRT, it is not graded with a gradual increase and it will weaken vulnerable plaque.  This should not be an issue with oral Estradiol, which is metabilized very differently than oral commercial estrogens.   Oral Estradiol has low risk but I still like to start low and work up in dose.

Abid

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