Who should be cautious about starting menopausal hormone therapy?

When considering menopausal hormone therapy (MHT), there are certain groups who should be cautious or have a more individualized assessment before starting:

• Women with a history of breast cancer: While recent evidence and expert discussions (including those with Dr. Avrum Bluming and Dr. Corinne Menn here at Alloy) show that MHT may be safer than previously thought, especially with certain formulations, it is still essential to have a thorough discussion with your healthcare provider about your personal risks and benefits. Vaginal estrogen, for example, is considered safe even for women with a history of breast cancer.
• Women more than 10 years past menopause or over age 60: Starting MHT later in life may carry a slightly higher risk of cardiovascular events, especially if there is underlying heart disease or risk factors like high blood pressure, high cholesterol, or diabetes. For these women, it is recommended to assess baseline cardiac risk, start with a lower dose, and use transdermal (patch or gel) estrogen rather than oral forms. You can learn more about this nuanced approach in our YouTube chapter on Hormone Therapy After the 10-Year Window and Starting HRT After Age 60.
• Women with a history of blood clots, stroke, or severe liver disease: These conditions may increase the risks associated with systemic hormone therapy, and alternative options or careful monitoring may be needed.
• Women with undiagnosed vaginal bleeding: This should be evaluated before starting any hormone therapy.

At Alloy, we always recommend an individualized, evidence-based approach. If you’re considering MHT, you can take our online assessment to get a personalized treatment plan, or browse our selection of FDA-approved hormone therapy products.

For a deeper dive into these topics, check out these helpful resources:

• Hormone Therapy After the 10-Year Window (YouTube)
• Starting HRT After Age 60 (YouTube)
• Alloy’s Menopausal Hormone Therapy Solutions

Here at Alloy, we’re committed to providing you with the latest science-backed information and expert care to help you make the best decision for your health.

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This answer was created using the following resources:

• Hormone Therapy 101 (pt.2) | Dr. Corinne Menn - Hormone Therapy After the 10-Year Window
• All about Hormone Therapy | Dr. Corinne Menn - Starting HRT After Age 60
• Menopause and Breast Cancer: Dr. Bluming's Guide
• Catching Up With Dr. Corinne Menn | Alloy
• Do You Need Menopause Hormone Therapy?
• Bioidentical Hormone Therapy: Your Comprehensive Guide
• NAMS Issues Updated Guidelines on Hormones