HRT for lady in her 70s?

[JJkate]

Hi all, someone I know was forced to come off HRT during the research cancer scare years ago. She's now in her 70s, getting recurring UTIs and joint pain amongst other things and really wants to go back on. A Dr has said she might be able to but must go on statins to bring cholesterol down first. Does anyone have any ideas why and if this will help? She is very healthy and very reluctant to take medication. Thanks 😊

My mum has gone back into HRT in her mid 70’s due to a few issues (osteoporosis was one). She was already on statins though and has been for several years. She’s found it ok, not without issue but generally ok and she sees a specialist for it

Local estrogen will help with the recurring UTIs

Age is no barrier to HRT now. So women in their 70s who had a break from it (or have never used it) can use it.

I've never heard of high cholesterol being a contraindication to HRT. In fact how many women would have their cholesterol tested before HRT? (Not many if any unless for other reasons.)

Has her GP checked her cholesterol because she asked for HRT?

She is very healthy
Long term though high cholesterol isn't great and it should be under 5.

How high is it? (if you know.) If it's very high it should be treated anyway, first by diet and exercise, and statins if they don't do the trick.

Transdermal HRT (ie not tablets) doesn't raise clot risk above what someone already has. Women over 60 can't use HRT as tablets.

@JinglingSpringbells do you have a link to where it is indicated for women who are 70 and have never used it? My mother has been refused based on the fact she's never been on it despite my thinking it would help her bones / brain and so on

I do know that some of the best menopause consultants in the UK do prescribe it for women that age.

Have you had a google?

The BMS [ BRITISH MENOPAUSE SOCIETY ] certainly has a statement on women over 60 starting HRT so the same should apply to someone 70.

@JinglingSpringbells yes been googling a while and can only find things that say the NHS doesn't recommend beginning it after 60 if you've never had it. Have looked at the BMS website and can't find the statement you say

@JinglingSpringbells aha I have found this https://www.drlouisenewson.co.uk/knowledge/hrt-in-later-life-or-after-menopause

https://thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

It's under Consensus Statements which is under PUBLICATIONS on the menu bar.

I know it's not easy to find!

HRT initiated before the age of 60 or within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.

If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of estradiol administration. Evidence from the Cochrane data-analysis as well as that from the long-term follow-up data of the WHI showed no increase in cardiovascular events, cardiovascular mortality or all-cause mortality in women who initiated HRT more than 10 years after the menopause.

@JinglingSpringbells thank you!

the British Meno Soc says
HRT is usually considered high risk in women with known CVD, or with a 10-year CVD risk ≥10% and in the presence of uncontrolled cardiac risk factors including blood pressure ≥180/110 mmHg, total cholesterol >7.8 mmol/L and triglycerides > 4.5 mmol/L

Statins are known to improve cholesterol levels.

I imagine that's the reason the doctor wants to get the lady to have better cholesterol levels using statins, before she tries HRT.

Why is she so reluctant to take statins? Practically everyone over a certain age with cholesterol issues is on them and it seems to help. Why is she so keen on HRT but not statins?

Another vote for topical oestrogen for UTIs. No need for full HRT unless other reason. Also, modern thinking on cholesterol is that the HDL:LDL ratio is more important than total cholesterol.

Hi, she has tried this for a few months and it hasn't helped unfortunately.

Many women need more than the 2 x a week dose and for someone in their 70s who is very depleted of estrogen, she may need to use it 4 x a week .

Worth persevering and using it more often.

Hi, yes they checked it and said it needs to be low before she can take hrt, t's 7. Her risk is 16% apparently (on that risk test). There is no family history of anything. Eats a wholefood diet, very active, has one glass of wine a day. She's been told she has to take statins for 3 months to see if it comes down before they'll consider hrt.

7 is high so she needs to use statins or focus on her diet. A daily glass of wine if it's a big 250mls glass isn't great. It can contribute to high cholesterol. I know it's not a lot of drinking but drinking every day isn't a good idea anyway even if it's a small amount. Not lecturing- just stating advice.