Sara Szal MD<\/span> <\/span><\/p>\n If you\u2019re a free subscriber, quick announcement that the annual paid price dropped from $125 to $99, and I\u2019m only leaving it there for a week or two. If you\u2019re been reading for free and wondering whether to go all in to get the paid protocols and deeper insights, this is the easiest the math will ever be. $99 for a full year, then in September, it goes back up. xo, Dr. Sara<\/p>\n<\/div>\n \u201cI\u2019m 68. I\u2019ve been on oral estrogen for years. I\u2019m in excellent health, no history of blood clots, no heart disease, no cancer. Should I be worried about staying on it? Or is it time to stop just because of my age?\u201d<\/strong><\/p>\n Several of our readers asked this question and many of you rallied behind her, wanting to know the answer. It\u2019s the key question that every long-term user, whether she\u2019s 65 or 75 or 85, and wants to reassess the risks, benefits, and alternatives. <\/p>\n The honest answer is that it depends. There\u2019s no simple yes or no at any of these ages. It\u2019s a set of distinctions most doctors don\u2019t have 15 to 30 minutes to walk through in a short, insurance-based medical appointment. So let\u2019s walk through them here, and feel free to add your questions at the end.<\/p>\n Share<\/span><\/p>\n Let\u2019s start with the good news. <\/span>No major guideline says a woman has to stop estrogen at a specific age. You\u2019ll see the numbers 65, 70, and 75 come up across the research below, and they\u2019re not contradicting each other. They mark different questions: when routine discontinuation stops being automatic, when starting fresh carries new risk, when continuing warrants a closer look. None of them is a prohibition.<\/span><\/p>\n A 2025 Cochrane review and The Menopause Society both reject stopping rules tied to age or years of use alone<\/span> [1][2][3]<\/span><\/strong>. Instead, the guidance is to reassess periodically: does the indication still hold, has anything changed in her personal or family history, does the formulation still make sense.<\/span><\/p>\n That\u2019s the establishment position, the conventional wisdom of mainstream menopause care, but it\u2019s also not the whole story, and the newest research adds a another layer worth taking seriously.<\/span><\/p>\n In 2025, a secondary analysis of the Women\u2019s Health Initiative (I know, I know, the wrong study in the wrong women with the wrong hormone therapy) looked specifically at women 70 and older with vasomotor symptoms.<\/p>\n They found that estrogen-alone therapy with conjugated equine estrogen nearly doubled the risk of atherosclerotic cardiovascular disease in this age group, an increase of about 217 excess events per 10,000 person years [<\/span>4<\/strong>]. The authors concluded that <\/span>hormone therapy should not be started in women 70 and older.<\/em><\/p>\n The conclusion is about starting therapy after 70. It is not a study of women who\u2019ve been on estrogen for years and are doing well on it.<\/span><\/p>\n The strongest recent warning is about starting hormone therapy late in life, but it tells us less about staying on it.<\/span><\/em><\/p>\n Leave a comment<\/span><\/p>\n Being on estradiol alone, rather than estrogen plus progesterone, almost always means a prior hysterectomy. And the risk profile of estrogen-alone therapy is meaningfully different from combined therapy.<\/span><\/p>\n In the Women\u2019s Health Initiative, estrogen alone did not raise breast cancer risk. Over 20 years of follow up, estrogen alone was associated with a lower risk of breast cancer and death from breast cancer. Combined estrogen-progestin raised breast cancer risk <\/span>[2][5]<\/span><\/strong>, presumably due to the synthetic progestin. Estrogen alone also showed no increase in coronary heart disease or all-cause mortality<\/span> [6]<\/span><\/strong>.<\/span><\/p>\n This is the single most common confusion I hear from patients. They read a headline about \u201chormone therapy and breast cancer\u201d without knowing which hormone therapy the study was testing. It\u2019s important that you understand, because the differences in regimen change the entire conversation. We don\u2019t have randomized trials to prove it, but the largest observational studies from Europe suggest that progesterone is safer and neutral regarding breast cancer risk.<\/span><\/p>\n Estrogen therapy relieves persistent hot flashes and night sweats, treats genitourinary symptoms, and protects bone. The fracture data are specific: roughly a one-third reduction in hip fracture risk<\/span>[2][5][7]<\/span><\/strong>. A large Medicare analysis of women who continued hormone therapy past 65 found estrogen-alone use was associated with lower all-cause mortality, lower rates of several cancers, and improved cardiovascular endpoints, with the lowest risk seen at low doses and with estradiol specifically<\/span> [8]<\/span><\/strong>.<\/span><\/p>\n None of this erases the age-related risks. Stroke risk rises with age and oral estrogen adds to it<\/span> [5][9]<\/span><\/strong>. Venous thromboembolism risk is also higher with oral estrogen<\/span> [9][10]<\/span><\/strong>, and gallbladder disease and urinary incontinence are more common with oral use as well<\/span> [9]<\/span><\/strong>. The question was never whether risk exists. It\u2019s whether the risk is manageable, and whether it\u2019s outweighed by what\u2019s being protected.<\/span><\/p>\n![\"\"](\"https:\/\/substackcdn.com\/image\/fetch\/$s_!m6Ws!,w_424,c_limit,f_webp,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F7f9f9bdd-603f-42d8-8699-909ddb4a6709_896x620.heic)
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