Does HRT reduce lifespan?
There is ongoing research into the effects of hormone replacement therapy (HRT) on lifespan. Some key points from studies so far:
- Several large studies have found connections between HRT and certain health risks in older women (over 60), especially when it was started many years after menopause. However, the data is still inconclusive about the effects on lifespan specifically.
- The timing and dosage of HRT makes a big difference. More recent evidence suggests:
- Starting HRT near the time of menopause onset (early 50s) may have neutral or beneficial effects on lifespan.
- Lower hormone doses in line with natural menopausal declines may pose fewer risks than higher doses.
- HRT taken earlier shows different effects than when taken later in older ages:
- In younger postmenopausal women, estrogen alone therapy during early menopause was linked with lower mortality in a 2017 study.
- But estrogen with progestin started a decade after menopause was associated with increased risks in the well-known Women's Health Initiative study.
- Longer duration of HRT may improve outcomes in younger women, but poses higher risks when started in older women:
- 2020 guidelines recommend women who start HRT in early menopause take it at least until the natural age of menopause (about age 51-59).
- But starting HRT later (especially combined therapy) may raise health issues and is only recommended short-term per guidelines.
- Continued HRT for 5-7 years from the onset of early menopause was significantly correlated with longer lifespan compared to never taking HRT, per a 2018 Dutch study.
- A woman's health status also impacts the benefit-risk ratio of HRT:
- Healthier women closer to menopause onset may gain protection against premature death.
- Women with health issues like heart disease or cancer likely face higher risks from HRT.
In summary, the timing and duration of HRT matters significantly. When initiated closely to menopause onset in generally healthy women, evidence suggests it may help extend a youthful lifespan up to the natural age of menopause. But starting years later or continuing longer-term into old age appears less advantageous or higher risk based on some research. As always, women should discuss their individual risk/benefit options with a doctor. Ongoing studies around optimal customization of HRT continue to shape the recommendations medical experts make.
