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Breaking Boundaries: Embracing Bioidentical HRT for Women Over 65

In the realm of women's health, the discussion around hormone replacement therapy (HRT) has often been met with complexities and uncertainties, particularly for women over the age of 65. However, recent research published in the April 9th, 2024, Menopause: The Journal of The Menopause Society offers promising insights into the safety and efficacy of HRT in this demographic, particularly when guided by our meticulous approach.

For years, conventional wisdom suggested that HRT beyond age 65 was unnecessary, as menopausal symptoms were believed to diminish with age. However, this perception is being challenged by a growing body of evidence suggesting that many elderly women continue to experience symptoms that could benefit from HRT. Acknowledging this reality, The Menopause Society revised its stance in 2022, advocating for individualized treatment decisions and emphasizing using lower doses and non-oral preparations to minimize risks.

For over a decade, my approach to HRT has emphasized the utilization of bioidentical hormones and careful monitoring of hormone levels and breakdown products to ensure safe therapy. This approach aligns with the study's findings, which explored the initiation and continuation of HRT beyond age 65 and its effects on various health outcomes.

One of the study's key findings is the association between estrogen therapy (ET) beyond age 65 and significant reductions in mortality risk, as well as reduced risks of certain cancers, cardiovascular conditions, and dementia. Importantly, the study underscores the importance of using bioidentical hormones and opting for topical preparations to achieve optimal outcomes while minimizing potential risks.

Moreover, the study's analysis of different HRT preparations highlights the importance of tailoring treatment regimens based on individual characteristics. By examining 40 different HRT preparations, the study provides valuable insights into the variations across types, routes, and strengths of therapy, further supporting my approach to personalized care.

Despite the study's strengths, including its substantial sample size and rigorous methodology, it's essential to acknowledge its limitations, such as the reliance on observational data and the potential influence of unmeasured confounders.

In conclusion, our approach at FSIM to HRT offers a comprehensive and evidence-based framework for safe and effective therapy in women over 65. By leveraging bioidentical hormones, monitoring hormone levels, and tailoring treatment regimens based on individual needs, I want to ensure that my patients receive the benefits of HRT while minimizing potential risks. As our understanding of menopausal hormone therapy continues to evolve, embracing a personalized approach as we do at FSIM is crucial in optimizing women's health outcomes in later stages of life.

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