Transdermal HRT

@mkoch I started about same age, but it hasn't prevented me from losing more each year in the spine. But then, I'm not sure what amt. of hormone is required to preserve bone, nor can any dr tell me. I've not had any fractures except falling on my tailbone few years ago...but it healed. I've had my sacral bone cut into for surgery and it's healed well. I think there is quality of bone vs density of bone...maybe something genetic. I'm very frustrated, as there must be some factor contributing to this that isn't typically tested for. I pretty much pass all my labs.

I am currently 69 so when I was peri - and menopausal it was during the time after the study that made everyone believe HRT was a no-no, therefore, consequently I now have significant osteoporosis but don’t wish to take all the scary meds the endocrinologist wants me to take. When I was 68 I spoke to my GYN about possibly starting HRT to stop my osteoporosis from worsening and to take away hot flashes I was still having( I was 10 yrs post menopausal). She stated that timing is important and starting HRT 10 yrs or > after menopause is controversial…. She discussed my case with the board at Yale for other opinions and consensus was they would approve transdermal estriadol and progesterone in my case - but they asked I read up on the studies of woman my age and timing post menopause and all research I found mentioned the pretty big increase in risk of dementia for woman starting HRT 10 yrs or > post menopause ( 38% higher risk).
I felt too high a risk and decided against .. just wanted to share in case this information could help anyone else….
Good luck

@mahonlye
https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/additional-treatments-for-dementia-risk/hormones

@gravity3
Yes, controversial as far as timing with starting HRT replacement - most agree starting early in perimenopause may help reduce risk - however every study and opinion I read seems to agree that the risk increases significantly with starting later - after 65 yrs of age or > 10 yrs post menopause.

@mahonlye

If I may, what is the latest study. And the link if you still have it

Sorry, I no longer have any of that saved, but should be very easy to find all the information about the studies and findings - it’s very well documented. You can even go to the Alzheimer’s Association and search for it there.

This is a repeat comment from me: I am 82, have been on HRT various forms since age 50. Now use patch at lowest dose. Never will stop. In my case, HRT is beneficial (I do not have a uterus which makes it simpler perhaps.) Gyno docs ok with my decision. Every person is different, but for me its only good.

I started transdermal HRT 3 months ago at the age 69 for osteoporosis. I was on Teriparatide before and then Raloxifene. When I read about the bone density results with HRT, I spoke with my gynecologist and she agreed. Other bone drugs have awful side effects!
One of the latest research studies clarified the WHO study. THE LANCET, Dec 2025, studied HRT and dementia. The study is called: Menopause hormone therapy and risk of mild cognitive impairment or dementia: a systematic review and meta-analysis
“This review found no evidence that MHT use either increases or decreases the risk of dementia in post-menopausal women. This reinforces current clinical guidance, that MHT prescription should be based on other perceived benefits and risks and not for dementia prevention. High-quality, long-term studies are needed to clarify the role of MHT and dementia risk, particularly regarding formulation, dose, route, timing, and duration of treatment, with a focus on women with premature ovarian insufficiency, early menopause, or mild cognitive impairment.”
For me the decision was easy. Hope this helps.

@gravity3
The study referred to by mahonlye is considered old news; it was a study on premarin, depoprovera and progestins, linked to the old WHI study.
There is no age limit for BHRT or even some forms of HRT; instead the criteria is now bound to each individual person and their symptoms, not their age.
Newer Less concern with age is tied frequently to the less dangerous BHRT, topical, vaginal delivery which is frequently used and better doctor analysis and follow up.
https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx
Menopause society new guidance on age and HRT tied to symptoms and not age:
https://menopause.org/press-releases/ongoing-individualized-hormone-therapy-appears-to-have-no-age-limit.
To put this into context, the old concerns were tied to HRT that was synthetic or non identical to the human body.
Plus, concerns that starting a woman on any form of HRT or BHRT might hold a risk of cardio problems. This is because a cardio system with few hormones is prone to stiffen and for plaque to form then when hormones are reintroduced and the cardio system becomes more pliable the left over plaque may loosen and cause a cardio event.
There is less concern now because doctors know to check for any potential problems and many begin vit k with their patients to help with potential calcium in the cardio system.
Then the dangers are less and even eliminated by use of BHRT, topical vaginal and a good doctor who checks and rechecks your health before and during use of hormones.
With this type of use and doctoring the lack of problems is substantial.
Indeed, in a huge population study in France the only group that had a zero percent increased risk of breast cancer was the one that used bioidentical progesterone.
https://cemcor.ubc.ca/resources/does-taking-progesterone-alone-or-estrogen-increase-womens-risk-breast-cancer/

@mahonlye
I believe that you may be confusing bioidentical progesterone and progestins, synthetic progesterone research and the various studies of one or the other.
This is easy to do because the FDA, for some confused reasoning, allows all progesterone, whether synthetic or bioidentical, to be called progesterone. This even though a synthetic progestin is chemically completely different from your natural progesterone and bioidential is exactly the same chemically.
But yes, synthetic progestin is tied to many problems. Studies suggest a small increased risk of Alzheimer’s with long-term use (5+ years), increased breast cancer risk, and potential cardiovascular events, particularly when started later in life for synthetic progesterone.
Bioidentical progesterone is not tied to these problems.
Bioidentical (micronized) progesterone is generally considered a safer alternative to synthetic progestins regarding cancer and cardiac risks, often acting as a protective agent for the endometrium. While some studies suggest it may help prevent dementia, findings are mixed, with benefits largely dependent on starting therapy near menopause. This seems to be tied to just the fact that fewer studies have been done.
I have a long list of studies, but this one seems to hit most of the concerns:
https://bcmj.org/articles/hrt-older-women-it-ever-too-late