A new study has found that hormone therapy taken during the perimenopausal years can slow down aging during menopause without increasing mortality risks. The reduction in aging was most dramatic in women of lower socioeconomic status, leveling out their mortality risk with women in higher-income demographic categories. However, hormone replacement therapy taken well into menopause may deliver benefits but carries an increased risk of stroke, cancer, and dementia. The positive effects of hormone therapy largely erase the negative impact on aging of low socioeconomic status for postmenopausal women, according to the study published in JAMA Network Open.
The study analyzed data for a cohort of 117,763 postmenopausal women, of which 40.3% had used hormone therapy at some point in their lives. Women who had used hormone therapy exhibited fewer indications of aging compared to those who had not ever used it. The strongest anti-aging effect was found in women who started hormone therapy at age 48.4 and used it for four to eight years. Interestingly, women of lower socioeconomic status benefited more profoundly from hormone therapy than women of higher incomes, who typically aged more slowly regardless of hormone therapy use. The study assessed aging using phenotypic aging, which looks at biological markers to measure the aging process.
Perimenopause, the years directly preceding the absence of eggs and the cessation of menses, is the time when hormone therapy is most likely to be beneficial for women. During perimenopause, estrogen production from the ovaries becomes highly variable, leading to symptoms such as vaginal dryness and hot flashes. Hormone therapy can help smooth the transition into menopause for women experiencing these symptoms. The study also found that historical hormone therapy use and decreased aging discrepancy were more strongly associated in women with a disadvantaged socioeconomic status, suggesting that hormone therapy could help offset all-cause and cause-specific mortality associated with phenotypic aging.
Hormone therapy, particularly after menopause as hormone replacement therapy, can have benefits for bone health, heart health, and cognitive health. For example, estrogen helps maintain calcium levels in the bones, reducing the risk of osteoporosis. The skin, with estrogen receptors such as collagen, also maintains a better appearance with hormone therapy. However, hormone replacement therapy should be used with caution and lower doses to minimize risks such as heart issues and breast cancer. Experts recommend physical activity as a safer way to promote overall health, including bone health, heart health, and cognitive health, alongside hormone therapy if necessary.
The safety and value of hormone therapy has been a topic of debate for some time. While early studies such as the Women’s Health Initiative suggested an increased risk of dementia and stroke with hormone therapy, newer research has highlighted the importance of timing. Hormone therapy during perimenopause may provide benefits without significant risks, while starting hormone therapy later may carry definite risks. Re-analyses of older data have also shown that hormone therapy may be beneficial during perimenopause and for a certain period after, depending on the individual’s health risks and needs.
