Age alone should not dictate stopping HRT, GP says; five questions to ask your doctor

Decisions about continuing hormone replacement therapy (HRT) after age 60 should be based on symptoms, individual health and patient preference rather than an arbitrary age cutoff, Dr. Ellie Cannon said in an article published Sept. 13, 2025.

Cannon, a general practitioner and columnist, wrote that the British Menopause Society — the professional body that publishes HRT guidance in the U.K. — does not require women to stop HRT at a particular age and advises that continuation should be considered case by case. She added that she has both started and continued HRT for patients well beyond their 60s when it improved quality of life.

In her column, Cannon described a recent consultation with a 79‑year‑old patient who wished to remain on HRT after reporting reduced joint pain and worsened bladder soreness and insomnia when she briefly stopped the treatment. Cannon said she assessed the patient’s medical history and maintained a very low‑dose transdermal patch to keep risks minimal.

Menopause can cause more than 30 symptoms, Cannon wrote, and many do not resolve simply because a person reaches their 60s. Common ongoing problems include night sweats, insomnia, depression, fatigue, vaginal dryness, recurrent urinary infections and joint pain. Cannon noted that HRT is particularly effective for hot flashes, loss of libido, bladder symptoms and some cognitive complaints such as brain fog. She also pointed out that HRT is an established treatment for osteoporosis, a condition affecting about three million people in the U.K., and that some women use HRT to address both menopausal symptoms and bone thinning.

At the same time, Cannon cautioned that certain risks associated with HRT — most notably breast cancer and stroke — increase the longer a person takes hormone therapy, and that those risks also rise with age independently. She emphasized that, on average, the absolute risks remain small but that duration of use and individual risk factors, such as a family history of cancer or high blood pressure, should inform decisions about continuation.

Cannon advised annual reviews with a clinician for anyone taking HRT long term. These reviews can assess whether dose adjustments or changes in formulation would reduce risk, for example switching from oral tablets to transdermal patches or using vaginal oestrogen, which is widely viewed as having a lower systemic risk profile and is considered safe for long‑term use for local symptoms.

She also urged clinicians to address modifiable cardiovascular risk factors as part of HRT reviews, including blood pressure, cholesterol and alcohol consumption.

Cannon offered five questions patients should ask their GP when discussing whether to continue HRT:

Question 1: What is my stroke risk? Cannon said stroke risk depends on factors such as blood pressure and smoking and can influence the choice of HRT formulation, with patches generally considered lower risk than oral tablets.

Question 2: How are my bones? She recommended discussing the need for bone density assessment because HRT can treat osteoporosis and may reduce the need for separate bone‑specific medications.

Question 3: Can I try vaginal oestrogen? Cannon described vaginal oestrogen as a low‑risk option that effectively treats vaginal and some bladder symptoms and can be sufficient for some women without systemic therapy.

Question 4: Can I try a lower dose? She said patients should be prescribed the lowest effective dose and that dose reduction is a common strategy to limit potential harms while maintaining symptom control.

Question 5: Am I at increased risk of breast cancer? Cannon noted that a personal or family history of breast cancer would affect the balance of risks and benefits and should guide HRT choices.

The article framed the current approach to HRT as more pragmatic than earlier, more prescriptive guidance, and urged individualized discussion between patients and clinicians. Cannon wrote that some women have taken HRT for decades; with regular review and appropriate risk‑management strategies, long‑term use can be a reasonable choice for those who derive significant symptomatic or bone‑protective benefit.

Clinical guidance from professional bodies continues to evolve as evidence accumulates. In practice, decisions on HRT duration and formulation involve weighing symptom relief and fracture prevention against the incremental risks that accrue with longer use, with annual clinical review recommended to monitor changing health status and to consider alternatives when appropriate.