There isn't much information about the risks and benefits of starting HRT this late.
The main possible risks with starting HRT a long time after menopause are cardio-vascular disease and stroke.
The recent paper published for World Menopause Day - on prevention of diseases after menopause reviewed a lot of the information on risk (my bold):
"Over the last decade, cumulated data from RCTs of MHT clearly demonstrate two distinct populations
of women who respond differentially to MHT according to timing of MHT initiation relative to age and time since menopause 62,63 . Specifically, CHD events and all-cause mortality benefits occur when MHT is initiated in younger women (< 60 years old) in close proximity to menopause (< 10 years since menopause) and a null and possible adverse effect occurs when initiated in older women (≥ 60 years old) remote from menopause (> 20 years since menopause) 62,63. These data have been reviewed
extensively and conclusions from previous data have been confirmed by the latest compendium of
MHT trial data from the WHI for all-cause mortality and CHD in women treated with unopposed estrogen 5. The cumulative data conclusively show that, when initiated in women who are < 60 years
of age and/or within 10 years of menopause, MHT statistically significantly reduces CHD and total
mortality 62,63. These results have been validated in the Danish Osteoporosis Prevention Study (DOPS)
conducted in women who were on average 7 months since menopause when randomized
to MHT of long duration, 10 years of randomized therapy and 16 years of total follow-up 72. The cumulative MHT randomized trial data initiated in younger women contrast to lipid-lowering and aspirin therapy in the primary prevention of CHD and, most importantly, in the reduction of all-cause mortality in women under primary prevention conditions (Table 1). "
"Conversely, in women on average 64 years of age, MHT non-significantly increases ischemic stroke and reduces hemorrhagic stroke (18% for CEE + MPA and 36% for CEE) in relation to placebo. All of these foregoing events are rare, 5–11 events per 10000 women per year of MHT. Importantly, the risk of stroke is statistically non-significant and rare in women who initiate MHT when < 60 years of age. "
The review paper from 2013 by the British Menopause Society and Women's Health Concern summarised the latest findings and recommendations and had this to say:
Long term effects of HRT
Cardiovascular
" Early cohort studies suggested that HRT was associated with a significant reduction in the incidence of heart disease, whether estrogen was prescribed alone or combined with progestogen.
In the WHI randomised controlled trial, women using conjugated equine estrogens (CEE) 0.625 mg alone or with medroxyprogesterone acetate (MPA) 2.5 mg had a small increase in incidence of coronary heart disease in the first 12 months.
‘Early harm' can occur when therapy is commenced in women over 60 with relative overdoses of oral estrogen.
When prescribing HRT for the first time in women over the age of 60, the lowest effective dose should be used."
Stroke
"Observational studies on the use of HRT and stroke have yielded conflicting results.
The WHI study revealed an overall increased incidence of stoke in women using estrogen and progestogen therapy or estrogen alone.
Re-analysis of the combined data from the estrogen and progesterone study and that of the estrogen alone study revealed a smaller increase in incidence of stroke in women who commenced HRT between the ages of 50 and 59.
The HERS study (the Heart and Estrogen progestogen Replacement Study) found no increased incidence of stroke with HRT.
On current evidence, HRT cannot be recommended for the primary or secondary prevention of stroke.
Caution should be exercised when prescribing HRT in women over the age of 60 particularly when they have a risk factor for stroke or thromboembolism. In these groups, current evidence would suggest that the transdermal route may be advantageous.
The effects of HRT may be dose related and the lowest effective dose should be prescribed in women with significant risk factors. "
I would doubt that her GP would refer her to an (NHS) menopause clinic on the basis of these symptoms alone but obviosuly a private consultant might well suggest a low dose transdermal oestrogen if s/he thought this would help.
Vaginal oestrogen can be used at any age from what I understand. I agree with the others that different measures should be able to help with her other complaints if she doesn't want to go down the menopause/hormonal route, and especially increasing regular physical exercise.
Hurdity x
