Do I Need HRT to Age Gracefully?

Why are some 90-year-olds thriving and they never took HRT? I am so confused on if I should take HRT or not. The risks scare me. I just want to thrive at 90.

—Please help me get off the HRT fence

A couple of years ago, my grandmother died at the age of 99. She was one of those thriving women you reference. Until she was in her early 90s, she bought individual Christmas presents for each of her 16 grandkids and three dozen great-grandkids. She drove herself to church and the grocery store until she was 95. She lived independently until she was 97. I would love to tell you I have figured out the secret to her longevity, but I have not.

I would caution you against thinking hormone therapy is the one key to longevity, though. Aging is complex. There probably isn’t one single thing that determines whether we will be like my grandma when we are older. Experts agree that how we age is influenced by our genetics, our environment, and our behavior. And surely there is also some luck involved. Exactly how each one plays into the equation is less clear.

When you experience menopause is largely genetic — although environment and behavior have an effect on menopause too — and is likely an indicator of how quickly your body is aging on a cellular level. While hormone therapy is safe for most women, the hormones we give as hormone replacement therapy don’t exactly replace the hormones we had before menopause. This is one reason why HRT has undergone rebranding and is now called hormone therapy or menopause hormone therapy. We can’t return a woman’s body to its premenopausal state by giving hormones back.

As a result, the best reason to take hormone therapy is to manage your perimenopausal symptoms like hot flushes, night sweats, and sleep disruption. If you are having symptoms, you should talk to your doctor about treating them. And the best thing you — or any of us — can do to be active nonagenarians is take a page from grandma’s playbook: inherit good genes, don’t smoke, stimulate your mind every day, surround yourself with friends and family, and don’t ever believe that you are old. To that foundation, I would add a healthy diet, regular exercise, and adequate sleep. Doing those things won’t guarantee you will see your 100th birthday, but they may increase the odds.

The upshot: The best reason to take hormone therapy is not to age better but to treat symptoms. Aging is like the result of a complex equation involving our genes, our environment, and our behavior.