Is it ever too late to start replacing lost estrogen, even when you’ve already aged as a consequence?
The Ask Barbie question for today is, “Is it ever too late to start HRT?”
And the answer is, “No, it is never too late to start HRT.”
But you deserve much more than just a simple “yes” or “no” answer. So let’s go through all the factors that determine the answer:
So the real question is this:
“If you go without estrogen for a prolonged period of time, and you incur the rapid aging that ensues without estrogen, is it ever too late to start replacing your lost estrogen?”
It’s really all about timing. Aging is literally a race against time.
The outside aging that occurs in the absence of estrogen is obvious. You can see it and feel it.
But the inside aging that occurs in the absence of estrogen isn’t so obvious, at least not for a while.
Well, the longer you go without estrogen, the more aging you will incur. And the inside aging involves aging of three organs:
The aging of your heart, bones, and brain result in the three fatal diseases of estrogen deficiency:
All three of these diseases are silent until deadly. That means there are no symptoms until it’s too late.
If you continue supplying your body with estrogen, you are essentially saving your heart, your bones, and your brain.
So the question, “Is it ever too late to start HRT?” really questions the race against time. Of course, you cannot turn back time. But if you take hormone replacement therapy, you can maintain the slow aging that occurs in the presence of your fountain of youth.
So, let’s address each of these organs individually. That way, you can see the effect of rapid aging on each one of them.
Rapid aging of your heart involves buildup of cholesterol plaque in your heart arteries. It just builds up slowly over time, little by little. Your laboratory cholesterol panel reflects this by worsening of your cholesterol labs over time. And what’s really happening is that your heart arteries are getting stiffer and harder.
Estrogen keeps your heart arteries soft and supple. In the early years of menopause, inadequate estrogen makes your heart arteries a little stiffer. But, the longer you go without estrogen, the harder your heart arteries get. This is what we call “hardening of the arteries.” And it is precisely what leads to a heart attack. This is why heart attack is one of the diseases of estrogen deficiency.
The longer you go without estrogen, the higher your risk for heart attack.
When it comes to your bones, the rapid aging occurs in the form of bone loss. This is all about bone quantity. It has nothing to do with bone quality. So, your bones go from being very dense and high in quantity … to being very porous and low in quantity. This is called, “osteoporosis.”
The longer you go without estrogen, the more bone you lose.
When it comes to your brain, your brain has always loved estrogen. Estrogen is its fuel. Your brain has estrogen receptors all over it. They are like parking spots for estrogen. And when estrogen parks in one of these estrogen parking spots, your brain buzzes beautifully. You think clearly, you are quick on your feet, you respond rapidly, you spell well, you do math well, you remember everything well, and you are witty.
But when you lose your estrogen at menopause, you have trouble concentrating. You forget words. You can’t remember anything. You have difficulty performing at work. You call it “meno-fog.”
You have meno-fog because the estrogen receptors in your brain are empty. They’re all a bunch of empty estrogen parking spots. And that means your brain is running on fumes.
With time, this becomes Alzheimer’s.
Now, our Ask Barbie question goes to the issue of time. And the question is, “If you run out of estrogen and don’t take any for a prolonged period of time … is it ever too late to start taking HRT in order to replace your estrogen?
And the answer is, “No, it’s never too late.”
The question comes up because there are both benefits and risks to taking HRT. And, of course, there are many risks to aging itself.
With regard to your heart, bones, and brain, you only have to focus on one of them in answering whether it’s ever too late to start HRT: your heart.
Your bones and your brain will always jump for joy and benefit greatly if you start taking HRT at any time, regardless of how long you’ve gone without it. But when it comes to your heart, it all depends on how much cholesterol plaque has built up in your arteries.
Obviously, starting HRT late in the game is not going to reverse any of the diseases that have already started progressing due to rapid aging. However, starting HRT late in the game can slow down the aging.
This brings us to something called “the estrogen window.” The estrogen window refers to the timeframe in your early menopausal years, when the benefits of taking HRT greatly outweigh the risks of taking HRT. And that is purely because you haven’t yet begun the rapid aging process.
The estrogen window refers to the first 5 to 10 years of your menopause. This is the time during which taking HRT can prevent all three of these diseases from ever getting started.
But if any of these has already gotten started, the most you can do by starting estrogen is stop the rapid aging process. You will not reverse any aging that has already occurred. You cannot turn back time.
Now, this estrogen window of 5 to 10 years comes from studies that lasted only 5 to 10 years. There is nothing magic about 5 to 10 years. In fact, I do not like the fact that there is a designated timeframe for any of this. It makes no sense. We do not all age similarly.
But there are some things that are true for all of us:
Your greatest benefit comes from starting HRT in the earliest years of your peri- or post-menopause so that you never start the rapid aging process in the first place.
Your second greatest benefit comes from starting HRT as early as possible in your early menopausal years so that the rapid aging process doesn’t get out of control.
And your third greatest benefit would come from starting HRT late in the game after these disease processes have begun. But in that case, all you’re going to do is stop them in their tracks. You will not reverse any aging that has already occurred.
Now the estrogen window has absolutely nothing to do with your age. Menopause can occur at any age, so forget about your age. All that matters is the timeframe between your body producing its own estrogen and replacing estrogen. The other critical thing to understand is that this is not a limited period of time. There is no time limit on how long you can take HRT. There is no cut-off age.
Somehow, people have confused the 5 to 10 year start time with a 5 to 10 year total time. Can you think of any other hormone replacement for which you take the hormone for only 5 to 10 years, and then stop it? No, because there isn’t one.
Can you think of any hormone replacement that you cannot start at a late date? No, because there isn’t one.
If you ran out of insulin and didn’t recognize it for five years, would it be too late to replace insulin? Of course not.
The bottom line is that you can start taking HRT at any time. And you can take it for as long as you want … or forever.
When you think about it, you’re probably going spend close to 50 years as a post-menopausal woman. So the 5 to 10 year timeframe means nothing.
Earlier, I said that your heart is the only organ that deserves consideration with regard to how late in the game you start HRT. And this is because heart attacks are the biggest killers of women.
Well, HRT for menopause can prevent a heart attack.
But, since there is great fear surrounding the topic of HRT for menopause, medical professionals prescribing HRT are worried that you’ll sue them if you happen to have a heart attack after you’ve started HRT.
HRT cannot cause a heart attack. But your clogged up heart arteries can.
So you will discover that the longer you’ve gone without HRT, the more doctors will refuse to prescribe it to you. And this is because they are doing what’s in their legal best interest, rather than what’s in your medical best interest.
You always want to do that which gives you the most benefit and the least risk. And you always deserve peace of mind.
This is not something for which you just take a chance. If you want to start taking HRT late in the game of your menopause, get a cardiac evaluation first.
Simply go to a cardiologist and say, “I want to know the status of my heart arteries.” Do not have a conversation about menopause with any cardiologist. Heart attacks are cardiologist’s bread and butter. No cardiologist wants you to know that all you have to do is take HRT to prevent a heart attack.
Once you’ve had a cardiac evaluation, you can decide whether or not you feel as though your benefits of HRT outweigh your risks of HRT.
If your cardiac evaluation is normal, then your benefits do outweigh your risks. And you can get HRT. You can even use your normal cardiac evaluation as leverage for getting HRT.
But, just because you have a normal cardiac evaluation, and just because you want HRT does not mean that you doctor will give it to you. Your doctor is operating within the confines of their:
All of those harbor statements indicating that they should not give you HRT if you have gone longer than 5 years without estrogen. Well, that’s just plain insane. However, that’s the way it is. And you need to know the state of affairs in order to succeed at getting what you want.
Take responsibility. Pay for the HRT yourself. Offer to sign a consent form, disclaimer, or waiver of liability. Do whatever it takes to save yourself from the rapid aging of your heart, bones, and brain that will continue worsening in the absence of estrogen.
So if you take HRT early in your menopausal life, you’re staying ahead of the game by avoiding the diseases of estrogen deficiency in the first place. This is prevention.
But if you don’t take HRT early in your menopausal life, and you choose to take it late in the game, you’ll be playing catch-up.
The younger you are, the fewer risks you have. The older you are, the more risks you have. This is true regardless of whether or not you take HRT.
The earlier in your menopause you start replacing your estrogen, the fewer risks you have. The later in your menopause you start replacing your estrogen, the more risks you have.
If you want to start HRT late in your menopause, manage your expectations accordingly.
Weighing your benefits and risks for starting HRT late in your menopause always requires tailoring. This is precisely what I do in consultations. So, if you are wondering if it’s too late to start HRT and want to assess your benefits and risks, please schedule a consultation with me at MenopauseTaylor.ME. I do them all online, and I will love helping you.
So there you have it: It is never too late to start HRT.
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