Hormone Therapy After 65: What New Guidance Really Means for Women’s Health

Dr, Tracy Tranchitella, ND | Sunrise Functional Medicine

For years, hormone therapy was treated as something women should stop at 60 or 65 — almost like a hard cutoff. That mindset largely came from the early release of the Women’s Health Initiative (WHI), which sparked widespread fear and led to the FDA’s black box warning on all estrogen-containing therapies. Women who genuinely needed relief suddenly felt like they had to choose between comfort and safety.

Now, with two decades of follow-up research and a clearer understanding of how hormones interact with the body as it ages, the picture is far more nuanced — and much more hopeful. The FDA’s recent decision to remove the black box warning reflects what clinicians have already known in practice: hormone therapy, when used thoughtfully and individually, is often safe and beneficial well past age 65.

Looking Back Helps Us Move Forward

When the WHI data was first released, they were interpreted as proof that hormone therapy caused significant risks across the board. But as researchers dug deeper, three important details emerged.

Age and timing matter.
Most WHI participants were well past menopause when they started therapy. The cardiovascular system goes through changes after estrogen levels drop — including stiffer arteries and more plaque development — so starting high-dose oral estrogen late in the game isn’t ideal. Later analyses confirmed that women who begin therapy within about 10 years of menopause have better outcomes than those who start much later.

Not all hormones act the same.
The WHI didn’t study the hormone therapies most clinicians use today. Participants received oral conjugated equine estrogens (CEE) and a synthetic progestin, medroxyprogesterone acetate (MPA). These forms behave differently in the body than bioidentical estradiol and progesterone. The delivery method also matters — oral estrogen elevates clotting risk, while transdermal estradiol largely avoids that.

Dose matters.
Everyone in the WHI received the same moderate oral dose regardless of age, metabolic status, or symptoms. Modern care individualizes dosing, which significantly changes the safety profile.

Once researchers factored in age, timing, formulation, dose, and delivery method, the initial interpretation simply didn’t hold up.

Understanding Hormones Through a Functional Medicine Lens

What helps Dr. Tranchitella’s patients the most is understanding why timing, dose, and delivery matter physiologically. Estrogen receptors behave differently at different life stages. Early in menopause, vascular tissue is still responsive — meaning estrogen can help maintain artery flexibility, support lipid balance, and calm inflammation. Years later, the vascular landscape has changed. Arteries may be stiffer, and small plaques may already exist. Introducing too much oral estrogen at that stage places pressure on a system that’s already working harder.

This is why individualized care is so important. It’s less about age and more about biological context: cardiovascular health, bone density, metabolic function, sleep patterns, stress levels, and the way a woman’s body metabolizes hormones. In functional medicine, we look at all of this before deciding whether hormone therapy makes sense — and at what dose.

Modern Research Tells a Very Different Story

Recent studies, including a large Medicare dataset of 10 million women over 65, show something striking: women who continued low-dose hormone therapy past 65 often experienced better long-term outcomes. That includes lower rates of:

• all-cause mortality
• certain cancers
• heart failure and cardiovascular events
• cognitive decline

The women who did best tended to use lower doses of transdermal estradiol or local vaginal estrogen, often paired with bioidentical progesterone when needed. This is very different from the WHI era — and it reflects how personalized treatment changes risk.

The FDA’s Change: A Moment of Clarity

In 2025, the FDA announced it would remove the black box warning. Updated guidance will highlight something clinicians have already practiced for years: age should not be a barrier to hormone therapy, especially when symptoms are significant and therapy is well-tailored.

This doesn’t mean hormone therapy is right for everyone. But it does mean women no longer need to assume they’re “too old” for relief, support, or even long-term health benefits.

What Continuing Hormone Therapy Might Mean for You

For many women, hormone therapy provides more than symptom relief. Supporting sleep, metabolism, joint comfort, libido, cognition, and mood can dramatically affect quality of life — especially during the years when all of those systems naturally shift. The key is direction, not assumption. Instead of asking, “Should women over 65 use hormone therapy?” the real question becomes, “Does this woman, with this physiology and these goals, benefit from hormone support?” That is the heart of functional medicine.

Personalized Care, Ongoing Monitoring, Better Outcomes

Hormone therapy isn’t something to start blindly or maintain on autopilot. It requires thoughtful testing, regular check-ins, and adjustments along the way. Levels look different depending on whether hormones are taken orally, through the skin, or vaginally — and interpreting those differences correctly is an important part of safe care.

Dr. Tranchitella focuses on how your whole system is responding, not just what one lab marker says. The goal is always harmony, not just symptom suppression.

A New Era of Possibility for Women’s Health

The story of hormone therapy has evolved — and women deserve access to the full, updated truth. The fear that settled in after the WHI was understandable, but it was based on incomplete information. Today, we have a clearer understanding, better tools, safer formulations, and a commitment to individualized care that simply didn’t exist decades ago.

If you’re wondering whether hormone therapy is right for you now — or right for you again — it’s worth having a conversation grounded in current evidence and your unique physiology. Your needs, your history, and your goals matter. Relief and long-term support are not reserved for any age group, and with the right guidance, hormone therapy can be a safe, empowering option well into later years. Learn more and request a consultation >>