Hormone replacement therapy in the elderly

Hormone replacement therapy improves the quality of life and prolongs life for many elderly women, whether it is initiated at menopause or much later. Counseling about hormone replacement therapy should be given to all postmenopausal women. Patients should be advised that estrogen will lower the chances of death and disability from cardiovascular disease and osteoporosis. Those with low bone density or risks for cardiovascular disease, including smoking and hypertension, will benefit more than those without. Older age may predispose a woman to the carcinogenic potential of estrogen. But this should be placed in statistical perspective for the patient, with estrogen's benefit still clearly outweighing the risk. By evaluating her personal history and attitudes, the physician should help the patient decide if the potential benefit is worth either the risk or the inconvenience of side effects. Although the available data bespeak the general advantages of estrogen replacement, optimum dose, type of estrogen, time of initiation, and duration of therapy need further study in the geriatric population.