Starting hormone therapy in perimenopause may help slow down aging

• Hormone therapy taken during perimenopausal years slows down aging during menopause without increasing mortality risks, according to a new study.
• The reduction in aging was found to be most dramatic in women of lower socioeconomic status, leveling out their mortality risk with women in higher-income demographic categories.
• While hormone replacement therapy received well into menopause may deliver benefits, it also carries an increased risk of stroke, cancer, and dementia.

A new study finds that postmenopausal women who received hormone therapy during perimenopause age more slowly than women who did not.

According to the study, the positive effects of hormone therapy largely erase the negative impact on aging of low socioeconomic status for postmenopausal women.

The authors of the study analyzed data for a cohort of 117,763 postmenopausal women registered in the UK Biobank . Of these, 47,461 women (40.3%) had used hormone therapy (HT) at some point in their lives. The data revealed that they exhibited fewer indications of aging than women who had not ever used it.

The strongest ‘anti-aging’ effect was found in women who used HT starting at age 48.4 years and for four to eight years.

The women who benefitted most profoundly from HT were those of lower socioeconomic status (SES), while the effect was less dramatic in women of higher incomes, who typically aged more slowly whether they used HT or not.

The study is published in JAMA Network Open .

What is phenotypic aging?

The study assessed aging in its study cohort using phenotypic aging. First author Yufan Liu , of the Beijing Key Laboratory of Environmental Toxicology at Capital Medical University, explained what it is:

“Briefly, while chronological age is simply the number of years you’ve been alive, phenotypic age takes a closer look at various biological markers in your body to measure the aging process. Therefore, phenotypic aging means that you are biologically older.”
— Yufan Liu

The study looked at discrepancies between participant’s phenotypic and chronological ages to assess the rate at which they were growing older.

Hormone therapy and perimenopause

The study says the time of a woman’s life at which HT is most likely to be beneficial is during perimenopause.

Perimenopause is the years directly preceding the absence of eggs and the cessation of menses, according to the WHO .

G. Thomas Ruiz, MD , board certified OB/GYN and Lead OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, explained want happens during perimenopause.

“A 48-year-old to 51-year-old woman is typically in a perimenopausal state, meaning they may not get periods every month. They don’t necessarily have consistent quality from egg to egg. From month to month, the estrogen production out of their ovaries is highly variable. On a low estrogen production month, they may start having vaginal dryness, vasomotor symptoms [ — such as hot flashes].”
— G. Thomas Ruiz, MD

Ruiz described a chaotic time: “They may not get a period for three months, and then when they do get a period, the bleeding may last for two to three weeks. So it really is a function of the ovaries getting in a situation where they’re just not working.”

“Women in their early 40s or younger may receive hormone therapy if they experience premature menopause, exhibit symptoms of premature menopause, or undergo a bilateral oophorectomy ,” Liu said.

Ruiz said that the value of HT for women in perimenopause is “to help smooth their transition into menopause.”

How socioeconomic status is linked to HT

“According to our study, historical hormone therapy use and a decreased aging discrepancy were more strongly associated in women with a disadvantaged socioeconomic status (SES),” Liu pointed out.

Liu said that this indicated that “hormone therapy might help them to offset all-cause and cause-specific mortality associated with phenotypic aging.”

“Causations should be interpreted with caution. The findings also could be interpreted as an advantaged position regarding various health aspects in individuals with a high SES, so this population might not benefit from using HT,” Liu noted.

Slowing down aging in menopause, but at a risk

How menopause affects bone health

“Within six months of the ovaries not producing estrogen, a woman starts to lose calcium from her bones at a more rapid rate than it enters. This ultimately leads to osteopenia and osteoporosis.”
— G. Thomas Ruiz, MD

“In your seventies and eighties [there] may be hip fractures, compression of the spine — kyphosis —humpback, and rib fractures. If an 80-year-old breaks a hip, the hip fracture may not kill her, but the recovery from the surgery and the consequences of surgery may,” said Ruiz.

Hormone therapy after menopause is termed hormone replacement therapy, which Ruiz cautioned should be accompanied by lipid testing for heart issues, which are more likely, and by mammograms for the increased risk of breast cancer. Lower doses of hormones are also indicated.

“I think the article was quite clear,” he said, “about the multi-organ system benefits that estrogen provides a woman.”

Experts agree that physical activity is a less potentially dangerous way to promote bone, heart, and cognitive health than medications of any kind.

Ruiz said bone health in menopausal women may be supported by hormone replacement therapy: “You have calcium continuing to enter the bone at a sufficient rate so that they don’t develop thinning of the bones — which is osteopenia or osteoporosis, or brittle bones.”

“The skin is filled with estrogen receptors — collagen— so the skin continues looking better,” he also noted. “The vaginal mucosa tends to maintain its normal appearance with a thick tissue.”

About the HT controversy: Timing matters

The safety and value of HT has been in question for some time.

In the early 1990s, the Women’s Health Initiative study of the effects of HT in postmenopausal women strongly suggested that it significantly increased the risk of dementia and stroke and did not reduce cardiovascular risk. There was contradictory research, such as the Nurses Health Study that found the therapy reduced the risk of dementia. Two recent studies found otherwise.

Recently, however, a re-appraisal of earlier research has uncovered a key factor that separates HT’s benefits from its adverse effects: timing. Most of the Women’s Health Initiative study’s participants were over 62, for example, by which time they no longer had estrogen receptors and had already developed atherosclerosis.

Data from the 1991 study has been re-analyzed , and the consensus among experts agrees with the new study: HT is helpful during perimenopause, and may be helpful later, but with definite risks.