Latest / The Dr Louise Newson Podcast / 59 - Can you start HRT after 60? What the evidence shows

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59 - Can you start HRT after 60? What the evidence shows · The Dr Louise Newson Podcast

• 0:00
  There are many benefits of taking hormones as many of you
• 0:03
  know, but one of the questions that comes up a lot is can I
• 0:06
  take HRT if I'm over the age of 60?
• 0:09
  So I want to unpick this because it causes so much confusion and
• 0:13
  I don't think it should. So let's think about hormones
• 0:17
  first. And when I talk about hormones,
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  I'm only talking about 3 of dozens of hormones we have in
• 0:23
  our body. So we've got progesterone, we've
• 0:26
  got estradiol and testosterone, and they're made in our ovaries,
• 0:30
  they're made in our adrenal glands, they're made in our
• 0:33
  brains, and they're made in other organs and tissues.
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  And as you know, they're chemical messengers.
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  So they go into our bloodstream and they affect every single
• 0:41
  cell in our body. They have really important
• 0:44
  biological actions ourselves to keep us healthy like our other
• 0:49
  hormones do. But when we become menopausal,
• 0:52
  the levels of these hormones reduce and decline, and then
• 0:56
  they stay low forever. Now, because we still produce
• 1:01
  hormones in other tissues, we are still getting some hormones.
• 1:05
  And because our other hormones are biologically active, they
• 1:08
  can often take some of the jobs of our other hormones, but not
• 1:13
  all of them. So we have receptors on us, on
• 1:16
  our each cell that are specific for each hormone.
• 1:21
  So we have a progesterone receptor.
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  We have an estudiol receptor. In fact, we have two of them and
• 1:27
  we have testosterone receptors. And as you know, I'm sure as
• 1:31
  well is that our cells are constantly being remade.
• 1:34
  Like if you think about just our skin, we're constantly shredding
• 1:38
  skin cells from our outside of our skin and our bodies making
• 1:42
  new ones all the time. Our bone is dynamically active.
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  We're, we're building new bone and breaking down bone all the
• 1:49
  time and repairing our blood vessels are regenerating in our
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  brains as well. We get, we are forming new brain
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  cells all the time and all of these cells have receptors for
• 2:01
  these hormones in them. And so our bodies work a lot
• 2:05
  better when we have the right amount and type of hormones in
• 2:10
  our body. But as I've said, when women
• 2:12
  become menopausal, the hormone levels reduce and stay low.
• 2:17
  The average age of menopause in the UK is 51, but we know in
• 2:22
  many countries the average age of menopause is younger, in the
• 2:26
  40s. And you also know that our
• 2:29
  hormone levels fluctuate and start reducing often 10 years
• 2:33
  before we're menopausal. So women in their 40s will have
• 2:37
  hormonal changes that often affect them.
• 2:40
  Now, traditionally, menopause has been thought of as something
• 2:44
  that doesn't cause periods, that indeed you have to be a year
• 2:47
  since your last period to officially be menopausal.
• 2:51
  But also once they discovered hormones many years ago, they
• 2:55
  associated low estrogen with hot flushes.
• 3:00
  So a lot of people think menopause is lack of periods,
• 3:04
  hot flushes and night sweats, the so-called vasomotor
• 3:07
  symptoms. And indeed many doctors still
• 3:10
  think that's how we define menopause.
• 3:13
  But we need to be thinking beyond that because we know the
• 3:16
  symptoms can be a lot more than flushes and sweats, and there
• 3:21
  are a lot more severe symptoms and flushes and sweats as well.
• 3:25
  When we've looked at our data of hundreds of thousands of women
• 3:28
  who are reporting their symptoms, often daily on our
• 3:31
  free Balance app, then we notice that the most frequent symptoms
• 3:35
  are those affecting our brains. So symptoms such as memory
• 3:39
  problems, fatigue, brain fog, poor sleep, reduced
• 3:44
  concentration, irritability, but also symptoms such as muscle and
• 3:49
  joint pains, urinary symptoms, reduced libido, and in fact,
• 3:54
  flashes and sweats aren't even in the top 20 of common
• 3:57
  symptoms. Now, symptoms are often worse
• 4:00
  and more severe during the perimenopause when hormone
• 4:03
  levels fluctuate. But when women are menopausal,
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  many of us still experience symptoms, symptoms of vaginal
• 4:10
  dryness, soreness, irritation, urinary symptoms.
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  So cystitis, urinary incontinence, increased
• 4:16
  frequency of urinary tract infections.
• 4:19
  Those symptoms often persist and continue, sometimes forever.
• 4:24
  But for many years, there's been lots of studies looking at how
• 4:28
  long the symptoms last for. And it depends what you read,
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  and it depends on the study. And some studies say 7 years,
• 4:34
  some say 10 years. So let's think about it.
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  Most women who are menopausal will have their symptoms in
• 4:42
  their 50s. But I've seen women who have had
• 4:45
  symptoms for decades. I've seen women in their 70s and
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  80s who are still struggling with symptoms.
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  And this is where we have to be thinking beyond symptoms,
• 4:55
  actually, because as I've already said, our hormones work
• 4:59
  in a biologically active way throughout every cell in our
• 5:03
  body. So whether we have symptoms or
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  not, the low hormones can have negative effects on the way that
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  our cells function. And we've known this for many
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  years. When we've look at the
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  inflammatory cells, when we look at the risk of diseases in
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  menopausal women, we've known for decades that the longer a
• 5:25
  woman is menopausal, the greater the risk of inflammatory
• 5:30
  conditions. And we need to wake up and think
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  about this because the commonest cause of death in women is
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  cardiovascular disease and also dementia.
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  So any way that we can reduce our risk of diseases is really
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  important. But it's not just those two
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  diseases. I'm sure you've heard me talk
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  about the list of diseases associated with menopause.
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  But just to recap, other inflammatory diseases include
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  type 2 diabetes, osteoporosis, clinical depression,
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  schizophrenia are thought of to be inflammatory diseases, non
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  alcoholic fatty liver disease and of course autoimmune
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  diseases, inflammatory bowel disease, cancers are related to
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  inflammation, Parkinson's disease, motor neuron disease,
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  multiple sclerosis. These are associated with
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  increased inflammation in the brain.
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  So once we think about these myriad of conditions that we
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  have an increased risk of when we don't have our hormones, then
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  it exposes us as menopausal women to a higher risk of
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  diseases. Now, I'm not here saying that
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  everyone will get those diseases, but it is fact that
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  without those protective hormones, progesterone,
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  estradiol and testosterone, our risk during menopause will
• 6:50
  increase of these diseases regardless of whether we have
• 6:54
  symptoms or not. So many people talk about
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  menopause being a life stage, being a transition, but if you
• 7:03
  think about what it is, so this hormone deficiency, it will last
• 7:08
  forever. Now, testosterone levels might
• 7:11
  increase a little bit with age. Sometimes in people it happens.
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  We can still produce Estes Island progesterone from other
• 7:18
  organs and tissues in our body, but essentially once the hormone
• 7:22
  levels are low, they're pretty low and that can that persists.
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  So whether you're 607080 or 90 or older, your hormone levels
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  will be low and you'll have increased inflammation in the
• 7:35
  body. And of course, there's lots of
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  things we can do to reduce our risk of diseases, to reduce our
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  incidence of inflammatory diseases.
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  And of course, we all should be looking at our lifestyle, what
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  we eat, whether we drink alcohol, whether we exercise,
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  whether we smoke and so forth. But without hormones, we can't
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  eat our way out of menopause. We can't replace our hormones in
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  other ways other than taking HRT.
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  So this is the big question. What do you do if you're in your
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  60s, seventies, 80s or 90s and you've never had hormone
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  treatment before? I see a lot of women in my
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  clinic and speak to a lot of women who have missed out on HRT
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  because in 2002, this big study, the Women's Health Initiative
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  study, the WHI study, was released and reported wrongly
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  actually, to not just the lay press but also to the medical
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  press as well. And it caused so much confusion,
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  and it's still causing a lot of confusion.
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  Now, before the WHI study, HRT prescribing was double what it
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  is now. So we've got a long way to go
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  before women who want their hormones back can have them.
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  There's all this misunderstanding.
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  There's this unfounded fear of hormones.
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  But I mentioned WHI because one of the things that came out of
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  this study was that women over the age of 60 shouldn't be
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  started on HRT. But I want to really unpick this
• 9:09
  for you because one of the things about this study is the
• 9:13
  type of HRT given to these women was not the type of HRT we
• 9:17
  prescribed. Now, and this is really
• 9:19
  important for everyone to understand, the estrogen that
• 9:23
  was given was a tablet type of estrogen and it was derived from
• 9:26
  pregnant horses urine. So although lots of people tell
• 9:30
  me they want something natural for their menopause and pregnant
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  horses urine is of course natural.
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  I do not want that in my body and I'm sure many of you don't
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  either. Pregnant horses urine doesn't
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  just contain estradiol, it contains different types of
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  estrogens and also it contains some progesterone.
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  It also contains some androgens and it contains all sorts of
• 9:52
  other hormones that we don't need as humans into our body.
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  So it does seem a bit crazy to be given that type of estrogen,
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  but the big problem really was the type of progesterone.
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  Now I say progesterone because it wasn't a progesterone.
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  Progesterone is a very specific chemical structure of the
• 10:14
  progesterone we produce ourselves.
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  So it was chemically altered to form something called Majoxy
• 10:20
  progesterone acetate. Very confusing that it's got
• 10:24
  progesterone in the title because it doesn't contain
• 10:26
  progesterone. It's a chemical.
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  It's been altered so it doesn't fit the receptors of the
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  progesterone receptors on every cell.
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  It doesn't have the same benefits that natural
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  progesterone does. It comes as a tablet.
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  It, like I say, it's synthetically made and it, we've
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  known for many years that there are small risks with synthetic
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  progesterone, including Medoxy progesterone acetate.
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  So in the WHI study, they really were giving the wrong type of
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  hormone at the wrong dose, but also to the wrong women because
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  the average age of the women in the study was 64 and this was
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  women starting HRT. Now they did this because they
• 11:10
  wanted to see the long term benefits of HRT, but it was a
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  placebo-controlled study, which meant that half of the women in
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  the study was given a placebo. So not the real deal, it was
• 11:22
  HRT. But we know that HRT is really
• 11:26
  effective at improving menopausal symptoms.
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  And like I said to you earlier, most symptoms occur around the
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  menopause and certainly in the 1st 10 years of being
• 11:36
  menopausal. So you can imagine giving HRT in
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  a randomized control study to a whole lot of women who have
• 11:44
  symptoms. You would very, very quickly
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  work out who was on placebo and who was taking HRT.
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  And so they didn't want that. They wanted to have women who
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  were as asymptomatic as possible.
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  So women who didn't have symptoms.
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  So what do they do? They chose older women, hoping
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  that most of them wouldn't have the flushes, the sweats, the
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  more common symptoms of menopause.
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  So the average age of the study was 64.
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  But there was another problem in the women that they chose
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  because a lot of those women had heart disease already.
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  So a lot of them had had heart attacks.
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  A lot of them were overweight, a lot of them had raised blood
• 12:25
  pressure. So they're giving a type of
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  hormone treatment that is associated with risk of raised
• 12:31
  blood pressure, risk of heart disease to women who already had
• 12:36
  cardiovascular disease. It's quite unwise.
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  And I don't know that if they wanted to do that study now,
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  they would be allowed to get through it because it just
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  doesn't make sense. I'm really excited to announce
• 12:50
  that I've written a new book. It's called Power of Hormones.
• 12:54
  It looks at how hormones actually work in our body and
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  why so much of what we've been told and taught, especially as
• 13:01
  women, has actually been wrong. I explore the science, the
• 13:05
  history, and the uncomfortable truths about how hormones have
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  been misunderstood, under taught, and often dismissed
• 13:13
  within medicine. There are some stories that are
• 13:16
  actually quite shocking, frustrating, and I think
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  essential for us all to know. This book is about understanding
• 13:23
  your body and hormones in a deeper way, about questioning
• 13:27
  symptoms that haven't always served women well.
• 13:30
  If you want to be among the first to read it, you can
• 13:33
  pre-order Power of Hormones now through the link in the show
• 13:36
  notes. So they were giving HRT
• 13:42
  synthetic hormones to older women who'd had heart disease
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  before. Unsurprisingly, you can guess
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  some of the results. I'm sure some of the results
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  showed that those women who took HRT had a higher incidence of
• 13:59
  heart disease and stroke than women who took the placebo,
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  especially when they started HRT over the age of 60.
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  And so when they analysed that data, there were warnings
• 14:11
  throughout from our MHRA in the UK, our Medicines Health
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  Regulatory Authority said women should not be taking HRT and
• 14:21
  starting HRT over the age of 60. They also said women should be
• 14:25
  on HRT for the shortest length of time because they were
• 14:29
  worried about this risk, especially of cardiovascular
• 14:32
  disease in older women. And I understand that, and as a
• 14:36
  doctor, I would not be giving synthetic HRT to women over the
• 14:40
  age of 60. But I've already said we don't
• 14:43
  prescribe those hormones. So I've been to a lot of
• 14:46
  lectures over the years really trying to work out in my head,
• 14:50
  why are we so scared of hormones over the age of 60?
• 14:54
  And the real scaredness has come from the WHI study, from this
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  data showing that starting HRT in women in their 60s,
• 15:05
  especially women who've got cardiovascular disease,
• 15:08
  increases their risk of a heart attack.
• 15:11
  But let's think I've already said I don't prescribe those
• 15:15
  hormones, and most of us don't. We prescribe the exact replica
• 15:19
  of progesterone, estradiol and testosterone.
• 15:22
  So when we give estradiol, it's derived from the soy plants.
• 15:27
  It's got the same structure as estradiol we've produced when
• 15:30
  we're younger, so it fits onto the receptor of cells very
• 15:33
  nicely and helps reduce inflammation.
• 15:37
  The same with progesterone. It's the exact replica of
• 15:40
  progesterone and even testosterone.
• 15:42
  But testosterone wasn't part of the WHI study, so there's
• 15:47
  nothing in our bodies that would suggest that giving Easterdale
• 15:52
  and progesterone to older women is going to be detrimental.
• 15:56
  We haven't got studies because no one's done them and I don't
• 15:59
  think anyone will to be fair. Firstly because there's not big
• 16:03
  pharma behind it and farmer usually sponsor a lot of big
• 16:06
  studies, but also it would be unethical to give people a
• 16:10
  placebo when we know there are benefits of taking hormones.
• 16:13
  I don't think women would actually sign up for the study
• 16:16
  either. We do.
• 16:17
  Then if we're not sure, as doctors we go back to basic
• 16:21
  principles, basic Physiology and understand what's going on and
• 16:26
  what are these drugs or so-called drugs that we're
• 16:29
  prescribing. I don't really think of them as
• 16:31
  drugs because they are just replacement hormones.
• 16:35
  So there's nothing on ourselves that changes when we're over the
• 16:38
  age of 60. And I've already said we get new
• 16:41
  cells forming in our body all the time.
• 16:45
  So when I reached the age of 60, my cells are not going to be
• 16:49
  different to how they were when I was 59.
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  And that's the same with other women as well.
• 16:55
  These new cells won't have a clue what age they are or
• 16:58
  they're not going to be acting differently in the presence of
• 17:01
  estradiol to how they would have happened or how they would have
• 17:05
  reacted a few years before when that person was in their 50s.
• 17:09
  It just doesn't make physiological sense.
• 17:12
  So often with women who want to start hormones at a older age,
• 17:16
  I'll talk to them and say we don't have good quality
• 17:19
  evidence, but we have a lot of basic science to actually
• 17:22
  reassure us about this risk or perceived risk, because the only
• 17:27
  risks have been with the synthetic hormones, which I
• 17:30
  don't prescribe for women. So when we start women on HRT,
• 17:35
  we talk to them about the reasons for giving hormones.
• 17:38
  And there are two main reasons. One reason is to help with
• 17:41
  symptoms, but the other reason, which I think is more important
• 17:45
  as a physician is actually is to reduce future risk of
• 17:50
  inflammatory diseases. So that includes all those
• 17:55
  diseases I've mentioned already. So cardiovascular disease,
• 17:59
  osteoporosis, type 2 diabetes, dementia, autoimmune diseases,
• 18:04
  cancers, the list goes on. And so whether a woman starts
• 18:09
  HRT in their 50s, sixties or 70s or beyond, they're likely to
• 18:15
  still have reduced inflammation from those hormones, reduced
• 18:20
  future risk of all those diseases, which is really
• 18:23
  important to think about. A lot of women say, well, I'm
• 18:26
  not sure if I've got symptoms or not because the flushes, sweats
• 18:30
  often abase after a few years. So they say, well, I don't get
• 18:34
  any flushes and sweats. I don't think I've got symptoms.
• 18:38
  You may have seen the symptom questionnaire that we've got and
• 18:40
  we've produced, it's on the Balance app, it's on my doctor
• 18:44
  Louise newson.co.uk website, and it's got dozens of questions.
• 18:49
  And often if you sit down and answer those questions, people
• 18:54
  will have symptoms. But of course, a lot of those
• 18:57
  symptoms, how do we know they're related to hormones or not?
• 19:00
  It might be just that you've got a bit of wear and tear,
• 19:03
  arthritis, maybe you might be feeling more tired because of
• 19:07
  your age. There might be some other
• 19:09
  conditions that are going on. So it's impossible to know.
• 19:13
  But actually what is useful is to have that questionnaire done
• 19:16
  as a baseline, because then what we can do is see how people
• 19:20
  change with their symptoms when they're taking HRT.
• 19:24
  So a lot of people, when we start them on hormones, so the
• 19:27
  body identical hormones, the exact replica of the hormones
• 19:31
  they produce when they were younger, people start to feel
• 19:34
  better. And it really varies how long it
• 19:37
  can take. When people are older, lots of
• 19:40
  people think it's going to take longer for the body to
• 19:43
  accommodate and change and work out what to do with these
• 19:47
  hormones because they might not have had them for 20 or 30
• 19:50
  years. So for example, if I start HRT
• 19:53
  on a woman in their 70s and they became menopausal age 45, that's
• 19:59
  25 years or so without hormones or with low doses of hormones or
• 20:03
  levels of hormones in their body.
• 20:05
  But sometimes people, I've remember seeing a lady years ago
• 20:08
  who was 78 and she'd had a hysterectomy when she was 48, so
• 20:12
  30 years. She'd been having night sweats,
• 20:15
  she'd been sleeping with a fan on, she'd been the duvet on,
• 20:19
  duvet off, really struggling. And literally within days of her
• 20:23
  having HRT she felt better and the night sweats had melted
• 20:27
  away. I've had other women who've
• 20:29
  taken a few months for their symptoms to settle and reduce.
• 20:33
  So it really varies. And often, as you know, it might
• 20:37
  take a while to get the right dose and type.
• 20:39
  If they didn't absorb very well, for example, through with the
• 20:42
  the gel or a patch, we might have to change the formulation.
• 20:47
  So there's always options and there's always things to change
• 20:50
  and improve. But as a general rule of thumb,
• 20:54
  once people start taking hormones after about 3 months,
• 20:57
  we usually notice some benefit, and that's where doing the
• 21:00
  symptom questionnaire can be very useful.
• 21:03
  Because quite a few women have said to me, wow, I get out of
• 21:06
  bed quicker. I don't have that walking on
• 21:09
  marbles feeling that I've always had under my feet.
• 21:12
  When I get out of bed, my joints aren't as stiff and sore, my
• 21:16
  muscles don't take in the same way.
• 21:18
  I generally feel happier as a person.
• 21:21
  I don't have the urinary symptoms that I had.
• 21:24
  I just feel better in myself. But I thought a lot of those
• 21:27
  symptoms were just part of aging.
• 21:30
  And how hard is it to unpick? Is it a hormonal problem or is
• 21:34
  it part of ageing? And we know that HRT is one of
• 21:38
  the most natural anti ageing treatments that we can have in
• 21:42
  our bodies. And that's really important to
• 21:45
  think about. Externally.
• 21:47
  People often notice that they look better, their skin looks
• 21:50
  better, their hair has a better texture, and often their nails
• 21:53
  are stronger. And a lot of people are critical
• 21:56
  of that and say, well, that's just a cosmetic thing.
• 21:59
  Women shouldn't be taking hormones if they just want to
• 22:01
  improve the way they look. But actually the counterattack
• 22:05
  to that is really thinking about the skin as the largest organ in
• 22:09
  our body. And if our skin looks good, then
• 22:12
  our internal organs are going to be healthier as well.
• 22:16
  If we're building collagen on our faces and in our skin, then
• 22:21
  it's going to help collagen internally.
• 22:23
  It's going to help keep our our musculoskeletal system really
• 22:28
  strong and able to function better.
• 22:31
  If we've got better bone structure in our faces, then
• 22:34
  we're going to have stronger bones throughout our skeleton as
• 22:37
  well. So we can think beyond the
• 22:40
  cosmetic side of taking hormones.
• 22:42
  The other thing to think about is testosterone, because we
• 22:45
  don't have very many studies about testosterone.
• 22:48
  The randomised control studies with testosterone have only been
• 22:51
  looking at libido and sexual function and sexual desire.
• 22:55
  And we know, we've known for many years actually, that
• 22:59
  testosterone can work throughout our body and it can help improve
• 23:02
  mood, energy, concentration, stamina.
• 23:05
  It can help improve muscle and joint pains, can help reduce
• 23:09
  frequency and severity of migraines.
• 23:11
  It can help with urinary tract symptoms as well.
• 23:15
  So we mustn't be thinking about or we mustn't be forgetting
• 23:18
  rather about testosterone in older women as well.
• 23:22
  One of the confusions about testosterone is people have been
• 23:26
  worried about synthetic testosterone.
• 23:29
  So people often say, well, there's an increased risk of a
• 23:32
  heart attack. There's side effects with
• 23:34
  testosterone, and these are the synthetic chemical versions of
• 23:38
  testosterone. The same way that we've got the
• 23:41
  synthetic forms of estudiol and progesterone, we've got
• 23:45
  synthetic forms of testosterone. But when we prescribe
• 23:48
  testosterone as a gel or a cream, it's the same molecular
• 23:52
  structure as our own testosterone.
• 23:54
  So therefore we can use it with confidence.
• 23:59
  A lot of people find their symptoms really improve and
• 24:02
  we're not putting their hearts and bodies at risk by having it.
• 24:07
  It is often the missing hormone for a lot of people.
• 24:10
  So it doesn't feel right to not allow women to have testosterone
• 24:14
  back if they've got low testosterone levels and they're
• 24:18
  keen to try it to see if it improves their symptoms.
• 24:22
  So women who are older than 60 often can try all three hormones
• 24:27
  at the right dose and type for them.
• 24:29
  That improves their symptoms and reduces inflammation and
• 24:33
  therefore improves future health.
• 24:36
  We have to remember that HRT is actually licensed for a
• 24:40
  treatment to reduce incidence of osteoporosis.
• 24:44
  And when we know that osteoporosis increases with
• 24:48
  increasing age, the risk of a fracture, especially a hip
• 24:52
  fracture, which is not insignificant, really does
• 24:55
  increase with age. Thinking just about bones is
• 25:00
  enough really to persuade a lot of women to be thinking about
• 25:03
  taking hormones at an older age. And just finally, before I end
• 25:07
  thinking about vaginal hormones as well.
• 25:10
  So whether you take HRT, systemic hormones or not, you
• 25:16
  should be thinking about your vagina and your urinary tract.
• 25:19
  We know the incidence of urinary symptoms really does increase as
• 25:23
  we age. We should of course be doing our
• 25:26
  pelvic floor exercises regularly, but we need to
• 25:29
  remember that we've got receptors for on the cells of
• 25:34
  our vagina, our vulva, our perineum, our pelvic floor, our
• 25:38
  urinary tract that respond to estudiol and testosterone and
• 25:43
  progesterone as well. So increasingly we ask a lot
• 25:47
  about people's urinary tract symptoms and vaginal symptoms.
• 25:52
  In the past, people have thought, well, if someone's not
• 25:55
  sexually active, we don't need to worry about vaginal hormones
• 25:58
  and that's really wrong. I see and speak to a lot of
• 26:01
  women who have a lot of pain and discomfort in their vulva, their
• 26:05
  vagina. A lot of women tell me they
• 26:07
  can't wear tight fitting clothes, they can't wear
• 26:09
  underclothes, they wear loose fitting skirts because it's so
• 26:12
  painful having something next to them.
• 26:15
  Vulva, because of all the, the, the, the, the tissues becoming
• 26:20
  quite thin, becoming very sore, the nerve endings becoming
• 26:24
  exposed to a lot of pain and discomfort.
• 26:28
  So using vaginal hormones can really help.
• 26:31
  And thinking about not just vaginal estrogen, but there's
• 26:34
  something called prostorone or DHEA, which is another hormone
• 26:39
  that converts to both estrogen and testosterone in the vulva,
• 26:43
  the vagina, the surrounding tissues.
• 26:46
  And that can be really important and really transformational as a
• 26:49
  daily pessary. So whether you take systemic
• 26:53
  hormones or not, using localised vaginal hormones can be really,
• 26:58
  really useful. And about 20% of women do need
• 27:01
  to use both. So we shouldn't be thinking that
• 27:04
  hormones are just for younger women.
• 27:06
  If anyone's been told you can't have hormones because you're too
• 27:09
  old, then I would suggest to go and speak to another doctor or
• 27:13
  clinician who understands the importance of hormones in older
• 27:16
  people. And there's absolutely no time
• 27:19
  limit. We are allowed to take hormones
• 27:22
  as long as we want to because there are always benefits from
• 27:25
  taking hormones. Because we're taking hormones to
• 27:28
  improve our future health, to keep our mind, our body, our
• 27:32
  organs as healthy as possible, then we can can continue taking
• 27:37
  hormones until the day we die. We don't have to stop them at a
• 27:41
  certain age and that's really important, especially when we're
• 27:44
  thinking about the body identical natural hormones,
• 27:47
  because they don't have the risks of the older types of
• 27:50
  hormones. So I hope that's just dispelled
• 27:52
  some myths for you and it allows you to think differently about
• 27:56
  the safety and and effectiveness of hormones at an older age.
• 28:03
  Thanks so much for listening. It would be amazing if you could
• 28:06
  follow me or subscribe because it will really make a difference
• 28:09
  to grow numbers, enable this to reach even more people.
• 28:13
  Thanks so much.