When is it too late to start hormone replacement therapy?

We want to consider the use of hormone therapy for symptoms. There is data to suggest that women continue having menopausal symptoms for more than a decade after the final menstrual period. However it does appear from the best-quality studies that hormone therapy, particularly combination estrogen plus progestin, is less safe the more years after the final menstrual period—especially in women in their 60s and 70s. What’s interesting about that idea is that there’s also very good data to suggest that it’s the women who are showing objective cognitive difficulties in their 60s and 70s who are actually responding the most negatively to hormone therapy. We do not recommend that women initiate hormone therapy if they transitioned through menopause many years ago.