(024) Monitored Hormone Therapy in Women 70 Years and Older: Aging Does Not Mean Sexual Retirement

Abstract Introduction Both Australian and US epidemiologic studies show that approximately 50% of partnered women, mean age 70, are sexually active. Septuagenarians often have genitourinary syndrome of menopause and may require hormone therapy (HT). Current guidelines, however, recommend HT primarily for menopausal women under 60 or within 10 years of onset. For women over 60 or more than 10 years post menopause, there is insufficient long-term data regarding risks of cardiovascular disease, breast cancer and thromboembolic events with HT. Due to risk perception and concerns about potential litigation, many healthcare practitioners are hesitant about providing HT to an older population. Objective This is a chart review of women ≥70 years at a single clinic who presented for sexual dysfunction, were counseled about HT use, risks and benefits, and were treated using monitored HT. Methods Charts from August 5, 2007 to August 1, 2025 were examined to identify women ≥70 years who are currently utilizing HT consisting of systemic and local bioidentical sex steroid hormones for at least 2 years. Currently HT consists of: systemic, non-oral estradiol (E2), oral progesterone and transdermal testosterone; and intravaginal DHEA or estradiol and compounded vestibular estradiol/testosterone. Monitored HT includes counseling regarding HT use, obtaining regular blood tests aimed at achieving target values of E2 (25-50 pg/mL), progesterone (1.0-2.0 ng/mL), and calculated free testosterone (cFT) (0.6-0.8 ng/dL), undergoing vulvoscopy with photography, cotton tipped swab testing to assess changes in genital appearance and function, and obtaining patient response to therapy including improvements and adverse events. Results All women born before 1955 and on monitored HT (n = 29), mean age 67 years at initial use of HT (range 52-79), were included in this analysis. 12 patients (43%) were ≥ 70 when starting HT. Sexual health concerns at presentation were: low desire (66%), low arousal (28%), muted/absent orgasm (45%) and dyspareunia (45%). Hormone blood test values before treatment and most recent results are shown in Table 1. Findings at last follow up vulvoscopy revealed improvement in clitoral atrophy, labial resorption, urethral telescoping and minor vestibular gland tenderness/erythema, with return of vaginal rugae (Fig. 1). These patients experienced the following benefits: satisfaction/improved sexual outcomes (67.9%) and decreased pain/itch/discomfort (56%). They experienced the following adverse events during treatment: breast tenderness (17.9%), hair loss (10.7%) and facial hair growth (3.6%), requiring hormone titration as appropriate, as well as major adverse cardiac events (MACE) (3.6%), cancer (0%), thromboembolic events (0%) and death (0%). Conclusions Older women pose challenges in sexual dysfunction management, requiring counseling to make sure they understand HT medication use, as well as risks and benefits. The annualized MACE event rate in this age group is 4.6%, and the risk of invasive breast cancer is 6.3%. Our experience has shown that after risk/benefit discussion, septuagenarians can undergo monitored HT with hormone blood tests approaching target values and positive changes on vulvoscopy. There are insufficient data to conclude that HT is a contraindication in an older population. Patients appreciated the opportunity for symptom relief, improvement in sexual function, and improved quality of life. Disclosure No.