How Old Is Too Old For HRT?

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It’s Q&A Day at 10almonds!

Have a question or a request? We love to hear from you!

In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small 😎

❝I think you guys do a great job. Wondering if I can suggest a topic? Older women who were not offered hormone replacement therepy because of a long term study that was misread. Now, we need science to tell us if we are too old to benefit from begininng to take HRT. Not sure how old your readers are on average but it would be a great topic for older woman. Thanks❞

‌Thank you for the kind words, and the topic suggestion!

About the menopause and older age thereafter

We’ve talked a bit before about the menopause, for example:

What You Should Have Been Told About The Menopause Beforehand

And we’ve even discussed the unfortunate social phenomenon of post-menopausal women thinking “well, that’s over and done with now, time to forget about that”, because spoiler, it will never be over and done with—your body is always changing every day, and will continue to do so until you no longer have a body to change.

This means, therefore, that since changes are going to happen no matter what, the onus is on us to make the changes as positive (rather than negative) as possible:

Menopause, & When Not To Let Your Guard Down

About cancer risk

It sounds like you know this one, but for any who were unaware: indeed, there was an incredibly overblown and misrepresented study, and even that was about older forms of HRT (being conjugated equine estrogens, instead of bioidentical estradiol):

HRT: A Tale Of Two Approaches

As for those who have previously had breast cancer or similar, there is also:

The Hormone Therapy That Reduces Breast Cancer Risk & More

Is it too late?

Fortunately, there is a quick and easy test to know whether you are too old to benefit:

First, find your pulse, by touching the first two fingers of one hand, against the wrist of the other. If you’re unfamiliar with where to find the pulse at the wrist, here’s a quick explainer.

Or if you prefer a video:

Click Here If The Embedded Video Doesn’t Load Automatically!

Did you find it?

Good; in that case, it’s not too late!

Scientists have tackled this question, looking at women of various ages, and finding that when comparing age groups taking HRT, disease risk changes do not generally vary much by age i.e., someone at 80 gets the same relative benefit from HRT as someone at 50, with no extra risks from the HRT. For example, if taking HRT at 50 reduces a risk by n% compared to an otherwise similar 50-year-old not on HRT, then doing so at 80 reduces the same risk by approximately the same percentage, compared to an otherwise similar 80-year-old not on HRT.

There are a couple of exceptions, such as in the case of already having advanced atherosclerotic lesions (in which specific case HRT could increase inflammation; not something it usually does), or in the case of using conjugated equine estrogens instead of modern bioidentical estradiol (as we talked about before).

Thus, for the most part, HRT is considered safe and effective regardless of age:

How old is too old for hormone therapy?

👆 that’s from 2015 though, so how about a new study, from 2024?

❝Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%).❞

❝Among senior Medicare women, the implications of menopausal hormone therapy use beyond age 65 years vary by types, routes, and strengths. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with estradiol rather than conjugated estrogen.

Read in full: Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses

As for more immediately-enjoyable benefits (improved mood, healthier skin, better sexual function, etc), yes, those also are benefits that people enjoy at least into their eighth decade:

See: Use of hormone therapy in Swedish women aged 80 years or older

What about…

Statistically speaking, most people who take HRT have a great time with it and consider it life-changing in a good way. However, nothing is perfect; sometimes going on HRT can have a shaky start, and for those people, there may be some things that need addressing. So for that, check out:

HRT Side Effects & Troubleshooting

And also, while estrogen monotherapy is very common, it is absolutely worthwhile to consider also taking progesterone alongside it:

Progesterone Menopausal HRT: When, Why, And How To Benefit

Enjoy!

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  • The Best Mobility Exercises For Each Joint

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    Stiff joints and tight muscles limit movement, performance, and daily activities. They also increase the risk of injury, and increase recovery time if the injury happens. So, it’s pretty important to take care of that!

    Here’s how

    Key to joint health involves understanding mobility, flexibility, and stability:

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    • Stability: body’s ability to return to position after disturbance.

    Different body parts have different needs when it comes to prioritizing mobility, flexibility, and stability exercises. So, with that in mind, here’s what to do for your…

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  • Guava vs Orange – Which is Healthier?

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    Our Verdict

    When comparing guava to orange, we picked the guava.

    Why?

    Both are great, but it wasn’t close:

    In terms of macros, guava has 2x the fiber, more than 2x the protein, and just slightly more carbs, for a tidy first-round win.

    In the category of vitamins, guava is higher in vitamins A, B3, B5, B6, B7, B9, C, E, and K, while oranges are higher in vitamin B1, yielding a 9:1 win to guavas here.

    Looking at minerals, guava has more copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while oranges have more calcium, making this round an 8:1 win for guavas.

    Adding up the sections makes for a very clear overall win for the guava, but by all means do enjoy either or both, as diversity is best!

    Want to learn more?

    You might like:

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    Enjoy!

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  • How can I stop overthinking everything? A clinical psychologist offers solutions

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    As a clinical psychologist, I often have clients say they are having trouble with thoughts “on a loop” in their head, which they find difficult to manage.

    While rumination and overthinking are often considered the same thing, they are slightly different (though linked). Rumination is having thoughts on repeat in our minds. This can lead to overthinking – analysing those thoughts without finding solutions or solving the problem.

    It’s like a vinyl record playing the same part of the song over and over. With a record, this is usually because of a scratch. Why we overthink is a little more complicated.

    We’re on the lookout for threats

    Our brains are hardwired to look for threats, to make a plan to address those threats and keep us safe. Those perceived threats may be based on past experiences, or may be the “what ifs” we imagine could happen in the future.

    Our “what ifs” are usually negative outcomes. These are what we call “hot thoughts” – they bring up a lot of emotion (particularly sadness, worry or anger), which means we can easily get stuck on those thoughts and keep going over them.

    However, because they are about things that have either already happened or might happen in the future (but are not happening now), we cannot fix the problem, so we keep going over the same thoughts.

    Who overthinks?

    Most people find themselves in situations at one time or another when they overthink.

    Some people are more likely to ruminate. People who have had prior challenges or experienced trauma may have come to expect threats and look for them more than people who have not had adversities.

    Deep thinkers, people who are prone to anxiety or low mood, and those who are sensitive or feel emotions deeply are also more likely to ruminate and overthink.

    Woman holds her head, looking stressed
    We all overthink from time to time, but some people are more prone to rumination.
    BĀBI/Unsplash

    Also, when we are stressed, our emotions tend to be stronger and last longer, and our thoughts can be less accurate, which means we can get stuck on thoughts more than we would usually.

    Being run down or physically unwell can also mean our thoughts are harder to tackle and manage.

    Acknowledge your feelings

    When thoughts go on repeat, it is helpful to use both emotion-focused and problem-focused strategies.

    Being emotion-focused means figuring out how we feel about something and addressing those feelings. For example, we might feel regret, anger or sadness about something that has happened, or worry about something that might happen.

    Acknowledging those emotions, using self-care techniques and accessing social support to talk about and manage your feelings will be helpful.

    The second part is being problem-focused. Looking at what you would do differently (if the thoughts are about something from your past) and making a plan for dealing with future possibilities your thoughts are raising.

    But it is difficult to plan for all eventualities, so this strategy has limited usefulness.

    What is more helpful is to make a plan for one or two of the more likely possibilities and accept there may be things that happen you haven’t thought of.

    Think about why these thoughts are showing up

    Our feelings and experiences are information; it is important to ask what this information is telling you and why these thoughts are showing up now.

    For example, university has just started again. Parents of high school leavers might be lying awake at night (which is when rumination and overthinking is common) worrying about their young person.

    Man lays awake in bed
    Think of what the information is telling you.
    TheVisualsYouNeed/Shutterstock

    Knowing how you would respond to some more likely possibilities (such as they will need money, they might be lonely or homesick) might be helpful.

    But overthinking is also a sign of a new stage in both your lives, and needing to accept less control over your child’s choices and lives, while wanting the best for them. Recognising this means you can also talk about those feelings with others.

    Let the thoughts go

    A useful way to manage rumination or overthinking is “change, accept, and let go”.

    Challenge and change aspects of your thoughts where you can. For example, the chance that your young person will run out of money and have no food and starve (overthinking tends to lead to your brain coming up with catastrophic outcomes!) is not likely.

    You could plan to check in with your child regularly about how they are coping financially and encourage them to access budgeting support from university services.

    Your thoughts are just ideas. They are not necessarily true or accurate, but when we overthink and have them on repeat, they can start to feel true because they become familiar. Coming up with a more realistic thought can help stop the loop of the unhelpful thought.

    Accepting your emotions and finding ways to manage those (good self-care, social support, communication with those close to you) will also be helpful. As will accepting that life inevitably involves a lack of complete control over outcomes and possibilities life may throw at us. What we do have control over is our reactions and behaviours.

    Remember, you have a 100% success rate of getting through challenges up until this point. You might have wanted to do things differently (and can plan to do that) but nevertheless, you coped and got through.

    So, the last part is letting go of the need to know exactly how things will turn out, and believing in your ability (and sometimes others’) to cope.

    What else can you do?

    A stressed out and tired brain will be more likely to overthink, leading to more stress and creating a cycle that can affect your wellbeing.

    So it’s important to manage your stress levels by eating and sleeping well, moving your body, doing things you enjoy, seeing people you care about, and doing things that fuel your soul and spirit.

    Woman running
    Find ways to manage your stress levels.
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    Distraction – with pleasurable activities and people who bring you joy – can also get your thoughts off repeat.

    If you do find overthinking is affecting your life, and your levels of anxiety are rising or your mood is dropping (your sleep, appetite and enjoyment of life and people is being negatively affected), it might be time to talk to someone and get some strategies to manage.

    When things become too difficult to manage yourself (or with the help of those close to you), a therapist can provide tools that have been proven to be helpful. Some helpful tools to manage worry and your thoughts can also be found here.

    When you find yourself overthinking, think about why you are having “hot thoughts”, acknowledge your feelings and do some future-focused problem solving. But also accept life can be unpredictable and focus on having faith in your ability to cope. The Conversation

    Kirsty Ross, Associate Professor and Senior Clinical Psychologist, Massey University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The Real Magic Number For Daily Fruit/Veg

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    What’s the magic number when it comes to daily fruit/veg? Is it the famous 5-a-day? Is it 7, as championed in Japan? More?

    In fact, the most important number is…

    Drumroll please…

    One.

    Specifically, “one additional fruit/veg per day”.

    More specifically: setting a goal of “one additional fruit/veg per day” resulted (when put to the test in studies) in a greater overall consumption of fruit and vegetables, than goals that seemed larger, such as “5 per day”.

    The studies

    Researchers Dr. Katherine Appleton and Dr. Zara Borgonha did a series of studies, and discovered the following:

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    • Study 3 found that goal-promoting posters increased fruit and vegetable sales in university cafeterias by about 10%, but the effect was short-lived and unaffected by achievability or relevance.

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    You can read about the studies themselves, here:”

    “Eat Five A Day” vs “Eat One More”: Increased fruit and vegetable consumption when goals are provided, and when goals are more achievable or perceived to be easier

    That “or perceived to be easier” is interesting, too, because in fact, eating 5 fruit/veg per day is really not a lot. If you’re vegan, that’s probably covered by breakfast. For others, hopefully it’s covered by the end of lunchtime. But really, if you are at all health conscious and do not have a conflicting chronic health condition that makes eating fruit and veg more troublesome (such as IBS, which is generally predicted by a diet low in fiber, considered to be a risk factor for developing it, later makes consuming a lot of fiber-rich foods more of a challenge), then for most people, eating a meagre 5 fruit/veg per day is not a lot.

    And yet, if you hadn’t been counting (like many of the students who were participants in the study), it’d probably seem like you have to go out of your way to get them, and count them up over the course of the day.

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    Some other magic numbers you should know

    While we’re talking fruit and veg and magic numbers…

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    So: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)

    Further, it is recommended (as a result of a truly huge study into gut health) to consume 30 different kinds of plants per week.

    That might sound like a lot, but it’s very achievable; check out this book we reviewed previously:

    How to Eat 30 Plants a Week – by Hugh Fearnley-Whittingstall

    Enjoy!

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  • How to Be Your Own Therapist – by Owen O’Kane

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    Finding the right therapist can be hard. Sometimes, even just accessing a therapist, any therapist, can be hard, if circumstances are adverse. Sometimes we’d like therapy, but want to feel “better prepared for it” before we do.

    Owen O’Kane, a highly qualified and well-respected psychotherapist, wants to put some tools in our hands. The premise of this book is that “in 10 minutes a day” one can give oneself an amount of therapy that will be beneficial.

    Naturally, in 10 minutes a day, this isn’t going to be the kind of therapy that will work through major traumas, so what can it do?

    Those 10 minutes are spread into three sessions:

    • 4 minutes in the morning
    • 3 minutes in the afternoon
    • 3 minutes in the evening

    The idea is:

    • To do a quick mental health “check-in” before the day gets started, ascertain what one needs in that context, and make a simple plan to get/have it.
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    • To reflect on the day, amplify the positive, and let go of the negative to what extent is practical, in order to rest well ready for the next day

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    In short, this book is a great prelude to (or adjunct to) formal therapy, and for those for whom therapy isn’t accessible and/or desired, a great way to keep oneself on a mentally healthy track.

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  • What’s the difference between an eating disorder and disordered eating?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Following a particular diet or exercising a great deal are common and even encouraged in our health and image-conscious culture. With increased awareness of food allergies and other dietary requirements, it’s also not uncommon for someone to restrict or eliminate certain foods.

    But these behaviours may also be the sign of an unhealthy relationship with food. You can have a problematic pattern of eating without being diagnosed with an eating disorder.

    So, where’s the line? What is disordered eating, and what is an eating disorder?

    PIKSEL/Getty

    What is disordered eating?

    Disordered eating describes negative attitudes and behaviours towards food and eating that can lead to a disturbed eating pattern.

    It can involve:

    • dieting
    • skipping meals
    • avoiding certain food groups
    • binge eating
    • misusing laxatives and weight-loss medications
    • inducing vomiting (sometimes known as purging)
    • exercising compulsively.

    Disordered eating is the term used when these behaviours are not frequent and/or severe enough to meet an eating disorder diagnosis.

    Not everyone who engages in these behaviours will develop an eating disorder. But disordered eating – particularly dieting – usually precedes an eating disorder.

    What is an eating disorder?

    Eating disorders are complex psychiatric illnesses that can negatively affect a person’s body, mind and social life. They’re characterised by persistent disturbances in how someone thinks, feels and behaves around eating and their bodies.

    To make a diagnosis, a qualified health professional will use a combination of standardised questionnaires, as well as more general questioning. These will determine how frequent and severe the behaviours are, and how they affect day-to-day functioning.

    Examples of clinical diagnoses include anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant/restrictive food intake disorder.

    How common are eating disorders and disordered eating?

    The answer can vary quite radically depending on the study and how it defines disordered behaviours and attitudes.

    An estimated 8.4% of women and 2.2% of men will develop an eating disorder at some point in their lives. This is most common during adolescence.

    Disordered eating is also particularly common in young people with 30% of girls and 17% of boys aged 6–18 years reporting engaging in these behaviours.

    Although the research is still emerging, it appears disordered eating and eating disorders are even more common in gender diverse people.

    Can we prevent eating disorders?

    There is some evidence eating disorder prevention programs that target risk factors – such as dieting and concerns about shape and weight – can be effective to some extent in the short term.

    The issue is most of these studies last only a few months. So we can’t determine whether the people involved went on to develop an eating disorder in the longer term.

    In addition, most studies have involved girls or women in late high school and university. By this age, eating disorders have usually already emerged. So, this research cannot tell us as much about eating disorder prevention and it also neglects the wide range of people at risk of eating disorders.

    Is orthorexia an eating disorder?

    In defining the line between eating disorders and disordered eating, orthorexia nervosa is a contentious issue.

    The name literally means “proper appetite” and involves a pathological obsession with proper nutrition, characterised by a restrictive diet and rigidly avoiding foods believed to be “unhealthy” or “impure”.

    These disordered eating behaviours need to be taken seriously as they can lead to malnourishment, loss of relationships, and overall poor quality of life.

    However, orthorexia nervosa is not an official eating disorder in any diagnostic manual.

    Additionally, with the popularity of special diets (such as keto or paleo), time-restricted eating, and dietary requirements (for example, gluten-free) it can sometimes be hard to decipher when concerns about diet have become disordered, or may even be an eating disorder.

    For example, around 6% of people have a food allergy. Emerging evidence suggests they are also more likely to have restrictive types of eating disorders, such as anorexia nervosa and avoidant/restrictive food intake disorder.

    However, following a special diet such as veganism, or having a food allergy, does not automatically lead to disordered eating or an eating disorder.

    It is important to recognise people’s different motivations for eating or avoiding certain foods. For example, a vegan may restrict certain food groups due to animal rights concerns, rather than disordered eating symptoms.

    What to look out for

    If you’re concerned about your own relationship with food or that of a loved one, here are some signs to look out for:

    • preoccupation with food and food preparation
    • cutting out food groups or skipping meals entirely
    • obsession with body weight or shape
    • large fluctuations in weight
    • compulsive exercise
    • mood changes and social withdrawal.

    It’s always best to seek help early. But it is never too late to seek help.

    In Australia, if you are experiencing difficulties in your relationships with food and your body, you can contact the Butterfly Foundation’s national helpline on 1800 33 4673 (or via their online chat).

    For parents concerned their child might be developing concerning relationships with food, weight and body image, Feed Your Instinct highlights common warning signs, provides useful information about help seeking and can generate a personalised report to take to a health professional.

    Gemma Sharp, Researcher in Body Image, Eating and Weight Disorders, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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