Initiation of Hormone Replacement Therapy in Late Menopause [ID 976]

INTRODUCTION: Systemic hormone therapy (HT) is traditionally limited to women within 10 years of menopause or younger than 60 due to concerns about cardiovascular risk. Since 2008, we have implemented a new protocol allowing HT initiation in postmenopausal women over 60 years old with a coronary calcium score (CCS) of 0, challenging conventional age-based restrictions. METHODS: Beginning in 2012, we implemented this protocol in South Florida. Women were eligible if they were more than 10 years postmenopausal or over 60 years of age and had a CCS of 0. Over 100 women meeting these criteria were included. Sociocultural and medical determinants influencing HT use in this population were addressed in complementary analyses. This protocol involved the off-label initiation of systemic hormone therapy beyond the standard 10-year postmenopausal window in women with a CCS of 0. RESULTS: Preliminary findings indicate favorable outcomes in terms of symptom relief, treatment adherence, and cardiovascular safety in women selected based on CCS rather than age alone. No major adverse cardiovascular events were reported during the follow-up period. The approach was well received among diverse ethnic groups, suggesting cultural acceptance when safety is clearly communicated CONCLUSIONS/IMPLICATIONS: This study supports a shift from age-based to risk-based criteria for HT initiation in late menopause. Coronary calcium scoring offers a practical and individualized method to safely expand access to HT in older postmenopausal women. Broader adoption of this protocol could reduce untreated menopausal symptoms in underserved populations while maintaining cardiovascular safety.