Hormone health after menopause

What happens to your hormones in your 60s

By your 60s, oestrogen has been at its post-menopausal baseline for a number of years. The hormonal picture is largely one of sustained absence rather than ongoing change. The volatility of perimenopause is long past. What remains is the cumulative effect of years without adequate oestrogen on bone, cardiovascular tissue, brain, skin, joints and the genitourinary system.

Testosterone continues a gradual decline in your 60s. In women, testosterone contributes to energy, libido, muscle maintenance, bone density and cognitive sharpness. Thyroid function also warrants attention — Hashimoto's thyroiditis and hypothyroidism are common in women over 60, and their symptoms overlap almost entirely with post-menopausal symptoms and with what is often attributed simply to ageing.

The health considerations that matter most

Bone density

The most rapid period of bone loss occurs in the first five to seven years after menopause. By your 60s, this acute phase has slowed, but cumulative loss becomes clinically significant. Osteoporosis affects approximately one in three women over 60 in the UK. The majority are undiagnosed until a fracture occurs.

A DEXA bone density scan is worth discussing with your GP if you have not had one — particularly if you did not take HRT during the early post-menopausal years, have a family history of osteoporosis, smoke or drink regularly, or have experienced fractures from minor impacts.

Cardiovascular health

Heart disease is the leading cause of death in women in the UK, and cardiovascular risk rises steadily through the 60s. Blood pressure, cholesterol, blood glucose and weight all tend to shift in less favourable directions through this decade. A full cardiovascular check is worth having at least every two years.

Genitourinary symptoms

Vaginal dryness, discomfort during sex, urinary urgency, recurrent urinary tract infections and increased urinary frequency affect an estimated 50 to 60 percent of post-menopausal women and worsen progressively without treatment. These symptoms do not resolve on their own.

Vaginal oestrogen — available as a pessary, cream or ring — delivers oestrogen directly to affected tissue with negligible systemic absorption. It is safe for the vast majority of women including many who cannot use systemic HRT, and it should be used long-term. Ask your GP for it by name: Vagifem, Ovestin or Estring are the main UK options. If you have these symptoms and have not been offered this, raise it at your next appointment.

Cognitive function

Memory, word-finding and processing speed are areas where many women notice change through their 60s. Sleep quality, cardiovascular health, physical activity and blood pressure management all have significant, well-evidenced effects on long-term cognitive function — these are the most important modifiable factors.

Muscle mass and strength

Sarcopenia — the age-related loss of muscle mass — accelerates through the 60s. Muscle loss affects metabolic rate, insulin sensitivity, balance, fall risk and independence in later years. Strength training combined with adequate protein intake is the most effective intervention.

HRT in your 60s

For women already on HRT, current guidance from the British Menopause Society does not recommend a fixed cut-off age for stopping. The decision should be based on individual circumstances, ongoing symptoms and a discussion with a specialist or informed GP. There is no evidence that automatically stopping at 60 or 65 is in a woman's best interests.

For women considering starting HRT in their 60s for the first time, the picture is more nuanced. The evidence for symptom relief, bone protection and quality of life remains relevant, and many specialists support starting in the early 60s where symptoms and individual risk factors support it. Body-identical HRT — transdermal oestradiol and micronised progesterone — is the preferred formulation.

Vaginal oestrogen should be considered separately and additionally, as it addresses genitourinary symptoms that systemic HRT alone may not fully resolve.

What actually helps

Strength training is the single most evidence-based intervention for this decade — addressing muscle mass, bone density, metabolic health, cardiovascular function, mood and cognitive function simultaneously. Two to three sessions per week using meaningful load is the recommendation.

For supplements, vitamin D3 with K2 supports bone density and cardiovascular health — essential in the UK context. Magnesium glycinate supports sleep, bone density and cardiovascular function. Omega-3 (EPA and DHA) supports cardiovascular and cognitive health. Collagen peptides with vitamin C have evidence for supporting skin, joint and bone health post-menopause.

When to see a specialist

• If you have not had a DEXA scan and have risk factors for osteoporosis
• If you are experiencing genitourinary symptoms and have not been offered vaginal oestrogen
• If you have not had blood pressure, cholesterol or blood glucose checked recently
• If you want to discuss whether to continue, stop or start HRT
• If you are experiencing significant fatigue, cognitive changes or joint pain — thyroid dysfunction should be ruled out