Unlock the Secret: The Surprising Age to Start HRT That Could Slash Your Alzheimer’s Risk by 32%—Are You Missing This Critical Window?

So, here’s a thought: menopause symptoms like hot flashes and insomnia are nothing to sneeze at—but what if the timing of your treatment could actually influence your brain health years down the line? Yep, hormone replacement therapy (HRT) isn’t just about easing those pesky menopause side effects anymore; recent research suggests starting HRT at just the right moment might lower your chance of developing Alzheimer’s disease. Crazy, right? But hold on—there’s a catch about when to start, and if you’re thinking you’re too late to the HRT party, don’t panic just yet. There’s a lot to unpack about how HRT works, the ideal window for starting it, and what you can do to keep your brain sharp even if you’re stepping in a bit late. Trust me, this isn’t just another “one-size-fits-all” health headline; it’s about smart decisions tailored to you. Ready to dive in? LEARN MORE

If you’ve already experienced menopause or are about to go through this stage in life, you’re likely familiar with symptoms such as hot flashes, vaginal dryness and insomnia. Some women find relief with natural solutions like changing their diet or using oils and creams. For others, hormone replacement therapy (HRT) is the most effective option. If you’ve been considering HRT, new research shows that starting it at the right time may reduce your risk of Alzheimer’s disease. Here’s everything you need to know, including how to protect your brain health if you’re starting HRT later than the “ideal” timeframe. 

How HRT eases menopause symptoms 

“Hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), is a medical treatment that replaces the hormones the body no longer makes in sufficient amounts after menopause,” says  Jila Senemar, MD, a board-certified ob-gyn and founder of JilaMD. “It is used to relieve symptoms such as hot flashes, sleep disruption, vaginal dryness and to support bone health.”

As a refresher, menopause is when the ovaries stop producing hormones and menstrual periods end, usually around age 51, Dr. Senemar says. It’s typically defined as 12 months without a period. “Falling estrogen levels are what drives hot flashes, night sweats, sleep disruption, brain fog, joint aches and vaginal dryness,” she adds.

“For the right patient, HRT helps ease most symptoms from this hormone loss while also supporting bone health and overall quality of life,” says Dr. Senemar. “It is best to start near [the] menopause transition, with the lowest effective dose and the most effective route of administration. If you have a uterus, you will also need progesterone.”

New study shows starting HRT early may lower Alzheimer’s risk 

During the 2025 meeting of the American Neurological Association occurring September 13 to 16, new research was presented on HRT and the risk of dementia, specifically Alzheimer’s disease. The study examined more than 50 studies on HRT and found that participants who began using HRT within five years of entering menopause had about a 32 percent lower risk of Alzheimer’s, while those starting HRT at age 65 or later had about a 38 percent higher Alzheimer’s risk. 

The study suggests the potential protective effect of HRT against cognitive decline when started at the right time. “The window of opportunity for HRT/MHT appears to be around menopause transition,” says Dr. Senemar. “During the menopause transition, estrogen sensitive brain circuits are still resilient. Adding physiologic estrogen maintains proper function and is likely effective for many years. Starting later, after years of transition, is not as effective.”

How starting HRT later impacts brain health

While starting HRT early is beneficial when it comes to brain health, beginning hormone therapy later on may have potential drawbacks. “Adding estrogen many years later may ‘stress’ evolving atrophic changes in the brain that occur with age and could result in brain and vascular tissue damage,” explains Dr. Senemar. “The timing of HRT may be connected to Alzheimer’s risk for this very reason: Near menopause, estrogen supports brain cell communication and inflammation. Many years later, after age-related changes have occurred, adding hormones could possibly be harmful.”

As Raj Dasgupta, MD, Chief Medical Advisor for Sleepopolis, adds,“Estrogen supports brain health by keeping blood flow strong and reducing inflammation. Right around menopause, that’s protective. But later, when the brain already has some wear and tear, hormones can stress the system and backfire.”

“If you started later, don’t panic. It just means your doctor should see if HRT still makes sense for you.” —Raj Dasgupta, MD. 

Dr. Senemar emphasizes that HRT should be thought of primarily as a way to treat menopause symptoms. “Use HRT/MHT for symptoms, not to prevent dementia,” says Dr. Senemar. “The benefits are most powerful during the transition period.” As with any medication, Dr. Senemar stresses HRT should be prescribed by a knowledgeable provider who’s familiar with your unique health history, menopause symptoms and risk factors for Alzheimer’s disease. 

When is the ideal time to start HRT?

Dr. Dasgupta and Dr. Senemar both say a good time to begin HRT is within 10 years of your last period and before age 60, when, in most cases, the benefits could be greater than any potential risks.

How to safely take HRT past the ‘ideal’ age 

If you’ve already started taking HRT past the recommended age or are considering it, you may wonder what this new research means for you.

“If you started later, don’t panic,” says Dr. Dasgupta. “It just means you and your doctor should check in on your risks and see if HRT still makes sense for you. And remember, things like exercise, sleep, diet and managing blood pressure also go a long way toward protecting the brain.”

Dr. Senemar agrees that some patients can still benefit from taking HRT past the ideal timeframe. “If a patient needs to start HRT after age 60 or more than 10 years since their last period, I take a safety-first, symptom-focused approach using the lowest effective dose, the most effective route and short trial with reassessment,” says Dr. Senemar. “Some women may still benefit for [treating] severe symptoms and bone protection, with careful monitoring.” 

What to do if HRT isn’t right you for

If you’re not a good candidate for taking HRT due to an increased Alzheimer’s risk or other factors, Dr. Senemar says there are other options available to you. Dr. Senemar says some of the most effective options include:

• Local vaginal estrogen for dryness or urinary issues, which is safe at any age, says Dr. Senemar
• Non-hormonal medications (SSRIs, SNRIs, Gabapentin) for hot flashes
• Supplements such as calcium, vitamin D and vitamin K3, as well as weight-bearing exercises for bone health and heart health
• Healthy habits like eating a balanced diet, getting regular exercise, optimizing sleep optimization and keeping your brain engaged—”all proven strategies to reduce long term risk,” says Dr. Senemar

The bottom line on HRT and Alzheimer’s risk

When it comes to health, there’s rarely a one-size-fits-all answer. The hot flash cure your aunt swore by may work well for you, but not for your friend. And while HRT may be the best option for someone else’s menopause symptoms, it might not be right for you. What matters most is having the knowledge to make an informed decision, know the recommended timing and working with your doctor to come up with a solution that fits your needs.