Australian guidance generally says starting MHT after age 60, or more than 10 years after menopause, is not usually recommended , but it can still be considered in selected women with persistent troublesome symptoms after an individualized risk–benefit review.

Practical meaning

  • The usual “best window” is within 10 years of menopause or before age 60.
  • After 60, the decision becomes more cautious because the balance of benefits and risks is less favorable for many women.
  • Starting at that age is not automatically forbidden ; it depends on symptoms, cardiovascular risk, breast cancer risk, clot risk, and the presence of a uterus.

How it is typically approached

  • Use the lowest effective dose and reassess regularly.
  • Make sure there is a clear indication, such as significant hot flushes, night sweats, or other troublesome menopausal symptoms.
  • If the goal is mainly vaginal or urinary symptoms, local vaginal estrogen is often preferred over systemic MHT, and it does not usually require a progestogen.

Australian menopause guidance in one line

Starting systemic MHT after 60 is generally discouraged, but a careful case- by-case decision can still support treatment for some women with ongoing symptoms.

What this means for a clinician discussion

A doctor would usually review:

  • Time since final period.
  • Personal and family history of breast cancer, VTE, stroke, and heart disease.
  • Whether the uterus is intact, because that affects the need for progestogen.
  • Whether non-hormonal options might work just as well.

Source-based takeaway

So the short answer is: Australian guidance does not recommend routinely starting MHT after 60, but it allows individualized exceptions when symptoms are significant and the risk profile is acceptable.

If you want, I can turn this into a concise forum-style reply or a clinician- style answer.