Not only do large numbers of North Americans start HRT at menopause, many continue HRT well into their 60s and 70s, convinced that the little pills give them a youthful zest.

HRT should not be started or continued to prevent or treat heart disease. The increase in heart attack risk with HRT appears in the first year, while stroke risk rises during the second year of use.

In particular, doctors should not prescribe HRT to older women, says [Marcia Stefanick]. "For the general population, hormones are something we should not be promoting in a big way at all after age 56. From 56 on I don't think many women are suffering from menopausal symptoms."