My wife adores her 15 year old Giant TCX Composite (size 44!). Arthritis means no getting out of the saddle for hills.
We've got the standard 52/38 up front and a slightly larger 11/26 at the back. A lot lower gearing is needed.
I had SRAM PG990 (I think) on the back of mine, that had (I think) a maximum 34 , which was great . I don't recall if this required a new rear derailleur cage. I think so.
The wife doesn't mind MTB components, as long as they're around Ultegra spec. I'd rather invest money in a bike she loves, than spend $5k (Aussie) on a equivalent replacement.
How low can we go?