Is Hormone Therapy Effective against Cognitive Decline?

In results published in the journal, Neurology, researchers uncovered significant evidence that hormone therapy treatments in early menopause reduce the risk of Alzheimer’s disease by as much as 30 percent.

Researchers of a population based in Cache County in Utah found that women who began hormone replacement therapy within five years of menopause had a 30 percent decreased risk of Alzheimer’s disease, especially when use persisted in excess of ten years. However, women who started hormone replacement therapy five years or more after menopause did not have a reduced risk of Alzheimer’s disease. 

The study followed 1,768 women, aged 65 or older at the start of the study for 11 years, during which time they were screened for dementia on three separate occasions. All of the participants, had already passed through menopause, but were asked to provide detailed information about their hormone use and age at menopause.

In many previous studies, results have shown that estrogen acts to protect a woman’s brain from Alzheimer’s, but the Women’s Health Initiative (WHI) brought this evidence into question. The WHI study data revealed that women who took Prempro (combined estrogen and progestin therapy) experienced an increased risk of dementia and, in the results released yesterday, it appears that age plays a role in this risk as well.

This evidence is more useful information that will help women make a more informed decision when deciding if hormone therapy would optimally benefit their health.

In 2012, multiple studies have uncovered strong evidence that hormone therapy not only relieves symptoms of menopause, but is valuable in reducing risk of disease, including cognitive decline, cardiovascular disease and cancer – in women who start hormone replacement therapy within ten years of menopause.  Among these, the most recent is the KEEPS study, whose preliminary data unveiled evidence that younger women who began hormone therapy early in menopause are not at an increased risk for heart disease.  This is unlike the WHI data, which showed that women who started hormone therapy within ten years of menopause had a significantly decreased risk of heart disease.

When compared, the results of these two studies suggest that the current recommendations on hormone therapy, as established by the U.S. Preventive Services Task Force (USPSTF), need to be revisited. The USPSTF announced on Monday that hormone therapy should not be used as a tool for prevention and treatment should as limited in duration as possible. A blanket recommendation like this, which the USPSTF has become well-known for, does not take into account the real focus of preventive medicine: each individual patient. Patients must be addressed on an individualized basis and the prescribing physician must be familiar with the research, do an extensive review of the woman’s medical history, assess risk factors and discuss the options, before any worthwhile decisions can be made.