Concerned About HRT and Dementia

That’s an important question. After clarifying recent information, I will answer at three levels.

In July 2002, the Women’s Health Initiative Estrogen plus Progestin (WHI) arm reported, in a large randomized placebo-controlled trial, that hormonal therapy caused more harm than good even though it prevented fractures (1). More recently women 65 and older in WHI showed a doubled risk for developing dementia if they were on hormones (2).

First, I am concerned that your question included the term “HRT.” Why? Menopause doesn’t need replacement because it is a normal part of every woman’s life and is not estrogen deficiency.

Second, you should be concerned if you are taking OHT and had a normal menopause. Although earlier, undoubtedly biased studies suggested that estrogen was beneficial for the brain, these recent WHI data represent the most scientific answer. It is shocking to learn that a therapy our society viewed as “natural” and “healthy” turned out to be harmful.

If you have not stopped OHT because of hot flushes and night sweats, you can find helpful, practical information through the Centre for Menstrual Cycle and Ovulation Research or email cemcor@interchange.ubc.ca.

Third — I am finally getting to the reassurance I want to give you: In the WHI only a few women in their late 60s in the hormone arm developed dementia — less than five for every 1000 women using hormones for a year. The study also showed a lower risk in those not smoking and who exercised regularly. Finally, for dementia prevention with aging it is important to remain an active participant in your world.

Hope this is helpful. All the best to you.

References

1. Writing Group for the Women’s Health Initiative Investigators. J Am Med Assn 2002;321-333.
2. Shumaker SA et al. J Am Med Assn 2003;289:2651-662.