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Can HRT reduce risk of Dementia?

24 February 2020

It is well established that HRT is the most effective treatment currently available for treating menopausal symptoms and for maintaining bone health and reducing risk of osteoporotic fracture. It is also becoming more evident that, when used within 10 years of the menopause, or under the age of 60, it reduces risk of cardiovascular disease. Where debate still lies is in its effect on dementia. A recently published study provides more information on the possible beneficial effect.

The authors examined the association between lifetime exposure to estrogen, from both natural ovarian function and from use of HRT, and cognitive decline in 2,114 women in a 12 year population-based study among women aged 65 or over in Cache County, Utah.

They found that both natural estrogen production and use of HRT were associated with prevention of age-related decline in cognitive function. Regarding natural ovarian function, early age of menopause is associated with decline in cognitive function, as has been shown in previously reported studies.

Regarding role of HRT, commencing HRT within 5 years of the menopause, provided particular benefit, and the longer that it was taken was associated with greater benefit.

In addition to this study, a prospective study from Finland published in 2017 showed that starting HRT soon after menopause and continuing it long-term was associated with a reduced risk for Alzheimer disease.

We may still not have enough definitive evidence from randomised trials, and may never have, but perhaps it is time for a full debate on the preventive role of HRT, not just on its role for symptom control.

References:
Lifetime estrogen exposure and cognition in late life: the Cache County Study. Matyi JM, Rattinger GB, Schwartz S et al. Menopause 2019 Dec;26(12): 1366-1374

Postmenopausal hormone therapy and Alzheimer disease: A prospective cohort study. Imtiaz B, Tuppurainen M, Rikkonen T et al. Neurology 2017 Mar 14;88(11) 1062-1068

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