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HRT and Dementia

7th May 2007

The association between HRT use and risk of dementia has been the subject of much debate; some studies appearing to show a reduced risk with HRT and others showing an increase. The Women’s Health Initiative (WHI) trial showed an increased risk of dementia in those who had been randomised to using HRT, but only in the older women. A new report adds strength to the idea that timing of commencement of therapy significantly influences the risk, as it appears to with effect on the heart. The Women’s Health Initiative Memory Study (WHIMS), an ancillary study to WHI, recently reported at the American Academy of Neurology annual meeting, showed an increase in risk of dementia in women who initiated HRT over the age of 65, but importantly, women using HRT under the age of 65 had a 46% overall reduction in dementia risk which was statistically significant, and a 64% reduction in Alzheimer’s disease. In practice, it would be very unusual to commence HRT in women over age 65 and so the increased risk in older women is not applicable to the majority of users, but the reduced risk in younger women is.

This further supports the theory of a “window of opportunity” whereby when HRT is used in the early menopausal years (first 10 or so), when in fact it is most likely to be needed for control of menopausal symptoms, it is very unlikely to be harmful for risk of dementia and may be more likely to be beneficial in reducing risk, the same as now is thought to apply to risk of heart disease. Again, it seems that using HRT in the early menopausal years for symptom control is of minimal risk and of great benefit to many women.

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