Using hormone replacement therapy (HRT) to ease the effects of menopause, even for short periods, was associated with a higher risk of dementia in a study in Denmark.
But even the study authors say that the cognitive decline may not have been caused by the treatment, according to a report published in the journal The BMJ.
However, the research contradicts some previous studies, which suggest that HRT may protect against cognitive decline if treatments are started near the onset of menopause.
The research was complicated by the fact that scientists could not distinguish between the reasons HRT was prescribed in the first place – to treat changes in sleep, mood, memory and thinking – and early symptoms of dementia.
Therefore, in some of the HRT-treated women in the study, the symptoms that prompted therapy may actually have reflected early neurological changes, the experts say.
Since 2000, researchers have monitored more than 60,000 Danish women, including 5,589 who were diagnosed with dementia.
In total, nearly 18,000 took this therapy, HRT, a combination of estrogen and progestin, with half starting treatment before the age of 53 and half stopping within four years. About 90% used oral medications.
Compared with women who never used HRT, those who did had a 24 percent higher risk of being diagnosed with dementia, the researchers found.
The risk increased with the duration of treatment, reaching 74% for more than 12 years of HRT.
HRT was widely prescribed before 2003, when a large randomized trial found that an estrogen/progestogen combination was linked to a two-fold increase in the risk of dementia among women over 65.
Subsequent studies did not show an increased risk of dementia when therapy was started at age 50-55 or shortly after menopause.
However, in the Danish study, the link between HRT use and dementia persisted regardless of whether treatment was started before or after age 55.
Study coordinator Dr. Amani Meaidi of the Danish Cancer Society’s Research Center in Copenhagen said that while the research could not prove that HRT contributes to dementia, the causality “is biologically plausible” and that further studies are needed.
Meanwhile, because of the well-known side effects of HRT, including increased risks of cancer and blood clots, experts in Denmark advise women with menopausal symptoms to first try lifestyle interventions such as not smoking, exercising, minimizing alcohol and caffeine consumption, and maintaining a healthy weight.
If lifestyle changes do not help and there are no medical reasons to avoid HRT, doctors are advised to prescribe hormone therapy with the shortest duration and lowest dose possible.
2023-07-18 21:04:00
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