Should you be using HRT to ward off dementia?

As a baby boomer with a number of baby boomer friends, there have been a couple of questions which come up regularly when we ladies are discussing menopause.

Does HRT (hormone replacement therapy) help preserve your memory and is it safe to take it for that?

Menopause is that wonderful time in a woman’s life where the monthly reminder of periods gradually fades away. This in itself is not usually an issue for most women.
What can be an issue though, is the huge array of associated, assorted symptoms that can accompany that phase.

One of the symptoms not commonly mentioned in the text-books or Doctor’s office, but one not infrequently discussed in our girls talks, is the issue of memory. In an unkind reminder of “pregnancy brain” what we now have raising it’s ugly head is “menopause brain”.
Yes, we seem to be “losing it”. Forgetting appointments, misplacing everything from the car keys to the occasional child, and stressing that not only are now entering that new phase of maturity called “middle age” we also think we might well be losing our mind at the same time.

By the time we reach our late forties and early fifties, that creeping awareness of one’s own mortality starts to develop. We notice our parents are ageing, sometimes becoming very sick or dying. Some of those parents may develop Alzheimer’s disease or dementia, and the sudden emergence of our own memory’s shortgivings can lead us to worry that we too may be at risk.

Moreover, it is known that people with Alzheimer’s and their caregivers are more likely to be women.
Maria Shriver brought home that message very clearly in her report “Women- the face of Alzheimer’s” last year.

So should we be using HRT to help save our memories?
How long should we take it for?
Does it actually make any difference?

Professor Andrew Kaunitz nicely answered these questions in an article from the Department of Obstetrics and Gynaecology, University of Florida College of Medicine.

He writes about a “critical window” of opportunity to use HRT.

In peri menopause, (the time leading up to periods actually finishing) or early menopause, using HRT is associated with a reduced risk of dementia.

However, women who start using HRT in later life actually gain no benefit and may in fact be doing harm.

A long-term cohort study from California published their findings late last year.
In this study, menopausal women aged between 40 and 55 and free of dementia, were between the years of 1963 and 1974 asked whether of not they used HRT. This was determined as being “mid life use”.

Women were again assessed some twenty five to thirty years after the mid life assessment, to see if they were using HRT. If so, they were counted as “late life” users.

Interestingly, what the group found was that those women who had only used HRT in the “mid life” had the lowest prevalence of dementia.
Those who had only used it in “later life” had the highest prevalence of dementia.

Those who had started in midlife and essentially just carried on had a prevalence similar to those women who had never used HRT at all.

Professor Kaunitz says he now advises his clients in the peri menopausal and early menopause that HRT may lower their future risk of dementia with the aim to gradually taper the dose over time and to either eventually discontinue the treatment entirely or suggest they remain on a very low dose. The total length of use also being determined by a number of other individual factors.

Meanwhile, perhaps we should also being looking to see how much relief HRT gives women afflicted by “menopausal brain”. The answer to that question may help women to then decide whether they want to use HRT either as a potential risk modifying agent of dementia, or purely for symptom relief of the “mid life brain”.

Whitmer RA, Quesenberry CP, Zhou J, Yaffe K. Timing of hormone therapy and dementia: The critical window theory revisited. Ann Neuro. 2010 Nov 12

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