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 Many women have been reluctant to use hormones for menopause
symptoms since 2002, when the Women's Health Initiative (WHI) study
in the U.S. linked treatments containing man-made versions of the
female hormones estrogen and progestin to an increased risk of
breast cancer, heart attacks and strokes.
While some previous research has also linked HRT to an increased
risk of dementia, results have been mixed and offered little clarity
about whether this risk should help inform women's decisions about
hormone use.
The current study involved almost 85,000 women diagnosed with
Alzheimer's disease in Finland between 1999 and 2013 and a control
group of about 85,000 similar women without this diagnosis. Roughly
30 percent of women in both groups used hormones; most took
"systemic" hormones in tablet or pill forms but some used vaginal
treatments.
Compared to women who didn't use systemic hormones, those who did
were 9 percent to 17 percent more likely to develop Alzheimer's
disease. The biggest risk was for older women who used HRT for more
than a decade.
"These findings should not be a cause for alarm," said senior study
author Dr. Tomi Mikkola of Helsinki University by email. "For the
short-term management of hot flashes, night sweats and disruptive
sleep, the benefits of hormone therapy clearly outweigh the risk."
Women typically go through menopause between ages 45 and 55. As the
ovaries curb hormone production, women can experience symptoms
ranging from irregular periods and vaginal dryness to mood swings
and insomnia.
Different types of hormone therapy are available, for example,
tablets containing estrogen only or a combination of estrogen and
progestogen, as well as transdermal treatments, such as patches,
gels and creams.
Alzheimer's disease is the most common cause of dementia among older
adults. The progressive brain disorder slowly erodes memory and
thinking skills and eventually leaves people unable to handle basic
tasks in daily life.
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Nearly all of the women in the study who had Alzheimer's were
diagnosed at age 60 or older, and 56 percent of them were over 80 at
the time of their diagnosis, researchers report in The BMJ.
Three in four women with Alzheimer's who were taking HRT had been on
hormones for more than 10 years when they were diagnosed.
In absolute terms, the researchers calculate, HRT is associated with
9 to 18 additional cases of Alzheimer's disease per year detected in
every 10,000 women ages 70 to 80, especially in those who used
hormone therapy for over 10 years.
The type of oral HRT - estrogen only or in combination with
progestogen - didn't appear to impact the risk of Alzheimer's.
Vaginal forms of hormone therapy didn't appear connected to
Alzheimer's disease risk.
The study wasn't a controlled experiment designed to prove whether
or how HRT might directly increase risk for Alzheimer's. It also
wasn't designed to determine whether certain doses or forms of
hormone therapy might directly contribute to that risk.
Evidence from this and other research isn't compelling enough to
warn younger women to avoid HRT just because they're concerned about
Alzheimer's disease, Dr. JoAnn Manson of Harvard Medical School and
Brigham and Women's Hospital in Boston writes in an editorial.
"The randomized trials to date support the cognitive safety of
estrogen therapy when taken in early menopause," Manson said by
email. "For recently menopausal women seeking treatment for
bothersome hot flashes or night sweats, these observational findings
should not discourage use of hormone therapy or materially influence
decision making."
SOURCE: https://bit.ly/2Frh4uU and https://bit.ly/2OhUPKr The BMJ,
online March 6, 2018.
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