Menopause hormone pills associated with dementia, causation unclear
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[June 29, 2023]
By Nancy Lapid
(Reuters) - Use of hormone replacement therapy (HRT) to ease the effects
of menopause, even for short periods, was associated with a higher risk
for dementia in a nationwide study from Denmark, but the cognitive
declines may not have been due to the treatment, researchers said on
Wednesday.
The study, published in The BMJ, contradicts some earlier studies that
suggest HRT may protect against cognitive decline if the treatments are
started near menopause onset.
The research was complicated by the fact that the scientists could not
distinguish the reasons HRT was prescribed in the first place - to treat
changes in sleep, mood, memory and thinking - from the early symptoms of
dementia.
Therefore, in some of the women treated with HRT in the study, symptoms
that prompted the therapy may actually have reflected early neurological
changes.
Dr. Sarah-Naomi James of the MRC Unit for Lifelong Health and Ageing at
University College London, who was not involved in the Danish research,
said the study "has fundamental limitations" in its ability to interpret
the link between HRT and dementia, given the similarities between
reasons for prescribing HRT and early symptoms of dementia.
"This new study alone should not change practice," James said in a
statement.
Starting in 2000, researchers tracked more than 60,000 Danish women,
including 5,589 who developed dementia. Overall, nearly 18,000 had
received HRT with a combination of estrogen and progestin, with half
starting treatment before age 53 and half stopping within four years.
Roughly 90% used oral medications.
Compared with women who never used HRT, those who did had a 24% higher
risk of an eventual dementia diagnosis.
The risk increased with duration of treatment, reaching 74% for more
than 12 years of HRT.
HRT was widely prescribed before 2003, when a large randomized trial
found the estrogen/progestin combination was linked with a two-fold
increase in dementia risk among women older than 65.
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Pharmaceutical tablets and capsules in
foil strips are arranged on a table in this picture illustration
taken in Ljubljana September 18, 2013. REUTERS/Srdjan Zivulovic/File
Photo
Subsequent studies showed no
increased dementia risk when HRT was started at ages 50-55, or
shortly after menopause. In the Danish study, however, the link
between HRT use and dementia persisted regardless of whether
treatment started before or after age 55.
The authors of an editorial published with the report noted the
study's limitations, writing, "The observed associations could be
artefactual and should not be used to infer a causal relationship
between hormone therapy and dementia risk" or to help doctors and
patients make decisions about using HRT.
Study leader Dr. Amani Meaidi of the Danish Cancer Society Research
Center in Copenhagen said while the study cannot prove HRT
contributes to dementia, causality "is biologically plausible," and
further research is needed.
In the meantime, due to well-known adverse 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 exercise, minimizing alcohol and caffeine use, not smoking,
and maintaining a healthy weight, Meaidi said.
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 the smallest dose possible, she said.
The North American Menopause Society advises: "For women aged
younger than 60 years or who are within 10 years of menopause onset
and have no contraindications, the benefit–risk ratio is favorable
for treatment of bothersome vasomotor symptoms and prevention of
bone loss."
(Reporting by Nancy Lapid in New York; editing by Julie Steenhuysen
and Sandra Maler)
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