Can HRT in Menopausal Women Lower the Risk of Dementia? It Appears YES

At the KAHN CENTER, we see many women entering or in menopause and a discussion of hormone replacement therapy (HRT) is a common topic. I favor it and ask women to read an important book called ESTROGEN MATTERS.

The association between hormone replacement therapy (HRT) use and dementia risk and responsive subgroups, are unknown.

A new study provides important information supporting HRT.

STUDY

In 183,450 postmenopausal women from the UK Biobank (mean 13.3 years follow-up), associations between HRT use (≥1 year) and all-cause dementia and dementia subtypes were studied. The impact of modification by menopause type, lifetime estrogen exposure, apolipoprotein E (APOE) ɛ4 genotype, and age at HRT initiation were studied.

RESULTS

Over 2.43 million person-years, 3,948 dementia cases were identified. HRT use was associated with lower all-cause dementia by 10%, with stronger associations in surgical menopause (26%), APOE ɛ4 carriers (23%) and women with lower endogenous estrogen exposure (26%). Initiation between ages 46 and 56 conferred the greatest benefit.

DISCUSSION

HRT use was associated with lower dementia risk, and these findings may help inform more tailored approaches to HRT prescribing in relation to women's lifetime dementia risk.

This study is an important advance in our knowledge of the long term benefits vs risks of sustained HRT at menopause. At the KAHN CENTER, we will continue to support HRT in women as close to menopause as possible and sustained over time.

Highlights

Hormone replacement therapy (HRT) was associated with lower risk of all-cause dementia and Alzheimer's disease (AD), but not non-AD
Stronger associations were evident for women who had undergone surgical menopause, were apolipoprotein E (APOE) ε4, and had a shorter time between menarche and menopause
Initiation of HRT between 46 and 56 years, but not > 56 years, was associated with reduced dementia risk
While further research is required to establish causality, the findings offer a foundation for future tailored HRT prescribing

Author

Dr. Joel Kahn

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