Hormone Replenishment Therapy (HRT)

If you’ve followed me for any length of time and read almost anything I’ve written about hormone replenishment therapy (HRT), you’ll know that my main message is this:

The right kind of HRT is a great option for most women in menopause.

There is a lot of research showing that estrogen benefits blood flow and cognitive function (among a long list of other benefits). Therefore, it was alarming then when a study from Denmark was recently published reigniting fear about HRT and dementia.

Bad News Makes Better News than Good News:

The published study was titled, “Menopausal hormone therapy and dementia: nationwide, nested case-control study.” The headline in my doctors’ email digest read, “HRT, Even Short-Term Use, Linked to Dementia in Women.”

Scary, right?

The Danish study matched one woman with dementia with ten women without dementia, and looked back at their use of HRT(case-control study). In Denmark, this kind of study can be done because people have national health care and therefore have accurate medical records going back over most of their lives.

The study found a connection between an increased incidence of dementia and the use of estrogen and progestin.

What’s the Real Deal?

When you read a headline like this, it is impossible to know the real deal until you look at the original study publication.

When I read the original paper, I learned that most (two-thirds) of the women diagnosed with dementia (the “cases”) had their last use of HRT over 8 years before their dementia diagnosis. Only 9% of the cases were still using HRT when they were diagnosed with dementia.

This could mean that the truth about hormones is the exact opposite of what this study suggests. Maybe STOPPING HRT causes an INCREASE IN THE RISK OF DEMENTIA.

The Bottom Line

In a case-control study design, you cannot say the HRT caused the dementia, you can only say an association was observed.

The study publication concludes as most do, by saying that more research is needed.

My message to you today

Cognitive issues like “brain fog” in the menopausal transition or menopause usually improve with estrogen replenishment. This study does not show risk that outweighs the benefits of the right kind of HRT. Instead, it stirs up fear, leading women and doctors to lean away from a great option for most women in menopause.

References:

Medscape article:

HRT, Even Short-Term Use, Linked to Dementia Risk in Women

Original study: “Menopausal hormone therapy and dementia: nationwide, nested case-control study”

https://www.bmj.com/content/381/bmj-2022-072770

Also: “HRT May Prevent Alzheimer’s in High-Risk Women”

Study showing benefit of estrogen on preventing Alzheimers (published January 2023); ***notice the mild cautious headline used with good news, as compared to the scary headline used above.***

HRT May Prevent Alzheimer's in High-Risk Women