When to consider hormone replacement therapy for a potential 32% reduction in dementia risk
Hormone replacement therapy taken during midlife can significantly reduce dementia and Alzheimer's risk by up to 32%, according to a recent meta-analysis This article explores the importance of hormone type, the role of the uterus, and the differences between synthetic and bioidentical hormones
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A recent meta-analysis suggests that hormone replacement therapy, when taken in the 40s and 50s as menopausal symptoms start, can potentially safeguard the female brain against Alzheimer's disease and dementia.
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The report discovered that the level of protection varies depending on the type of hormone.
According to The Menopause Society, the average age when menopause begins, which is defined as not having a period for 12 consecutive months, is 51. However, women can naturally experience this phase anywhere between the ages of 40 and 58. These symptoms, known as perimenopause, can include hot flashes, night sweats, sleep and libido disturbances, heart palpitations, and vaginal pain, and may occur for several years leading up to menopause.
Dr. Lisa Mosconi, the lead study author, emphasized the significance of a "window of opportunity" for hormone replacement therapy. Director of the Alzheimers Prevention Program and the Womens Brain Initiative at Weill Cornell Medicine in New York City, Dr. Mosconi stated that hormone therapy is most effective for the brain when taken during midlife alongside menopausal symptoms, aiding women during this transitional period. Recent analysis published in the journal Frontiers in Aging Neuroscience supports the idea that starting hormone replacement therapy soon after the onset of menopausal symptoms enhances the brain's protection.
Taking hormones while in menopause reduces the risk of dementia by 26% if taken for more than 10 years. However, starting estrogen-progesterone therapy after the age of 65 or more than 10 years after menopause increases the risk of dementia, according to neuroscientist and holistic health care certified professional, Mosconi.
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Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases in Florida, believes that hormone replacement therapy, when administered appropriately, can be highly effective in reducing the risk of cognitive decline and slowing down the progression of Alzheimer's disease in certain women.
Isaacson suggested that this may particularly apply to women who have one or more copies of the APOE4 genetic variant, which is found in approximately 25% of individuals. He emphasized the importance of neurologists and primary care physicians collaborating closely with gynecologists to monitor treatment outcomes over time. Additionally, the type of hormone is also significant in this context.
According to current science, the story goes beyond this. The potential harm or benefit of hormone replacement therapy is also influenced by the specific hormones prescribed, particularly for older individuals.
In cases where the uterus has been surgically removed through a hysterectomy, estrogen-only hormone therapy may be recommended. However, if the uterus is still present, it is advisable for women to use a combination of estrogen and progesterone to avoid the risk of developing uterine cancer.
For women in their 40s, 50s, and early 60s, both estrogen-only and estrogen-progesterone therapy were found to be beneficial in preserving brain health, according to Mosconi. She stated, "If we examine the data during midlife, we see that both types of hormone therapy, namely estrogen-only and estrogen-progesterone, provide protection for the brain. And that is indeed encouraging news."
Woman using hormonal therapy in the bathroom at home .
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Using estrogen-only therapy during midlife carries a higher risk for menopausal women compared to utilizing a patch or vaginal cream, according to a study. The analysis revealed that individuals who solely used estrogen had a 32% higher risk of developing dementia, while those using a combination of estrogen and progesterone experienced a 23% decreased risk compared to those who did not undergo hormone therapy.
Estrogen plays multiple roles in protecting the brain, as confirmed by scientific research. This hormone acts as a "master regulator" in the brain, crucially facilitating glucose absorption. Additionally, estrogen governs the functioning of cellular powerhouses responsible for supplying energy to the body for metabolism. Moreover, estrogen promotes brain plasticity, facilitating the rewiring, reorganization, and establishment of new connections within the brain.
According to Mosconi, estrogen is involved in an array of functions. It stimulates neurons and brain cells to operate at enhanced levels, fostering improved performance. Estrogen also supports the production of neurotransmitters like serotonin, which profoundly influence mood, sleep, and appetite. Furthermore, estrogen plays a pivotal role in the immune system, including within the brain, acting as an anti-inflammatory hormone that also functions as an antioxidant.
The role of the uterus
There is good news for older women as well, but only if they dont have a uterus and are using estrogen-only hormonal therapy, Mosconi said.
Starting hormone therapy at age 65 or later, or more than 10 years after the final menstrual period, has no effect on estrogen-only therapy. The overall impact is neutral.
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The risk of dementia for women who start estrogen-progestogen therapy after age 65 or more than 10 years after menopause is increased by up to 30%. However, the significance of this risk is not completely clear, according to Mosconi. She stated that the studies on this topic are inconsistent, with evidence supporting both protective and negative effects. On average, the data suggests an increased risk of dementia.
It is possible that progesterone may have an antagonistic effect on the neuroprotective properties of estrogen, as suggested by the study. Alternatively, the presence of dementia-related indicators like amyloid plaques and tau tangles in the aging brain could also impact the risk. Further research is required.
"What I find intriguing is that in all the studies we reviewed, which reported a negative association with the use of estrogen combined with progesterone, the women were using a synthetic form of progesterone," Mosconi commented.
Synthetic vs. Bioidentical:
Progesterone replacement can be done in two ways. The first option is to use bioidentical micronized progesterone, which has the exact same molecular structure as the progesterone naturally produced in the ovaries. The second option is to opt for a synthetic form of progesterone called progestin, which is similar to the hormones produced in the ovary but not identical, according to Mosconi.
Women with PMS or PMDD were also more likely to have more severe menopause symptoms, the study showed.
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"There is evidence suggesting that bioidentical progesterone is relatively safer compared to synthetic progestins, which are believed to be the main cause of the elevated risk," she stated. "Nevertheless, additional studies are required to substantiate this claim."
Presently, a significant number of physicians advocate for the prescription of bioidentical estrogen and bioidentical progesterone, which can be conveniently administered through transdermal patches placed on the skin. Mosconi asserts that this method of delivery is more secure."
According to Mosconi, using hormones via the skin has a milder effect as they bypass liver processing. In contrast, taking hormones orally increases the risk of cardiovascular issues due to liver involvement. Mosconi mentioned the development of a promising hormone replacement called selective estrogen receptor modulator (SERM) for older women.
"These preparations are specifically designed to exclusively target the brain - a truly ingenious feature as it ensures that the estrogen directly affects the brain without affecting the reproductive organs or increasing the risk of cancer," she explained.
According to Mosconi, there is no need to take a combination of SERM estrogen and progesterone.
Scientists are working on new forms of hormone replacement therapy that go directly to the brain, thus making them safer for menopausal women.
According to her, estrogen promotes cell growth, which is associated with a higher chance of developing uterine cancer. However, if the estrogen does not even reach the uterus, there is no need for progesterone.
Experts recommend that women engage in conversations about their hormonal symptoms with a menopause specialist while waiting for scientific advancements. It is crucial to recognize individual differences, as the most suitable solution for one woman's brain health may not work for another.
Furthermore, certain women are not eligible for hormone replacement therapy due to factors such as family medical history, heart issues, or clotting disorders. For these women, it is advisable to explore alternative nonhormonal options that have been thoroughly evaluated.
