Hormone therapy is not associated with cognitive harm for women if therapy begins around the age of menopause in healthy women, according to University of Wisconsin-Madison research presented this week at the 2018 Alzheimer’s Association International Conference (AAIC) in Chicago.
Fifteen years ago, the Women’s Health Initiative Memory Study (WHIMS) published surprising results suggesting that women using hormones for menopausal symptoms had an increased risk for dementia and mild cognitive impairment.
“An Update on Menopausal Hormone Therapy Trials” was presented by Carey Gleason, PhD, a scientist and clinician at the UW School of Medicine and Public Health and co- leader of the Minority Recruitment Satellite Program of the Wisconsin Alzheimer’s Disease Research Center.
Gleason and her team reviewed findings from several clinical trials in which cognitive and mood effects of hormone therapies were assessed. These include the Kronos Early Estrogen Prevention Study – Cognitive and Affective Ancillary Study (KEEPS-Cog); the Early vs. Late Intervention Trial with Estradiol – Cognitive Endpoints (ELITE-Cog); the WHIMS – Young (WHIMS-Y) and a re-analysis of data from diabetic women enrolled in the WHIMS.
One important factor explored in the new research was timing of hormone use. Women enrolled in the Women’s Health Initiative Memory Study were all age 65 or older. Most women considering hormone therapy will start the medication when menopause begins, which is usually around the age of 51.
Another factor influencing the effect of hormone use was health of the woman. A critique of the WHIMS is that the many of the women enrolled in the study were at high risk for cardiovascular and metabolic diseases. For example, more than 30 percent of women in the WHIMS had a body mass index consistent with morbid obesity.
“Recent findings have added to our understanding of the complex effects of hormones on the brain,” Gleason said. "Still, questions remain. With Dr. Kejal Kantarci from the Mayo Clinic our team at the University of Wisconsin in Madison is launching a follow-up study to the seminal KEEPS-Cog. In the KEEPS-Continuation study we will examine the long-term effects of menopausal hormone therapy, re-evaluating the women 12 years after they were enrolled in the original KEEPS."
"These data are sorely needed to guide women through the menopausal transition and to help them make personalized informed decisions about management of their menopausal symptoms and prevention of future health problems."
The impact of menopausal hormone therapy on aging and Alzheimer’s Disease remains unclear, as does the issue of different long-term effects of the various forms of hormone therapy.