HRT and Cognitive Function

Can Hormone Replacement Therapy (HRT) guard against dementia in women? Is there a “timing” link between HRT and dementia?

HRT, Basic Guidelines. First, let me review the basic criteria for HRT use. According to the widely accepted guidelines set forth by the U.S. Preventive Services Task Force (USPSTF), there are two primary conditions for which initiating Hormone Replacement Therapy is appropriate:

1) Moderate to severe menopausal symptoms such as hot flashes and night sweats affecting the quality of a woman’s life.

2) Bone loss that may lead to osteoporotic fractures (HRT as preventive measure for a somewhat serious condition).

Outside the above two conditions HRT is not recommended. It is of course clear that during the course of HRT, a number of other symptoms/issues may also get addressed in which case this is viewed as an added bonus for those who started HRT for one or both of the above reasons.

The “critical window theory” of HRT. Studies have demonstrated a positive correlation between taking Estrogen during the premenopausal or early menopausal years (late 40’s early 50’s) and protection against dementia, whereas estrogen taken many years after (early 60’s and beyond) appears to not only have zero neurologic benefit, it in fact may be harmful.

1) Based on observational studies, including a long-term cohort study from California (http://www.ncbi.nlm.nih.gov/pubmed/21077179) whose results were recently published, women who took HRT in their late 40’s or early 50’s for the purpose of alleviating vasomotor symptoms such as hot flashes or night sweats had a reduced risk for dementia.

2) In contrast, the Women’s Health Initiative clinical trial found that initiating HRT later in life (average age of participants were 63), was associated with an increased risk of dementia.

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