For several years, it’s been commonly accepted that hormone replacement therapy increases a patient’s risk of developing different types of dementia like Alzheimer's disease and Lewy body dementia. This has prevented many women from obtaining the treatment they need, when they need it.
Below, we take an in-depth look at the medical community’s previous stance on HRT and dementia risk and explore how that stance has changed over time with new information. Keep reading to learn why earlier studies were problematic, the current recommendations for hormone treatment, and how physicians can keep their patients’ risks low.
In 2022, theAmerican Academy of Neurology (AAN) compiled the data of more than 100,000 Taiwanese women to assess the potential relationship between dementia and HRT. Of the women studied, only 35,000 were receiving HRT. The remaining 70,000 were not.
The study revealed a significantly higher risk of all types of dementia for women undergoing hormone replacement. As this information traveled throughout the medical community at the time, physicians became more reluctant to treat their postmenopausal patients with HRT.
Unfortunately, the study itself was flawed in many ways. First, almost 75% of women in the non-HRT group started menopause later in life, while over 50% of the HRT group started menopause early. This is important information since other research indicates that early-onset menopause itself is associated with a higher risk of dementia for reasons entirely unrelated to hormone therapy.
Researchers also only included women from Taiwan in the study, limiting the data to mostly people of Asian descent. This makes it impossible to know if the same results would apply to other demographics.
Another issue is with misinterpretation. Many physicians overlook the nuances of the AAN study, relying only on the overarching claim that HRT and dementia are linked when making decisions for their patients. Doctors often take the data at face value without thinking critically about how the study was done and where the information came from, resulting in poor judgment calls and potential harm to patients.
Newer research holds promise for the field of hormone therapy. A recently published study inJAMA Neurologysuggests that patients who aren’t already starting to develop dementia don’t increase their risk by starting HRT. The study indicated that women with low amyloid proteins at the beginning of treatment generally saw no change in these levels after hormone replacement.
However, the analysis also suggested that women who developed early menopause or who started HRT five or more years after menopause beganare at a higher risk. Researchers did note an increase of amyloid proteins after hormone therapy in these patients, indicating that timing is a crucial component of successful treatment.
Women whostart hormone therapy as soon as possible after menopause begins typically experience the most benefits from treatment.JAMA’snew research boldly highlights the value of starting HRT quickly and the potential consequences of delayed care.
HRT is considered the “gold standard” treatment for classic, yet disruptive symptoms of menopause like hot flashes, night sweats, rapid mood changes, vaginal dryness, and decreased libido. With the proper dose of hormones, many women can obtain almost complete relief.
Having a better understanding of the relationship between hormone therapy and dementia risk can help physicians make smart choices that are in the best interests of their patients. Medical practices that currently or plan to offer HRT in the future can benefit from:
Using a personalized approach for each patient can help doctors choose the right therapy at the right time to reduce the chances of unwantedside effects or failed treatment. Instead of using blanket statistics that may or may not apply to a specific patient, physicians are encouraged to consider each individual’s background, race, family history, symptoms, and other contributing factors that are unique to them.
Physicians should also conduct comprehensive screenings to assess patientcandidacy for hormone replacement and provide counseling to individuals before beginning their treatment. Screenings should rule out the presence of existing dementia markers and late-onset menopause to ensure patients who receive HRT are at the lowest risk.
In light of new research, HRT experts are also making changes to treatment guidelines and recommendations for physicians, like:
Most women are unlikely to develop an increased risk of dementia with hormone treatment, especially when started during early menopause. Continuing HRT is usually recommended since the benefits of hormone replacement almost always outweigh any potential dangers. That said, it’s key that physicians and their patients work closely together to decide if now is the right time to start or continue hormone therapy.
Even though HRT is rarely stopped due to dementia risk, it’s still important for physicians to monitor their patients for symptoms of Alzheimer’s disease and other forms of dementia before and during treatment.
This includes checking with patients and their families for things like memory loss, confusion, paranoia, and poor judgment, as well as regularly performing blood tests and brain scans to assess for clinical decline. Ideally, physicians will have obtained a comprehensive baseline of test results before treatment so that new tests can be compared to for signs of change.
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