Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. The use of menopausal hormone therapy was not associated with an increased risk of developing dementia or Alzheimer’s disease

2. Estrogen-only therapy for 10 years or more was associated with a decreased risk of dementia

Evidence Rating Level: 3 (Average)

Approximately 80% of women experiencing menopause report symptoms including hot flashes, sleep disturbances, depression, cognitive and concentration decline, and even development of neurodegenerative diseases. Biological studies have found that estrogen has a neuroprotective role and therefore prescribing estrogen to ease menopausal symptoms is often warranted. However, hormone replacement therapy studies have been inconclusive with certain research suggesting higher risks of cognitive harm. This study aimed to assess and understand the impacts of hormone therapy and the risk of developing dementia. Specifically, it conducted two nested case-control studies using primary care databases; QResearch and CPRD GOLD. These databases offered information between 1998 and 2020 of all prescriptions used for menopausal treatment including estrogen and progestogens as well as topical hormonal preparations such as vaginal creams for menopausal women. Time intervals were also used to calculate durations of exposure for each prescription. Furthermore, analyses were performed separately for Alzheimer’s disease and vascular dementia. In total, n= 118 501 cases of women over the age of 55 with a diagnosis of dementia were identified and matched to n= 497 416 controls (women over 55 without dementia). 16 291 (14%) of the cases and 68 726 (14%) of controls had used menopausal hormone therapy for more than three years prior to the study index date. Additional findings revealed that 34% of patients with dementia were diagnosed with Alzheimer’s whereas 21% had a diagnosis of vascular dementia, and 3% having both. Overall, no significant association between the use of menopausal hormone therapy and dementia risks was found. There was however, a decreased risk of dementia for participants younger than 80, taking estrogen-only therapy for 10 years or more. A strength of the study was that it took into account the age of the participants, the dosage and type of medications, various methods of applications of therapy, as well as duration of therapy. However, a limitation was the lack of available data recording specific dates of menopause as well as differentiating women who may have experienced neurocognitive decline without an official diagnosis of dementia. Overall, the study can offer some reassurance to women and health care professionals that there were no increased risks of developing dementia associated with the continued use of their estrogen-only hormone therapies.

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