short-term and cyclical use estrogen And large observational studies have shown that progestin therapy for menopausal symptoms is associated with an increased risk of dementia.
Investigators believe that a woman in her 50s who took hormone replacement therapy (HRT) for menopausal symptoms was associated with a 24% increased risk of developing dementia, Alzheimer’s disease (AD) Comparison after 20 years with those who did not take HRT. This risk was also present in women who used HRT for a short period of time. menopause Onset.
However, both researchers and experts not involved in the study are unsure whether the increased risk of dementia is attributable to HRT use, or whether there are other potential dementia risk factors in women who require HRT. They warn that more research is needed to investigate whether
Nelsan Purhadi, M.D., Ph.D., Chief Investigator at the Danish Dementia Research Center at Copenhagen University Hospital Rigshospitalet, said, “Does our findings indicate a causal relationship or an underlying predisposition for dementia in women who need HRT?” I can’t guarantee that it does,” he said. Medscape Medical News.
Dr. Nelson Purhadi
Still, he added, the findings back up the evidence. Women’s Health Initiative Memory Study (WHIMS) is the largest randomized trial of menopausal hormone therapy and dementia.
of findings Published online on June 28 BMJMore.
Conflicting findings
Until the introduction of WHIMS in 2003, HRT was widely prescribed to relieve symptoms of menopause. However, the WHIMS, which included more than 4,000 women aged 65 and older, found that HRT was associated with a two-fold increased risk of dementia.
Subsequent published studies have yielded mixed results, adding to the controversy surrounding the safety of HRT.
To find out whether the age at which HRT is started or how long it lasts affects health status, Pourhadi and his team conducted an observational study.
Researchers followed more than 60,000 Danish women aged 50 to 60 between 2000 and 2018 using diagnostic and prescription information from the Danish National Patient Registry.
About 5,600 women developed dementia, and 56,000 did not, according to registry records. Of the 5,600 women with dementia, 1,460 were diagnosed with her AD.
Approximately 18,000 participants in the study sample received HRT. 1,790 (29%) in the dementia group and 16,150 (32%) in the control group. Half started treatment before age 53 and half stopped treatment within 4 years. About 90% were using an oral estrogen-progestin combination.
The median age at which participants started HRT was 53 years in both cases and controls, and the median duration of use was 4 years.
Long-term use means increased risk
People who used estrogen-progestin therapy had a 24% increased risk of developing all-cause dementia compared to those who did not use HRT (hazard ratio) [HR]1.24; 95% CI, 1.17–1.44).
The increase in dementia risk was similar between continuous treatment regimens (estrogen plus progestin taken daily) and cyclic treatment regimens (estrogen plus progestin taken daily for 10 to 14 days per month).
Longer duration of HRT use was associated with increased risk, ranging from 21% increased risk (HR, 1.21; 95% CI, 1.09 to 1.35) to 74% increased risk for those who used within one year. increased (HR, 1.21, 95% CI, 1.35) with use over 12 years, 1.74; 95% CI, 1.45 – 2.10).
Women who started HRT between the ages of 45 and 50 years had a 26% increased risk of developing all-cause dementia (HR, 1.26; 95% CI, 1.13–1.41). Meanwhile, there was a 21% increase in women starting HRT between the ages of 51 and 60. High risk (HR, 1.21; 95% CI, 1.12 to 1.29).
Progestin-only or vaginal estrogen-only treatment was not associated with the development of dementia.
Since this is an observational study, the researchers concluded, We need more research,” he said.
no causality
with accessories EditorKejal Kantarsi, M.D., professor of radiology at the Mayo Clinic in Rochester, Minnesota, noted that three clinical trials were conducted. whims of a young woman The 2013 WHIMS-Y did not show an association between cognitive function and HRT.
Dr. Kejal Kantarsi
“While Pourhadi et al.’s study was carefully conducted using national registries, the observed associations may be artifactual, inferring a causal relationship between hormone therapy and dementia risk. These findings cannot inform shared decision-making about the use of hormone therapy.”Symptoms of menopause,” she said in an editorial.
Dr Amanda Hesslegrave, Senior Research Fellow at the British Dementia Research Institute in London, United Kingdom, also commented on the findings, saying in a release from the UK’s Science Media Centre, that the study was ‘women taking HRT. It may be unsettling for people, but it is.” The study highlights how much we still don’t know about the effects of hormones on women’s brain health, and with promising treatments on the horizon, we’re making it a research priority. Action should be encouraged to make it a sector. ”
There was no specific funding for this study. Kantarci reports that he is engaged in unpaid educational work on Alzheimer’s disease at Biogen, and is the principal investigator of the Imaging Ligand study, funded by Eli Lilly and Avid Radiopharmaceuticals. I am also a person.
BMJ. 2023;381:e072770, p1404. full text, editorial
For more Medscape neurology news, join us here. Facebook and twitter.
