08:30pm Monday 25 September 2017

Taking Hormones During Menopause Doesn't Hurt Women's Cognition

A University of Wisconsin-Madison study of about 700 women tested two types of menopausal hormone therapy against placebos and found that neither altered women’s scores on cognitive tests, but that one type of therapy did seem to improve their mood. The women were recruited from the Kronos Early Estrogen Prevention Study (KEEPS), a study sponsored by the Kronos Longevity Research Institute (KLRI). The KEEPS enrolled women at nine sites across the US.

Previous studies had shown that hormone therapy (HT) increased risk for cognitive decline in women over age 65; it was not known if there were similar cognitive effects of HT for younger women. HTs were once widely prescribed to replace hormones no longer produced by the ovaries after menopause. But HT use has declined, based on evidence that it is associated with increased risk of heart attack, stroke and some cancers. On the other hand, HT has proven beneficial in slowing bone loss, and relieving hot flashes and night sweats.

“This study adds to our understanding of the risks and benefits of menopausal hormone therapy,” says Dr. Carey Gleason, assistant professor of medicine at the School of Medicine and Public Health. Gleason does her research at the Geriatric Research, Education and Clinical Center (GRECC) at the William S. Middleton Memorial Veterans Hospital.

“For example, the findings could mitigate concerns about cognitive harm for women who opt to use hormone therapy to treat climacteric symptoms (hot flashes) during menopause. Unlike the Women’s Health Initiative (WHI), which focused on women older than 65, we found that HT did not harm learning, memory, executive function or other cognitive skills for women close to the age of menopause.”

Women on oral replacement hormones – but not those using the transdermal patch – also reported symptoms of depression and anxiety improved during the study.

The study took place at nine academic medical centers and studied 693 women who had an average age of 52.5 years and were about one year past their last menstrual period. The women were randomly divided into three groups: one group received oral estrogen plus 12 days of progesterone (used for first 12 days of the month); a second group received a transdermal estrogen patch plus 12 days of oral progesterone; and the third group received placebo patches and pills.

The participants were followed for four years and completed tests of learning, memory, other cognitive skills, and mood.

There were no differences between the groups on cognition outcomes. Women who received the oral estrogen and progesterone did show some improvements in anxiety and depression symptoms over the four years of the study.

“These data do not indicate that hormone therapy should be a first-line therapy for mood disorders,” Gleason adds. “Rather, the findings suggest if a woman is inclined to use HT, for example to manage her menopausal symptoms, she may also experience some mood benefits. But again, each woman must weigh the potential benefits against the risks.”

The study was funded by grants from the National Institutes of Health and published online in the journal PLoS Medicine.

University of Wisconsin School of Medicine and Public Health


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