Dementia and Long-term Hormone Replacement Therapy

Women with cognitive symptoms ask whether they should start or continue hormone replacement therapy (HRT) to prevent dementia. Ten years ago, my advice to them was that they should. But times change as does the best available research.

A new 12-year study looked at 35,000 women on HRT and compared them to 70,000 controls. The risk of dementia of all types ( Alzheimer’s and vascular) was 35% higher in the HRT group. The relationship was dose-dependent but the duration of HRT was not a significant predictor of dementia risk.

Proposed mechanisms by which long-term HRT may lead to a higher dementia risk include a higher risk for stroke and increased inflammatory mediators.

Whether this risk outweighs the benefits of HRT on improving quality-of-life by reducing menopausal symptoms is, of course, a difficult decision. Individual factors matter and a case-by-case risk-benefit analysis can guide this choice.

Adapted from an editorial by Hershey and Tarawneh in Neurology October 25, 2022.

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