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In the early 2000s, a major women’s health study – the Women’s Health Initiative (WHI) made headlines. As an ongoing study started in the 90s, the WHI asked: Could menopause hormone therapy (MHT), used to reduce menopause symptoms, also protect against serious health problems in later life?
A smaller arm, the WHI Memory Study (WHIMS), focuses on brain health in women without dementia.
When the results were released in 2002, they were shocking. Women on MHT were more likely to develop heart disease, stroke, breast cancer and dementia – not less. Doctors immediately advised against MHT, prescriptions dwindled, and for years, MHT virtually disappeared from conversation.
But the story told by the findings was incomplete at the time. The WHI findings were not wrong; He revealed the real risks. But in the years since, researchers have re-examined the WHI data – not just the brain findings, but also heart, stroke and cancer outcomes – to better understand when, why and how MHTs should be used. Today, experts agree that for many women who start MHT around menopause and do not have medical reasons to avoid it, the benefits outweigh the risks, and MHT can be safely prescribed to manage menopause symptoms.
Nevertheless, many myths persist about MHT, including misconceptions about how it affects brain aging.
Let’s dispel some of the biggest myths about MHT and brain health.
Myth 1: MHT increases dementia risk for all women
According to WHIMS, women who started MHT at age 65 or older were more likely to develop dementia than those who did not. But most women start MHT much earlier, usually in their 40s or 50s, around menopause.
And time is of the essence for MHT.
The researchers describe this as the critical window hypothesis: Starting MHT around menopause may help brain health, while starting years later may increase the risk of cognitive decline and dementia. WHIMS did not test this “window” – most participants had gone through menopause long ago and no longer had menopausal symptoms. So when used at the right age, for the right reasons (experiencing menopausal symptoms), results do not show effects of MHT.
Recent studies show a mixed picture: Some women who start MHT closer to menopause may see brain benefits in later life, such as better memory and fewer dementia-related changes. Others see little difference in cognition and dementia risk — but no worse outcomes.
However, starting MHT much later, such as in your 70s or more than five years after menopause, may be associated with more tau protein buildup, a marker of Alzheimer’s disease.
In short, MHT is not automatically bad for the brain, but its effects may depend on when it is started and what type is used.
Myth 2: All MHTs affect the brain the same way
When people hear “MHT” (formerly known as hormone replacement therapy or HRT), they may imagine a standard treatment. But MHT comes in many forms, and these differences can matter. In WHIMS, women took conjugated equine estrogen pills and medroxyprogesterone acetate if they had a uterus. This combination was once standard treatment, but is now rarely used.
Today, 17-beta estradiol (a type of estrogen) is more common and is linked to brain benefits and reduced risk of cognitive decline.
People with a uterus also take progestogens to reduce the risk of uterine cancer. Progestogens may support brain health, but may also blunt the protective effects of estrogen, including its role in the development, maintenance, and function of brain cells that support memory and thinking. Obviously, both the type and combination of hormones matter.
The delivery methods of MHT – which are available as pills, patches, gels, creams, sprays or vaginal rings – also matter because each is processed differently.
Oral pills pass through the liver and may increase the risk of blood clots and high blood pressure, which can affect brain health by slowing blood flow and increasing the risk of stroke.
Patches and gels absorbed through the skin may pose less risk by avoiding the liver.
The bottom line is that not all MHTs are created equal. But even with the right form and timing, can MHT prevent dementia?
Myth 3: WHIMS showed that MHT could prevent dementia
Somewhere along the way, MHT was transformed from a treatment for menopause symptoms to a purported defense against dementia. This misconception is related to WHIMS, which asked whether MHT could reduce the risk of dementia.
But reducing risk is not prevention. WHIMS did not test whether MHT prevents dementia, and because the study enrolled women long after menopause, the results do not show what happens when MHT is used during the menopause transition. Nevertheless, the findings were often taken to support broader claims about MHT and brain health, even though MHT was never designed as a stand-alone strategy to prevent dementia or reduce dementia risk.
And not everyone needs or should take MHT. Some women go through menopause; Others struggle. MHT is not one size fits all.
But why do some women have symptoms and others not? New research suggests that menopause symptoms themselves may provide signals about brain health, possibly reflecting the brain’s sensitivity to falling estrogen. Since estrogen supports memory, thinking, and mood, more symptoms may indicate a greater likelihood of brain aging.
About the authors
Jahinur Ismail is a professor at the Cumming School of Medicine, Jasper Crockford is a medical science master’s student, and Mariam Gharemani is a research data scientist at the Hotchkiss Brain Institute at the University of Calgary. This article is republished from Conversation Under Creative Commons license. read the original article,
And it’s not just the symptoms – it’s their impact on daily life. When night sweats disrupt sleep or cause mood swings, strain in relationships, stress and fatigue can put further strain on the brain.
In short, MHT is not a magic shield against dementia. But for those who struggle and can safely take MHT, managing menopause symptoms can aid current well-being and future brain health.
Next chapter for MHT
WHIMS marks an important first chapter in the MHT story, but the science is still unfolding.
Researchers are now asking: When is the best time to start MHT? Which hormones matter most? Who benefits, and why?
Menopause is individual. For some people, MHT brings relief and a better quality of life. It is not a guaranteed protection against dementia. But for the right person, at the right time, MHT can support healthy brain aging – an encouraging sign for the next generation entering midlife with more knowledge and support than ever before.
Do you want to be a part of this growing story? Consider joining Canadian studies like CAN-PROTECT or BAMBI, which explore how MHT and the menopausal experience affect brain aging.