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New research finds “no evidence” that hormone therapy commonly prescribed for menopausal women either increases or reduces the risk. dementia,
While experts stress that more studies are needed, the findings are said to “reinforce current clinical guidance” that hormone therapy should be prescribed based on other purported benefits and risks rather than for dementia prevention.
Hormone therapy, also known as hormone replacement therapy ,hrt), designed to replace hormones that are naturally depleted menopause,
This treatment helps reduce a variety of symptoms, including hot flushes, mood changes, sleep disturbances, and night sweats.
Available in various forms such as tablets, gels, sprays or creams, HRT may contain various hormones, including estrogen, progesterone, and sometimes testosterone.
A comprehensive review conducted by a team of researchers from the UK, Ireland, Switzerland, Australia and China examined 10 studies involving more than one million women.
The team investigated whether HRT use affected the risk of mild cognitive impairment (MCI), which affects thinking and memory, or dementia, in pre- and post-menopausal women.
The study included patients with MCI, those experiencing early menopause, and women with premature ovarian insufficiency, where the ovaries stop working before the age of 40.
Analysis, published in lancet healthy longevityconcluded that there was “no significant association” between HRT and the risk of mild cognitive impairment or dementia.
Furthermore, the timing, duration or specific type of HRT used showed “no significant effect”.
The researchers reiterated that there is “no evidence that” using hormone therapy “increases or reduces the risk of dementia in post-menopausal women” and that prescriptions “should be based on other perceived benefits and risks and not for dementia prevention”.
They also called for high-quality studies to further clarify the role of hormone therapy and dementia risk, particularly focusing on women with early menopause or mild cognitive impairment.
Dementia disproportionately affects women globally, even with longer life spans, with an estimated 982,000 people in the UK living with the condition, almost two-thirds of whom are women.
Melissa Melville, lead author of the study and a PhD student in UCL psychology and linguistics, highlighted this disparity.
She said: “Worldwide, dementia affects women disproportionately, even when taking into account women’s longevity, so there is an urgent need to understand what may be driving that risk, and to identify ways to reduce the risk of dementia in women.”
Ms Melville said: “Menopause hormone therapy is widely used to manage menopause symptoms, yet its effects on memory, cognition and dementia risk remain one of the most debated issues in women’s health.
“Conflicting research and concerns about potential harms have fueled public and clinical debate, leaving women and physicians uncertain whether menopausal hormone therapy may increase or decrease their risk of dementia.”
Amy Spector, professor of psychology and linguistics at UCL, said the World Health Organization (WHO) currently offers no guidance on menopause hormone therapy and cognitive outcomes, leaving a significant gap for practitioners and policy makers.
They hoped the review would help inform upcoming WHO guidelines to reduce the risk of cognitive decline and dementia expected in 2026.
Professor Spector concluded: “To cut through the noise, we reviewed the most rigorous research on this topic and found that menopausal hormone therapy does not affect dementia risk, either positively or negatively.
“More high-quality, long-term research is still needed to fully understand the long-term effects of menopausal hormone therapy.”
However, menopause expert Louise Newson offered a different view, suggesting that “It is impossible to say from this research that HRT either increases or does not reduce dementia risk.”
He argued: “We have known for decades that our three hormones progesterone, estradiol and testosterone are made in our brain and that they have specific roles in our brain, including improving the way nerve cells grow, function and communicate with each other.”
Ms Newson stressed the importance of “common sense” in the debate, noting that modern HRT prescribes hormones with the same molecular structure as natural ones, unlike older synthetic types.
They concluded that women prescribed HRT containing progesterone, estradiol and testosterone experience more benefits than risks, including improvement in symptoms such as memory problems and reduced future risk of osteoporosis and heart disease.