Women Need to Be Advised About the Risks of Long-term Hormone Replacement Therapy

There continues to be a debate about whether hormone replacement therapy (HRT) is beneficial in reducing risk of dementia in postmenopausal women or whether HRT should be avoided because of the associated risk of dementia and stroke. Observational studies have shown an apparent reduction in the risk of Alzheimer disease (AD) with use of HRT,^1,2 but the study groups in these reports were not always matched for age, education, or medical comorbidities (HRT groups were sometimes younger, healthier, and more highly educated than non-HRT groups). One large randomized clinical trial of HRT vs placebo was able to avoid the inherent biases of the observational studies.³ By the end of the 4-year trial, the authors concluded that the risks of HRT outweighed the benefits because twice as many women on HRT (compared with those on placebo) developed dementia. In a systematic review published by the Cochrane Database,⁴ the authors concluded that HRT was not indicated for either primary or secondary prevention of dementia in postmenopausal women. Nevertheless, many patients with subjective cognitive decline or mild cognitive impairment are still arriving in neurologists' offices and asking whether they should continue taking HRT to prevent dementia.