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Editorial
September 2, 2022

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

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October 25, 2022 issue
99 (17) 733-734

Abstract

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.

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References

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Zandi PP, Carlson MC, Plassman BL, et al; Cache County Memory Study Investigators. Hormone replacement therapy and incidence of Alzheimer disease in older women: the Cache County Study. JAMA. 2002;288(17):2123-2129.
2.
Shao H, Breitner JCS, Whitmer RA, et al; Cache County Investigators. Hormone therapy and Alzheimer disease dementia: new findings from the Cache County Study. Neurology. 2012;79(18):1846-1852.
3.
Shumaker SA, Legault C, Rapp SR, et al; WHIMS Investigators. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003;289(20):2651-2662.
4.
Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017;1(1):CD004143.
5.
Sung YF, Tsai CT, Kuo CY, et al. Use of hormone replacement therapy and risk of dementia: a nationwide cohort study. Neurology. 2022;99(17):e1835-e1842.
6.
Savolainen-Peltonen H, Rahkola-Soiralo P, Hoti F, et al. Use of post-menopausal hormone therapy and risk of Alzheimer's disease in Finland: nationwide case-control study. BMJ. 2019;364:1665.
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Vinogradova Y, Dening T, Hippisley-Cox J, et al. Use of menopausal hormone therapy and risk of dementia: nested case-control studies using QResearch and CPRD databases. BMJ. 2021;374:n2182.
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Resnick SM, Henderson VW. Hormone therapy and risk of Alzheimer disease: a critical time. JAMA. 2002;288(17):2170-2172.
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Maki PM, Henderson VW. Hormone therapy, dementia, and cognition: the Women's Health Initiative 10 years on. Climacteric. 2012;15(3):256-262.
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Georgiadou P, Sbarouni E. Effect of hormone replacement therapy on inflammatory biomarkers. Adv Clin Chem. 2009;47:59-93.

Information & Authors

Information

Published In

Neurology®
Volume 99Number 17October 25, 2022
Pages: 733-734

Publication History

Received: July 25, 2022
Accepted: August 16, 2022
Published online: September 2, 2022
Published in print: October 25, 2022

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Disclosure

L. Hershey receives a stipend from Neurology for serving as an Associate Editor and from MedLink Neurology for writing annual updates about dementia and memory loss. R. Tarawneh reports no relevant disclosures. Go to Neurology.org/N for full disclosures.

Study Funding

The authors report no targeted funding.

Authors

Affiliations & Disclosures

From the University of Oklahoma Health Sciences Center (L.H.); and Department of Neurology (R.T.), Center for Memory and Aging, University of New Mexico, Albuquerque, NM.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Rawan Tarawneh, MD
From the University of Oklahoma Health Sciences Center (L.H.); and Department of Neurology (R.T.), Center for Memory and Aging, University of New Mexico, Albuquerque, NM.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Hershey [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

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