The New York Times recently reported on a large study in Denmark, a study which suggests that hormone therapy used to manage menopausal symptoms may increase the risk of developing Alzheimer's disease and other forms of dementia.

The study, done by the Danish Dementia Research Centre at Copenhagen University Hospital Rigshospitalet, found a 24% higher rate of dementia, including Alzheimer's, among women who used hormones compared to those who did not.

However, the study could not determine whether the increased risk was due to the hormones themselves or the menopausal symptoms that led women to seek treatment, which are also associated with dementia risk. Some experts argue that the symptoms of menopause, such as hot flashes, insomnia, and depression, may be the underlying factors linking hormone therapy and dementia.

Critics highlight that the study was observational and could not establish a causal relationship between hormone therapy and dementia. They point out contradictory evidence, including studies suggesting a reduced risk of dementia with hormone therapy.

The study only examined a specific formulation of hormones, while different formulations may yield different outcomes. Experts emphasize the need to consider individualized approaches and differentiate between various hormone therapy compounds when assessing the risks and benefits of treatment for menopausal symptoms.

‍Opposition to the Study Within the Medical Community

Medical professionals at the Mayo Clinic and Harvard Medical School argue that these findings do not establish a causal relationship.

The sample size, which involved over 60,000 women over the age of 60, failed to determine the precise reasons why women were prescribed HRT, and did not consider long-held, confounding variables such as pre-existing cognitive issues or menopausal symptoms that can mimic early signs of dementia.

The medical professionals went on to say that clinical trials are needed to determine whether HRT medication itself causes dementia, and that they caution against changing current practice based solely on the recent findings.

The experts were also keen to note that there are different types of dementia and different types of HRT, and the study's findings may not apply universally.

They highlight the benefits of body-identical hormones, which have lower risks and are prescribed by the NHS, as compared to the synthetic progestins examined in the study. Several recent studies (here, here, and here) suggest that women who take body-identical hormones have a lower risk of Alzheimer's, indicating that the relationship between menopause, hormones, and dementia is complex.

As such, it is important for women to consider individualized consultations and weigh the known and potential benefits and risks of HRT before making a decision.

The Wellcore Position

Ryan Lester, Physician Assistant and Lead Clinician at Wellcore, states:

"This article is referring to a recently published Danish study that assessed the relationship between menopausal women who were on hormones and dementia. The key here is that all of the women on hormones were on a non-bioidentical form of progesterone called progestins, in addition to estradiol.

Multiple studies in the last few decades have demonstrated that progestins are strongly associated with an increased risk of depression, breast cancer, cardiovascular disease, and diabetes. They are rarely used in menopausal women anymore. 

Most clinicians prescribe bioidentical progesterone which has been shown to protect against breast cancer, uterine cancer, and osteoporosis in addition to alleviating the most bothersome menopausal symptoms.

These women were also on estradiol, the bioidentical form of estrogen which has been shown in multiple studies over multiple decades to protect against heart disease, stroke, and certain forms of dementia like Alzheimer's.

We should not discount the long term benefit of estrogen replacement therapy with estradiol on dementia risk because of the concurrent use of progestins as seen in this study."

In Summary

Ultimately, it is important to consider the specific hormones used in the study and their respective effects.

Some hormone treatments for menopause may cause dementia if in fact those treatments include progestins or other non-bioidentical forms of hormones.

Bioidentical hormones used to treat menopause do not cause dementia and in fact, bioidentical hormone therapy, particularly the use of estradiol and progesterone, have shown positive outcomes in terms of protecting against certain health conditions and improving menopausal symptoms. More specifically, they have been shown to have protective effects against breast cancer, uterine cancer, osteoporosis, and cardiovascular disease and can alleviate menopausal symptoms.

IMPORTANT: The Wellcore Women’s Hormone Optimization Program only incorporates the use of bioidentical hormones and as such, the results of this study do not apply to our program.

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