As with many things in life, timing may be everything when it comes to hormone therapy.
A new study from Kaiser Permanente, presented at last week's Alzheimer's Association International Conference on Alzheimer's Disease in Chicago, reported that women who began hormones at menopause had a 24 percent reduced risk for all forms of dementia, including Alzheimer's disease. Older women who started hormones at age 65 or so had up to a 46 percent increased risk of dementia.
As I have said so often before, for the millions of women going through menopause, I don't think there is anything more frustrating than trying to make sense of all the confusing research on hormones.
But for older women who have gone through menopause years earlier, the message is clear. Starting hormones later in life to stave off chronic diseases such as osteoporosis, heart disease and dementia is rarely a good idea.
We already have many good lifestyle and medical treatments that will greatly reduce the risk of osteoporosis and heart disease. As we are also learning at this conference, lifestyle choices that are good for the heart are also good for the brain. Everything from a heart healthy diet, regular physical exercise, omega-3 fatty acids and even caffeine may be just what the brain needs to stay healthy.
And we also learned it is never too late to reap some benefits from a healthy lifestyle. Therefore, no older woman should assume the small risks that come with starting estrogen when there is so much she can do to lower her risk.
But what about all the baby-booming women approaching menopause who may be suffering, or the women already in the throes of menopause who want to do everything they can to stay healthy?
Here is what we know. Hormones can protect women from bone loss and fractures but only as long as these women are taking the hormones. Once they stop hormones, the benefits quickly disappear.
A number of observational studies have shown that hormones can reduce the risk of heart disease and dementia by as much as 30 to 40 percent. However, many of these observational studies looked at younger healthy women who chose to take hormones either because of menopausal symptoms or because they and their physicians believed hormone therapy was a good idea for them.
A breakdown of the larger research studies including the Nurses' Health Study and the Women's Health Initiative found that heart disease risk may be reduced by hormones in midlife women starting hormones while hormones increase the risk in older women.
The North American Menopause Society has recently issued a new set of guidelines for midlife women who are experiencing menopause symptoms, which suggested that for them the benefits of hormones short-term may be more important than any small risk.
I have written about this previously. However, research from the Women's Health Initiative study did not find an overall benefit of hormones, but the average age in this large government study was about 62. The smaller randomized trial that was part of the WHI referred to as WHIMS studied women 65 years and older. Researchers found the risk of dementia for the women who took hormones was twice as great as it was for women who took placebos
So what's new?