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.
Timing for Heart Disease Protection Important, Too
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?
The aforementioned large study from Kaiser found that there just may be a window of opportunity to begin hormones. Researchers tracked all their female patients from midlife on during the 1960s and 1970s. They took note of every woman who started hormones at midlife and followed them to see how many would develop dementia. They found that women who began hormones early in menopause had a 24 percent reduced risk of developing dementia.
The researchers next tracked pharmacy records of all their female patients from age 65 and over, noting who began hormones at this much later date. Over the ensuing years they found that women who began hormones later in life had a remarkable 46 percent increased risk of dementia. All forms of dementia were counted, including Alzheimer's disease and vascular dementia.
Why do hormones help protect younger brains and harm older brains? No one knows for certain, but a recurring theme at the Alzheimer's conference this week emphasized that the earlier we begin caring for our brains, the better. It simply may be too late to change the course of aging brains and Alzheimer's disease if we start treatments long after the damage is done.
Estrogen researchers believe that the active form of estrogen, estradiol, has protective effects on the brain whereas the synthetic progestin, medroxyprogesterone, may somehow interfere with this good effect. So a second hormone study presented at the meetings tested estradiol at a 1.0 mg standard dose along with another progestin, and found some intriguing (but early) results.
Women who took hormones who had excellent memory at the start of the study had continued good memory throughout. However women with slower memory on a test called the delayed verbal recall test actually had worsening memory when they used hormones. According to the researcher, "It was almost like estrogen helped preserve brain function in the healthy women and failed to protect the brain function in less healthy brains."
We may also be able to prevent these age-related diseases by boosting brain power and function through diet, exercise of both the brain (did you know that obsessing is good for your brain and body?), a touch of caffeine, and maybe even vitamins such as omega-3 fatty acids and antioxidants.
The latest headlines are yet another reminder that no "one-size-fits-all" solutions apply for all women.
If you are young and considering hormones, talk to your doctor about taking: the lowest possible dose of natural estrogen, the skin patch form that bypasses the liver, and a natural form of progesterone such as micronized progesterone capsule or vaginal insert rather than the synthetic progestin's (you only need progesterone if you have a uterus and need to protect it from estrogen buildup of the lining every month or so for about 10 to 12 days total).
I will be writing about hormones whenever something comes out in the news. Millions of baby boomers (such as me) demand information and answers to the hormone dilemma so we can make the best decisions to preserve our health.
In the weeks to come, I will also fill you in about some of the other exciting research presented at the International Conference on Alzheimer's disease in Chicago.
As always, I welcome your comments and questions to this very confusing matter.