For decades, hormone replacement therapy was considered the best treatment for menopausal symptoms. At one time, aside from the intended effect of mitigating the uncomfortable hot flashes and other menopausal irritations, it was considered good for the heart, brain and bones. Many women were placed on it, at least for a time, during their menopausal journey.
As I am very small boned and at high risk for osteoporosis, I was placed on the hormones long before any signs of menopause. I remember vividly asking my doctor, about five years ago, how long I'd be on the hormones. She said, with certainty, that I'd be on it into my 70s. I was in my late 50s at the time. The next year, when I went in for my physical, she took me off the drug. Most doctors were doing the same. New studies were showing significant heart risk for women on HRT.
Now, the scary part for women like me. Two new studies reported on in the Jan. 13 issue of Neurology, the medical journal of the American Academy of Neurology, in an article titled, "Hormone therapy linked to brain shrinkage, but not lesions," show that "...commonly prescribed forms of postmenopausal hormone therapy may slightly accelerate the loss of brain tissue in women 65 and older beyond what normally occurs with aging."
What was it that I heard about estrogen protecting the brain? I was quite smug, for a time, as the estrogen in HRT was supposed to help prevent dementia, as well as all the other good stuff. I felt fortunate and confident.
Now, the conclusion of these studies that came from the Women's Health Initiative Memory Study, a substudy of the National Institutes of Health's (NIH's) landmark Women's Health Initiative (WHI) hormone therapy clinical trials, shows just the opposite.
Earlier, when there were studies that showed memory problems in older women who had been on HRT, the thinking was that it was related to bleeding in the brain from "silent strokes." This new information, however, shows that the total volumes of brain tissue in regions critical to memory were slightly smaller in patients they studied who had been on the drug. In other words, according to the new studies, we're looking at brain shrinkage, "in two critical areas of the brain: the frontal lobe and the hippocampus. Both areas are involved in thinking and memory skills, and loss of volume in the hippocampus is a risk factor for dementia."
Now, researchers will be looking to see if the effect is a problem for those who took it at a young age, before any memory problems were apparent. However, this looks like one more reason for today's women who are going through menopause to take HRT only if desperately needed for quality of life, and then for the shortest period of time possible.
I'm now waiting for studies that show it didn't help bones either. Sigh! These studies could keep me awake nights, if I let them, but I guess I'll leave that to the researchers who work at this. I'm just grateful they found some of these negative side effects before I'd been on HRT 20 years or more. And since I don't know what the baseline size of my brain was, I couldn't even tell if there was shrinkage, should I have a scan. Maybe that's a blessing, since I can't do anything about having taken it.
Published On: January 23, 2009