Declines in oestrogen during menopause may have cognitive effects
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Recent research suggests that beginning hormone replacement therapy (HRT) within five years of menopause onset may reduce the risk of Alzheimer’s disease. However, initiating HRT later in life could have the opposite effect, indicating that the timing of HRT administration plays a crucial role in its impact on brain health.
Women are more susceptible to Alzheimer’s disease post-menopause compared to men, potentially due to decreased levels of the hormone estrogen, which plays a key role in regulating brain energy production and inflammation. As a result, HRT has been considered a potential intervention to lower Alzheimer’s risk in menopausal women. Yet, studies on the effectiveness of HRT have yielded conflicting results.
Research conducted by Fnu Vaibhav at Pandit Bhagwat Dayal Sharma University of Health Sciences in India and his team analyzed data from 53 studies involving over 8.4 million post-menopausal individuals to investigate the incidence of Alzheimer’s disease. The findings revealed that participants in randomized controlled trials who received HRT had a 38% higher risk of developing Alzheimer’s compared to those who did not receive HRT. In contrast, observational studies showed a 22% lower risk of Alzheimer’s among HRT users.
According to Vaibhav, the disparity in results could be attributed to the age of the participants, with those in randomized controlled trials typically being 65 years or older, whereas participants in observational studies were generally younger. Further analysis indicated that individuals who initiated HRT within five years of menopause had a 32% reduced risk of Alzheimer’s disease over varying follow-up periods.
Roberta Brinton, a researcher at the University of Arizona, who was not involved in the study, emphasizes that the menopausal transition signifies a neurological shift. As estrogen levels decline, the brain undergoes changes in energy metabolism, potentially leading to neurodegeneration. Brinton suggests that starting HRT during or soon after menopause could prevent this metabolic shift. However, if the brain has already undergone this transition, the benefits of HRT may be limited.
Vaibhav stresses the need for further research to clarify the effects of HRT on Alzheimer’s risk. Without a clear understanding, women may miss out on potential benefits or face unintended harm. Consequently, more studies are essential to unravel this confusion and provide evidence-based recommendations for menopausal women.
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