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HRT could protect middle-aged women against Alzheimer’s

Taking hormone replacement therapy to cope with the menopause could protect women against Alzheimer’s disease, research suggests.

A seven-year study has found women who take HRT see fewer changes to the brain that are usually associated with ageing.

Detailed scans suggests HRT may help preserve the structure of the prefrontal cortex – the part brain linked to memory and thinking.

The results also suggest HRT may even help ward off dementia.

The Mayo Clinic team found women taking the treatment had lower accumulations of amyloid plaques – toxic proteins that are linked to Alzheimer’s disease.

Researcher Dr Kejal Kantarci said: ‘We found that one form of menopausal hormone therapy taken soon after menopause may preserve brain structure in the portion of the brain responsible for memory and thinking skills.

‘It may also reduce the development of amyloid plaques that can build up and lead to memory loss.’

The menopause, which commonly strikes women in their late 40s and early 50s, can cause hot flushes, headaches, and night sweats.

HRT tackles these symptoms by providing oestrogen as the body stops producing it.

But the new findings suggest the treatment may also protect the brain.

Experts believe this is because oestrogen has a protective impact on the connections in the brain – and when natural hormone production stops this protection disappears.

Replacing it artificially could restore protection.

The findings are particularly significant because many women go without the drug after well-publicised studies in the early 2000s raised fears of side effects.

The new paper, published in the Neurology journal, involved 75 healthy women with an average age of 53 who had gone through the menopause within the last three years.

Twenty women were given HRT pills, 22 received HRT patches and 33 received ‘placebo’ pills or patches which contained no treatment.

The women were kept on the treatment for four years and then tracked for a further three after the therapy ended, and underwent MRI brain scans every few months.

The researchers found women who took

Study participants were given memory and thinking tests as well as MRI scans at the start of the study, at 18 months, at three years and at the end of four years of hormone treatment, and then again three years after therapy ended.

Researchers measured overall brain volume and the accumulation of brain lesions and compared scores on thinking and memory tests.

A total of 68 women also had positron emission tomography (PET) scans to detect plaques in the brain that are related to memory loss and Alzheimer’s disease.

Researchers found that participants who took estradiol via skin patches maintained brain volume in the dorsolateral prefrontal cortex, an area of the brain that assists with memory, thinking, planning and reasoning, over the seven years of the study.

Women who maintained volume in this area of the brain were also more likely to have a lower amount of the amyloid plaque deposits that are related to memory loss and Alzheimer’s disease.

This suggests that estradiol therapy may have long-term effects on the brain.

Researchers also found that for those taking estrogen pills, there were greater structural changes in the brain during therapy, but those changes stopped when participants stopped taking the pills.

Scores on thinking and memory tests were similar for women in the hormone therapy groups and those taking placebo.

‘More research is needed to determine the biological reasons behind brain changes during menopausal hormone therapy,’ said Kantarci.

‘Future research is also need to better define just how the different hormonal products, pills versus skin patches, affect the brain.’

The number of women taking HRT plummeted after studies published in the early 2000s raised fears of side effects.

Usage of the drug in Britain fell from 36 per cent before the studies to around 10 per cent today.

But NHS guidelines watchdog NICE issued new guidance in November 2015 advising GPs to start offering the drug to more women.

They said that out of 1,000 women taking HRT for five years, there would only be six extra cases of breast cancer and 1.5 additional cases of ovarian cancer.

Taking menopausal hormone therapy soon after menopause to relieve symptoms may also benefit the brain, according to a study published in the March 21, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.

‘We found that one form of menopausal hormone therapy taken soon after menopause may preserve brain structure in the portion of the brain responsible for memory and thinking skills,’ said study author Kejal Kantarci, MD, MS, of the Mayo Clinic in Rochester, Minn., and a member of the American Academy of Neurology.

‘It may also reduce the development of amyloid plaques that can build up and lead to memory loss.’

For the study, researchers identified 75 healthy women with an average age of 53 who were between five months to three years past menopause.

Of those, 20 women took conjugated equine estrogen in pill form, 22 received estradiol via skin patches and 33 received a placebo of either the pills or patches.

In addition, the women taking active hormone were also given progesterone pills for the first 12 days each month. Placebo pills were given to those in the placebo group.

Study participants were given memory and thinking tests as well as MRI scans at the start of the study, at 18 months, at three years and at the end of four years of hormone treatment, and then again three years after therapy ended.

Researchers measured overall brain volume and the accumulation of brain lesions and compared scores on thinking and memory tests.

A total of 68 women also had positron emission tomography (PET) scans to detect plaques in the brain that are related to memory loss and Alzheimer’s disease.

Researchers found that participants who took estradiol via skin patches maintained brain volume in the dorsolateral prefrontal cortex, an area of the brain that assists with memory, thinking, planning and reasoning, over the seven years of the study.

Women who maintained volume in this area of the brain were also more likely to have a lower amount of the amyloid plaque deposits that are related to memory loss and Alzheimer’s disease.

This suggests that estradiol therapy may have long-term effects on the brain.

Researchers also found that for those taking estrogen pills, there were greater structural changes in the brain during therapy, but those changes stopped when participants stopped taking the pills.

Scores on thinking and memory tests were similar for women in the hormone therapy groups and those taking placebo.

‘More research is needed to determine the biological reasons behind brain changes during menopausal hormone therapy,’ said Kantarci.

‘Future research is also need to better define just how the different hormonal products, pills versus skin patches, affect the brain.’

A limitation of the study is that the women were all in good cardiovascular health, so the results may not be similar for those with heart problems, diabetes or other health issues.

However, Kantarci noted that not including those with heart issues may have made it easier to observe the effects of hormone therapy on the brain, since there was no interference from contributing heart problems.

The study was supported by the Kronos Longevity Research Institute and the National Institutes of Health.

To learn more about the brain, visit www.aan.com/patients.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 34,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy

Dr Sara Imarisio, Head of Research at Alzheimer’s Research UK, said:

“There is ongoing research into the role that hormones might play in diseases like Alzheimer’s, but previous studies into the effects of hormone therapy have been mixed. This small study found no link between mHRT and memory and thinking, but women who had taken the hormone estradiol via skin patches showed some signs of better brain health.

“Hormonal differences may go some way to explaining why more women than men develop dementia, but more studies are needed to piece together the effect of hormones on the brain and how different forms of hormone therapy might impact brain health later in later life. Anyone who is concerned about the effects of HRT should speak to their GP.”

Taking hormone replacement therapy to cope with the menopause may benefit the brain, Mayo Clinic research suggests

The researchers found women taking the treatment had lower accumulations of amyloid plaques - toxic proteins that are linked to Alzheimer’s disease

The researchers found women taking the treatment had lower accumulations of amyloid plaques – toxic proteins that are linked to Alzheimer’s disease

IS THERE ANY RISK USING HRT FOR WOMEN GOING THROUGH MENOPAUSE?

Menopause, which commonly strikes women in their late 40s and early 50s, can cause depression, hot flushes, headaches and night sweats. Long term, it can also cause bone disease and memory loss.

Hormone replacement therapy (HRT) tackles these symptoms by replacing the female sex hormones – oestrogen and progestogen – as the body stops producing them.

But while it can transform the lives of many women, studies have shown that there may be an increased risk of breast cancer and heart disease from HRT. As a result, many women no longer accept HRT treatment and some doctors will not prescribe it.

It was however noted by the Woman’s Health Concern (WHC) that one of the American studies used women in their mid-sixties who were often overweight as subjects, and these are unrepresentative of women in the UK.

Furthermore, a controlled trial from Denmark reported in 2012 has demonstrated that healthy women taking combined HRT for 10 years immediately after the menopause had a reduced risk of heart disease and of dying from heart disease, contradicting the reports of the earlier studies.

The WHC says HRT is safe provided it is taken for the correct reasons, i.e. to alleviate the symptoms of the menopause, and at the minimum effective dose. 

Source: WHC 



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