HRT provides no brain benefits for young menopausal women, new study finds

Taking hormone replacement therapy soon after menopause starts won’t protect against memory problems or other signs of cognitive decline that occurs with aging, according to a new analysis of a landmark clinical trial published online Monday in the journal JAMA Internal Medicine. It also, though, won’t harm brain function in middle-aged women who take hormone therapy to relieve menopausal hot flashes, night sweats, and mood swings.

That’s reassuring news to those seeking menopausal symptom relief from hormone therapy but may also be worried about previous research showing that hormones speed cognitive decline and increase the risk of dementia in elderly women.

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Researchers from the Brigham and Women’s Hospital and elsewhere relied on data from more than 1300 female participants, ages 50 to 55, who were randomly assigned to take HRT for an average of seven years as part of the Women’s Health Initiative clinical trial. Cognitive testing—performed about seven years after the trial ended—found no differences in memory, problem-solving, or learning skills in those who took hormone therapy and those who took placebos.

What the latest analysis didn’t address is whether taking hormones right at the onset of menopause—when symptoms occur-- have any benefits or risks in terms of cognitive function. The volunteers who participated in the Women’s Health Initiative had all gone through menopause years earlier.

But it does give pause to the “window of opportunity” theory that suggests women who take HRT to alleviate menopausal symptoms may enjoy certain health benefits that they don’t get when they take it later in life. Recent research suggests a decreased heart disease risk in women who take hormones right after the onset of menopause.

“In contrast to these multiple studies of timing of hormone initiation and heart disease,” wrote Francine Grodstein, an epidemiologist at Brigham and Women’s Hospital in an editorial that accompanied the study, “similarly convincing evidence, including the report in this issue, has not accumulated regarding such a window of opportunity” for protecting the brain against the ravages of aging.