Hormones May Not Help After Menopause

Hormone replacement therapy shows neither benefits nor harm in new study

(RxWiki News) Women sometimes find the hormonal changes that come with menopause to be troublesome. Occasional mental fogginess is one of their complaints.

Hormone therapy has been considered a means of keeping a clear head. A new study, however, has concluded that certain kinds of hormonal therapy did not have any substantial effect on some post-menopausal women's cognitive functions.

"Ask your pharmacist about hormone replacement therapy."

Mark Espeland, PhD, FASA, a bio-statistician at Wake Forest School of Medicine in Winston-Salem, North Carolina, was the lead researcher on a team investigating the mental effects of hormone therapy on women.

These researchers reviewed roughly seven years' worth of medical records from 1,326 post-menopausal females in the Women's Health Initiative Memory Study.

Of those women, 696 used a commonly prescribed estrogen that is made from horse urine and 630 took a placebo, a fake pill with no medicinal properties. Their average age was about 53 years. At the time of their last period, they were about 46 years old.

In a primary test of "global cognitive function," women whose uteruses had been surgically removed and who were taking 0.625 milligrams daily of estrogen scored 37.67 out of a possible maximum score of 50. Those taking a placebo scored 37.28.

The same test showed that women who still had their uterus and were taking 0.625 milligrams of estrogen, plus 2.5 milligrams daily of progestin, scored 38.08. Women with a uterus who took only a placebo scored 38.26.

Progestin is a synthetic form of the natural female hormone, progesterone.
"Our findings provide reassurance that [estrogen]-based therapies when administered to women earlier in the post-menopausal period do not seem to convey long-term adverse consequences for cognitive function," the researchers explained. "Although we cannot rule out acute benefits or harm, these do not appear to be present to any degree ... One exception may be for minor, longer-term disturbances of verbal fluency for women prescribed [estrogen] alone. However, this may be a chance finding."

Andre Hall, MD, a Fayetteville, N.C.-based obstetrician-gynecologist who reviewed the study, said its findings renewed the years-long controversy over using hormone therapy during and after menopause.

"The question has always been whether the benefits of these medications out weigh the risks," said Hall, of Birth and Women's Care. "This article concludes that there were no additional benefits or risks to cognitive function in the sample population of women aged 50 to 55. Given this information, the [previous] recommendation from the American College of Obstetricians and Gynecologists remains pertinent: Women should use the lowest dose of medication for the shortest period of time in order to achieve symptomatic relief."

For their part, researchers highlighted another finding. In addition to not changing overall cognitive function for the women they studied, both the hormone therapy and placebo showed no significant difference in scores on a secondary set of tests. Those secondary tests measured such things as verbal and memory skills and the ability to start and finish a task. Whether women took the placebo or hormones, those scores also were extremely close.

What prompted the researchers to study women aged 50 to 55 were previous studies showing that post-menopausal women aged 65 and over had lost small amounts of their cognitive skills while taking hormone therapy, the researchers wrote. Such decline remained years after they stopped taking the hormones.

The researchers did not explain how the scores generally defined the level of cognitive ability among the studied women. Researchers used a modified version of the Telephone Interview for Cognitive Status. Previous researchers have debated the validity of that test.

The study was published June 24 in the JAMA Internal Medicine.

The researchers reported receiving grants from the National Institute on Aging, National Heart, Lung and Blood Institute and US Department of Health and Human Services.

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Review Date: 
June 20, 2013