The current guidelines given by the FDA and ACOG (American College of Obstetrics and Gynecology) for hormone replacement therapy are to start it soon after menopause and use the lowest dose for the shortest possible period of time. This should be evaluated yearly by your doctor. I wanted to take some time to highlight the results of the Cache Study. This was a prospective study of the incidence of dementia among 1357 men and 1889 women with mean ages of 73.2 to 74.5 residing in a single county in Utah. Participants were first assessed in 1995 through 1997 with follow-up conducted in 1998 to 2000. History of women’s current and former use of hormone replacement therapy as well as calcium supplements and multivitamins was ascertained at initial contact.
At the time of follow-up, thirty five men (2.6%) and 88 women (4.7%) developed Alzheimer disease. The incidence in women increased after age 80 and exceeded the risk among men of a similar age. Women who used hormone replacement therapy had a reduced risk of Alzheimer disease (26 cases among 1066) compared with non hormone replacement users (58 cases among 800). Risk varied with duration of hormone replacement use so that a woman’s sex-specific increase in risk disappeared entirely with more than 10 years of treatment (7 cases among 427). No similar effect was seen with calcium or multivitamin supplement use.
This study concluded that there was no effect with current hormone replacement use unless the duration of treatment exceeded 10 years. It seems from these results that postmenopausal depletion of endogenous estrogens may contribute to the risk of dementia in women.
Many women I speak with are concerned about the risk of breast cancer and certainly for good reasons. However, it seems that other diseases should also be of concern and each woman needs to discuss the risks and benefits of any treatment with her practitioner.
About the Author
Brenda Houdlette
