Bmi study showing oestrogen for hrt increases dementia risk

[Codlingmoths]

Found on Twitter, pretty recently published but still haven’t seen anything else about it! https://www.bmj.com/content/381/bmj-2022-072770
I am not menopausal yet so limited knowledge or experience, but what a setback for women if this is true. The study says the effects persist in the sub 55 yo group. I do remember our mothers talking about the stress of not being sure if it increased their cancer risk, and now here we are again maybe… Very happy for someone to tell me all the reasons why it’s not as serious as it sounds, it’s midnight here and I’m tired and off to bed.

HRT has made such a positive difference to my life that even if it does increase my risk of dementia, or anything else, it's a risk worth taking.

I’m sure lots of people would do the same, but others wouldn’t. It’s a huge shame. (But I would say it’s better to know this than not know it!)

I think I am correct in saying that the women involved were on previous forms of HRT, not the types that are prescribed now in the UK.

I’m not quite there yet but for me it’s more about the quality of life than the quantity. I’d rather enjoy my 50s than suffer through menopause in the hopes that I’m less likely to develop dementia when older.

I'm sure it's only a few weeks ago that a study said that HRT appears to help PREVENT dementia. Because I read the article and regretted my choice not to take it.

Can you find that one @saraclara ? Would be good to line them up together! (I’ll probably be even more confused)

I'm decade's off needing it, but could weight lifting, vitamin D and calcium offset the risk of brittle bones?

From the report -

Most women who received combined hormone therapy in this study used orally administrated drug formulations, including the progestin drug norethisterone. Thus, as a result of the prescription pattern of menopausal hormone therapy in Denmark during the study period, we were not able to distinguish between modes of administration of menopausal hormone therapy as well as types of progestin. We did not have information on progesterone, as opposed to synthetic progestins.

Like many women I am using progesterone (utrogestan) and oestrogen gel.

Ah I didn’t know that progestin is different from what most women take.

As in, thanks for explaining that!

This was the article. Time goes fast when you're getting old. It was six months, not a few weeks!

https://www.theguardian.com/society/2023/jan/14/hrt-potentially-important-in-reducing-womens-dementia-risk

It looks a reasonable quality study, but the results are far from definitive. The 2 big problems I can see in a quick read are:

1. There were several other factors that were significantly different between the HRT and non-HRT groups. And some of those differences are already known to be associated with higher risk of dementia. So it is very possible that it's not a case of HRT -> dementia, but of [unknown facor X] causing people to both develop dementia and be more likely to need (or choose to take) HRT.

2. Because of the nature of both the study and of dementia, most people will have been on older types of HRT - they state most were on oral forms, which are already known to be higher risk for other adverse effects than the newer patch and gel types. So even if the risk is both real and causal, it may not apply to people taking HRT now.

From another study -

Evidence suggests that there are important differences in breast cancer risks with different progestogens used in combined [oestrogen + progestogen] hormone replacement therapy (HRT) regimens; micronised natural/bio-identical progesterone appears to be a far safer choice than synthetic progestins.

It’s a big unknown right now imho. I think the most we know with some studies showing an increased association and some a decreased association of HRT with dementia is that HRT provides no protection and is unlikely to increase risk. Keep in mind, these are associations, no one has yet found any causal link between HRT and higher or lower dementia.

There are certainly studies that show this.

I read about that a few years ago and stopped with hrt because of it.

I am 4 years off.

I miss it but am surprisingly functional!

My feeling currently is that, for me, the risk of a fatal accident from extreme lack of sleep outweighs most other risks that could emerge later.

That was my understanding too.

There has also been another study since this one was published saying the opposite.

If HRT works for you, do it. You may not live long enough to get dementia. And if you do live long enough, you might still not get dementia. Whereas menopausal symptoms are here and now.

It's not saying that HRT increases the risk of dementia. It is saying that they found those who had used HRT were more likely to have dementia. They state that further study is required to understand why that is the case. It may be the HRT causing the dementia or it may be that those who are more likely to use HRT are also more likely to develop dementia for some other reason.

They found a correlation between the two. Correlation and causation are different. What the study does mean is that it's worth doing more research to try to understand why those who use HRT are more likely to develop dementia and that is what the authors are suggesting as the outcome of their study.

Like a lot of these studies, it's not that conclusive. I wouldn't base a decision around it. Similar to the milk/cancer risk (appears to increase the risk of some cancers but decrease the risk of others). I just wouldn't worry myself enough.
I didn't take HRT and menopause is done with, but my friends and relatives who have taken it have been almost evangelical about its benefits, so it clearly works for them.

My Mum had been on HRT and also had Alzheimers and breast cancer, so although I didn’t rule out the possibility of HRT altogether, I decided to “see how it goes” and keep an open mind.

I actually thought I was developing dementia when I could only keep a single thought in my head at one time - not ideal as a senior nurse with hundreds of patients on my caseload - coupled with increased anxiety. Wish I’d known these are menopausal symptoms, I still might not have taken HRT but it would have been reassuring to know why my mind seemed to have gone.

Anyway, all over now apart from the occasional hot flush which may just be due to our insanely hot but sadly unregulatable Aga. My mind and memory are back to normal and I don’t miss the periods, or the hormonal headaches and spots.

Too late to be personally affected by either article, but I am very interested, due to my terror of dementia happening to me - 2 of my Mum’s 3 siblings also had it, AND my paternal grandfather.