Hrt linked to dementia

[Ninaguineapig]

I thought it was supposed to prevent it.

amp.cnn.com/cnn/2023/06/28/health/hrt-dementia-risk-wellness/index.html

Please read these things a bit more critically. The headline literally says ‘experts disagree’ and late one of the study authors says

“My coauthor and I are very concerned that the message from this study will be that hormone therapies cause dementia, and that’s not what’s happening here.”

Read the facts.

1 It's an observational study (not random, double blind)
2 It doesn't differentiate between types of HRT, doses and regimes.
3 It doesn't include factors like smoking, exercise and obesity (all of which are the biggest risks for dementia)
4 It didn't consider women's existing symptoms (ie memory loss, brain fog) that may have been early signs of dementia .

The University of Copenhagen and Danish Dementia Research Centre researchers could not isolate vascular dementia from other types of dementia, which could provide further insight.

They acknowledged women using HRT may already have a predisposition to both menopausal vasomotor symptoms – such as hot flushes and night sweats - and dementia.

As such, they conclude: 'Further studies are warranted to determine whether these findings represent an actual effect of menopausal hormone therapy on dementia risk, or whether they reflect an underlying predisposition in women in need of these treatments.

I agree the study doesn’t show HRT causes vascular dementia, but it does show that HRT does not prevent vascular dementia (which has been hypothesised and in some marketing of HRT listed as a ‘possible benefit’)

Are there any RCT studies that showed HRT prevented dementia?
Or prevented broken hips?
Or prevented heart attacks?
Or prevented T2 diabetes?

Observational evidence is all we have to go on, for the posited benefits related to any of those outcomes, afaik.

A lot of confounders were considered : "All statistical models included education, income, cohabitation, hypertension, diabetes, and thyroid disease as potential confounding variables"

"All statistical models included education, income, cohabitation, hypertension, diabetes, and thyroid disease as potential confounding variables"

Does anyone know - did they actually test the women for these diseases, or just ask them if they knew whether they had them or not? My doctor took three goes to 'find' my thyroid disease, and I haven't a clue if I have pre/diabetes or not.

Thyroid disease especially is under-diagnosed in middle aged women. As are auto-immune inflammatory diseases like (sero-negative) psoriatic arthritis.

Health conditions came from their medical records, I think. It's Danish study, Autumn,data over 18 year period. So even if you found out how testing happens today for those conditions in Denmark, might have been different in year 2000. Such problems with observational data quality is a reason why RCTs are preferred, but no RCT on people using HRT is going to run 18+ years. At least it's case-control design, not simple cross-sectional.

I suppose you could reliably say that the diagnosed conditions will be at the more severe end of spectrum, that's why they got diagnosed, not the (very) mild ones. That rule about severity of the health condition applies to the controls, too, though, the people without dementia diagnosis.

The control women were age 68-78 by year 2018, so beyond 'middle age' by monitoring end.

Thing about a case-control like this study design, they most likely were just looking for risk factors, whatever they could reasonably deduce from the data. If HRT history is what they found that mattered, then that's what they found. They probably didn't start out with expectation they were studying HRT particularly. It is only proof of association, not proof of cause and effect. Rather like all the observational-design studies that proclaim HRT had xyz benefits....

I'm well jealous they didn't need ethics approval to get access to the patient registers. Presumably still many other access hurdles.

There are some trials where women's outcomes were twofold - a Danish trial showed benefits not only for CVD but also bone density, but the trial was for one of those only.

The most important factors influencing dementia are family history, lack of exercise, smoking and alcohol use.

This observational trial didn't separate out body-identical HRT and synthetic. Or doses, or mode of delivery.

Unfortunately, it doesn't provide a conclusive answer on whether HRT contributes to dementia risk, because the study did not consider some of the other factors known to be involved, such as social isolation, smoking or dietary factors like alcohol.

From the Alzheimer's charity.

Int

. Rather like all the observational-design studies that proclaim HRT had xyz benefits....

And all the ones that appear to prove risk like the Million Women study!

yeah, I agree HRT is unlikely to be an important influence on dementia risk.

It's good to highlight important risk factors for dementia.

There really should be more threads on this board talking about the benefits of exercise, minimal alcohol intake, not smoking, not being socially isolated. I imagine many MNers in the peri/menopausal stage of life could use support in achieving a healthier profile in each of those areas.

It's actually being discussed now on Radio 4 woman's hour.

The author of the study says they don't know if the women who did have dementia would have got it anyway or not.

It seems 'incredible' that using body-identical HRT that is exactly the same as women's natural hormones could cause / be associated with dementia in such a short time, as in this study. If they took HRT for a year, then developed dementia at 70 it can't be proved that HRT 'gave them dementia'.

A lot of observational studies start with a theory and then try to prove it.

'The most important factors influencing dementia are family history, lack of exercise, smoking and alcohol use.'

Pretty sure that just being female is also a massive risk factor because we're far more likely to get it than men, even accounting for the fact we live longer.

I came on to post about this. I had a panic when I saw the headline but some of the calm sensible replies here have calmed me down. Thanks!

Surely given the ages of these women they would have been on the old style 'horse urine' HRT, not the newer body-identical type.

I agree also that the headline is misleading and irresponsible - there are many risk factors for dementia, and ones like smoking, obesity etc. never seem to get the same attention in the media, whereas HRT is subject to all sorts of scaremongering.

I've heard brain doctors say that dementia starts decades before the symptoms show. So I'm choosing to believe that HRT did not cause it in these women as they probably took it when the dementia was already forming.

I wonder if women who later were diagnosed with dementia went to the drs with anxiety etc and were prescribed hrt, when the mental symptoms were actually the result of very early dementia, or if the background and behaviour around anxiety (worrying, ruminating, previous traumas) actually led to dementia, which I believe is possible.

We've read so many posts on this board declaring hrt prevents against dementia so can we now all please agree that at best we just don't know and if this study has any credibility then the opposite may well be true.

The only thing we do know is it protects against osteoporosis, but only for as long as it is taken.

Please can MNHQ edit the thread title. Its rather alarming!

Also, ppl were prescribed HRT AFTER menopause. These days it is prescribed for symptoms BEFORE full-blown meno kicks in.

It terrifies me because every female in my family has died with dementia. No history of anything else, cancer, heart issues etc. my mum had early onset
None smoked, most drank very lightly
The only thing that none of them really did was exercise

I quit smoking, drink once a year or so, and exercise 3-5 days a week but WFH so am isolated in a sense but talk to people every single day in my job (by the weekend I don't want to speak!)
If they found HRT does have a preventative effect on dementia I'll be banging down the door at my GP

One thing I can guarantee - my GP will on my case again telling me that not only does HRT 'cause' breast cancer, ovarian cancer, and womb cancer, but also that it 'causes' dementia. Can cast iron guarantee it. <Big sigh>

Twice now I've had to stop her mid-flow about ovarian cancer to remind her I had my ovaries removed some years ago, along with quite a lot of other things like my uterus. She's definitely not a fan of HRT, and can't see any benefits at all. So, back on the merry-go-round we will go.

and what happens to women? They lose estrogen from age 50.
Unlike men who have testosterone for life albeit in lower amounts.

I have been against hormonal contraception and hrt whole my life. It's a gut feeling that they are not good for you.

I hope it does not cause dementia or anything else to be honest, but without HRT I would not be here. I can quite confidently say that HRT saved my life - sleeping around 2 hours a day, sleeping on towels for huge night sweats and the feeling that it would be better for everyone if I just drove my car into a wall made the decision to take HRT easy.

I have been on HRT for 16 years and have not one single intention of stopping any time soon.

Coming from a family with dementia running from generation to generation (and fairly early onset in some cases) I can say that it in our cases it does start way way before any really obvious signs. Short term memory loss / or difficulty with short term memory from early adulthood seems a common indicator in our family