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Good Reasons to Take Hormones

Estrogen could lower your risk of dementia.

Key points

  • Estrogen helps protect the brain and can lower the risk of dementia.
  • Estrogen combined with progestin can raise the risk of Alzheimer's.
  • If experiencing memory loss during menopause, talk to a gynecologist about estrogen-only therapy, especially if Alzheimer’s runs in the family.

Sex hormones, particularly estrogen, help protect the brain, and when they naturally decline during menopause, some women experience mild memory loss and trouble finding words.

So would taking hormones help? It matters whether you take estrogen alone or estrogen combined with progestin (a synthetic form of progesterone, another sex hormone) and for how long. The short answer: estrogen alone can help. That conclusion was most recently backed up by research published last month in the prestigious BMJ.

The new study suggests talking to your gynecologist about estrogen-only therapy if Alzheimer’s runs in your family and you’re experiencing effects on your memory during menopause. You might even stay on your program for a decade or more.

If your gynecologist suggests a combination therapy for your menopausal symptoms, limit your use to no more than five years.

What the Research Says

For some time, there has been evidence that hormone replacement therapy (HRT) could increase the risk of Alzheimer’s. The new study backs up that idea for combination therapy. Your risk increases each year, for an average increase of 11 percent for between five and nine years of use and 19 percent for ten years or more.

This was a large study—with more than 118,500 women aged 55 and older who had been diagnosed with dementia, matched by age and other factors to nearly 500,000 women without dementia. In both groups, 14 percent had used HRT before the study began.

Then things get a little complicated. The researchers also concluded that women who took estrogen-only therapy for ten years or more had a lower risk of dementia.

Overall, HRT didn’t raise your risk of dementia, a category that includes cognitive effects from strokes, Parkinson’s, and other factors. Alzheimer’s accounts for 60 to 80 percent of all dementia cases.

Does HRT Cause Cancer?

HRT got a bad reputation in 2002 when women realized that it increases the risk of breast cancer and heart disease, stroke, and blood clots.

Again, estrogen-only formulations are safer. Estrogen increases breast cancer risk only after ten years, and it does introduce a risk of ovarian cancer, which you can guard against with regular exams. And by the way–there is no evidence that “bioidentical” and “natural” hormones are safer than synthetic hormones.

Talk to your gynecologist about the risks and weigh the risks against the benefits. Beyond leveling out your hormones, so you have fewer or milder symptoms of menopause, HRT may protect you against other illnesses associated with aging. Alone, estrogen protects against vaginal dryness and bone loss, and bone fractures, and combined with progestin, it protects against colon cancer.

After menopause, women tend to develop more belly fat, and the belly fat increases the risk of type 2 diabetes and heart disease. But research suggests that combination HRT, especially with an exercise program, can keep your trimmer.

If your primary problem is vaginal dryness, you can insert estrogen directly into the vagina without increasing your risk of cancer.

If you decide to use combination HRT, your best option would be to begin early, use a lower dose, and stop as soon as possible.

Make an individual decision: Women who are heavy smokers, very overweight, or at high risk of stroke or have high blood pressure should be especially cautious with HRT. But for women with complex symptoms, it’s worth considering.

A version of this piece appears on Your Care Everywhere.