Can HRT reduce your risk of dementia?

Many of us worry about dementia, particularly if there is someone in our family who has been affected. As there isn’t a known cure for dementia, doctors and scientists focus on prevention, by taking steps to improve heart health and reducing known risk factors, which include high blood pressure, diabetes, obesity and smoking. There’s also some evidence that regular exercise, an active social life, and stimulating hobbies such as learning a new language, playing a musical instrument, or tackling puzzles like crosswords and sudoku can help reduce the risk of dementia and cognitive decline.

In recent years, there has been a great deal of research into dementia, and some studies suggest that HRT could potentially reduce the risk of dementia, specifically Alzheimer’s, along with other neurodegenerative diseases, including Parkinson’s.

Your risk of dementia

According to the Alzheimer’s Society, worldwide, women with dementia outnumber men 2:1. It’s not yet fully understood why this is the case, and it isn’t entirely explained by the fact that women live longer than men. It is important to note that even though the risk of dementia increases with age, dementia is caused by diseases in the brain and not by age alone.

There is limited knowledge about women’s brains and risk of dementia, partly due to the fact that women have only been included in clinical trials since 1993. However, brain scans indicate that the rate at which brain cells die is faster in women than in men, and some researchers believe that this could be linked to declining levels of the hormone estrogen during the perimenopause and menopause. Some studies have shown that estrogen can have a protective effect on brain cells, which is why researchers are working hard to assess whether taking HRT could reduce the risk of dementia.

Estrogen and the brain

Estrogen affects how your brain grows and functions, which is why experts like Dr Lisa Mosconi, who is the author of The XX Brain and Director of the Women’s Brain Initiative, believes that the menopause can be a turning point for brain health and cognitive function.

Dr Mosconi explains: “Estrogen stimulates the brain, keeps the neurons firing, supports the growth of new cells and helps existing cells to form new connections. When estrogen levels fall during the menopause transition, your entire body – including your brain – goes into a deprivation state. We have found that there is an overall reduction of brain energy levels during menopause, which might be one reason why you can suffer hot flushes, night sweats, anxiety, depression, brain fog, and even memory loss.”

She adds: “Testosterone has similar functions but, in men, it declines very gradually over time. In many cases, men are fertile into old age. But estrogen really goes away during menopause – suddenly your most potent estrogen is gone. For some women, it can happen almost overnight if you have surgery, and sometimes due to cancer treatment, and that’s a shock. A lot of people see menopause as a natural process we go through, which is absolutely correct. But they don’t see it as a process that puts you at an increased risk of future conditions – including dementia – and this is what’s really key.”

The benefits of body identical HRT

As estrogen supports brain function, there’s increasing evidence to suggest that taking HRT could also play a key role in reducing the risk of dementia. Research from the University of Arizona Center for Innovation in Brain Science found that people who took HRT went on to have a 58% lower risk of Alzheimer’s. Here are some of their key findings:

• The greatest benefits were seen in women who had taken HRT for six years or more: they were 79% less likely to develop Alzheimer’s and 77% less likely to develop any neurodegenerative disease, including Parkinson’s.
• Taking body identical HRT (rather than synthetic hormones) resulted in the greatest reduction of risk.
• HRT administered through the skin in a patch, gel or spray reduced the risk of Alzheimer’s, while taking oral HRT (a pill) reduced the risk of combined neurodegenerative diseases.
• Taking HRT for more than one year gave greater protection from Alzheimer’s, dementia and Parkinson’s disease than short-term treatment, where HRT was taken for less than one year.

Dr Roberta Diaz Brinton, senior author on the paper, says: “The key is that hormone therapy is not a treatment, but it’s keeping the brain and this whole system functioning, leading to prevention. It’s not reversing disease; it’s preventing disease by keeping the brain healthy.”

Can HRT cause dementia?

Some people are at a greater risk of developing dementia due to a family history, predisposing condition or other risk factors. This is why it’s vital to have individualised advice.

There has been a recent study in Finland that suggested HRT increases your risk of dementia, but this research has caused a great deal of controversy. As the study was observational, it’s possible that other factors influenced these results, and the Royal College of GPs were clear to point out that the research did not prove that HRT causes dementia. Professor Michael Baum, Professor Emeritus of Surgery, University College London, has called the research “unhelpful and misleading.”

Reducing your risk of dementia

It’s crucial to look at lifestyle factors that support brain health to help minimise your risk of dementia. This includes eating a healthy diet that’s rich in polyunsaturated fatty acids, which are found in fish and legumes, taking regular exercise, prioritising relaxation and reducing your stress levels, and getting enough sleep.

It can be a challenge to make these lifestyle changes, especially if you’re not feeling your best. Insomnia, aches and pains, and fatigue are all common symptoms of the perimenopause and menopause – but they can be relieved with the correct type and dosage of HRT, giving you the energy and focus you need to prioritise your health and wellbeing.

We already know that improving heart health can help reduce the risk of dementia and this can be done by exercising regularly, staying a healthy weight and not smoking or drinking excessively. As an added bonus, taking HRT through the skin, via a patch, a gel or a spray, can help to keep cholesterol down and lower your blood pressure.

Sources of further information:

University of Arizona Study

Dementia and women from Alzheimer’s Society

Response to Finland Study

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