As for why the later-stage HRT seems to make matters worse? It isn’t totally clear, but “it could be that the responsiveness of the brain cells has changed by this point,” Dr. Holtzman says. So while cells in a younger person (that were continuously exposed to estrogen prior to HRT) might benefit from a fresh influx of estrogen, ones that had a break from that estrogen bath might react negatively to it. It’s also possible that by age 65 and beyond, the brain typically develops certain abnormalities linked with Alzheimer’s, and adding estrogen to the mix then just exacerbates things. That effect could be tied to inflammation, too, Dr. Holtzman notes: “It’s conceivable that in younger women, estrogen supports the protective type of inflammation in the brain, but at later stages, it triggers the bad kind.”
How to tell if (and when) you should consider hormone replacement therapy
As Dr. Vaibhav notes in the release, there isn’t enough evidence yet to suggest HRT be taken specifically to prevent Alzheimer’s (even in the early stages of menopause). So the decision comes down to your personal experience of the menopause symptoms it can help treat, and what you and your doctor decide is best.
When it comes to the other potential effects of HRT, the good news is, it’s been widely proven safe and shown to benefit cardiovascular health and overall longevity in multiple studies. Prior controversy surrounding its usage can largely be traced back to a 2002 study, the Women’s Health Initiative (WHI), the results of which have largely been refuted. (Researchers initially found that participants taking HRT had a slightly increased chance of having a heart attack, stroke, breast cancer, and dementia—but what became apparent shortly after is that most of them were over the age of 60, likely several years past menopause, when we now know HRT is less effective. And a followup analysis of the WHI found that HRT actually reduced the risk of several conditions for those who started it in their 50s.)
That said, there are risks to taking HRT, particularly for anyone who has ever had breast or endometrial cancer, a heart attack or stroke, blood clots, or liver disease. And it can cause side effects in some people—including breast soreness, spotting, bloating, and headaches—which may be worth considering as you weigh your decision.
But what we know from the research above is, if you’re cleared by your doctor to take HRT and you’re struggling with menopause symptoms, there’s no reason to avoid it, Dr. Holtzman says, presuming you’re within five years of menopause. “If anything, it’s going to be helpful to start it sooner than later, not damaging,” he says. In that scenario, it’s also worth chatting with your doctor about stopping HRT after a couple years, when menopause symptoms tend to let up, to avoid the potential negative impact on your brain down the line.
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