Last summer, hormone replacement therapy was linked to heart trouble. Now, it’s Alzheimer’s disease and other forms of dementia.
Yet despite startling new evidence showing hormone pills may cause ailments they once were thought to help prevent, some women and doctors say they’re still not ready to abandon the menopause treatment.
The latest data suggests estrogen-progestin pills double the risk of dementia in women aged 65 and older, a development that “is very shocking,” said Dr. Barbara Soltes, a reproductive endocrinologist at Chicago’s Rush-Presbyterian-St. Luke’s Medical Center.
Soltes said many of her patients who continued taking hormones after last year’s bad news on heart troubles did so thinking they were helping stave off Alzheimer’s and other memory problems associated with aging.
While many likely now will quit as millions of women already have Soltes said she likely will continue to prescribe the supplements for relief of change-of-life symptoms.
“I’m sure it’s not the last word,” Soltes said.
The study appears in Wednesday’s Journal of the American Medical Association.
Participants who took hormones for an average of more than four years faced double the risk of developing Alzheimer’s or other forms of dementia, compared with those on dummy pills. That means in one year, for every 10,000 women taking hormones, 23 more cases of dementia will develop.
Researchers also found that hormones did not protect against less severe mental decline, such as mild memory loss.
The belief that the supplements could help women keep their minds sharp was based on smaller, less rigorous studies.
But this one was part of the government’s gold-standard Women’s Health Initiative study, a portion of which was halted last summer after finding an increased risk of breast cancer, heart attacks and strokes in women who took one type of combined hormone pill.
“It’s another nail in the coffin” for the use of hormones during and after menopause, said gynecologist Dr. Robert Blaskiewicz, a Saint Louis University professor.
Some experts say that based on what is now known about supplements, women past menopause should not take hormones at all. Others say women needing relief from night sweats and other menopausal symptoms should take the lowest possible dose for the shortest time.
Cindy Yeast, a 50-year-old Washington-area publicist, says she began taking supplements two years ago in part to avoid mild dementia that affects her elderly parents. She said she may not give up on the pills just yet.
“Every time a new study comes out, you can’t just react,” Yeast said. “You have to weigh what is this doing for me now.”
It’s unknown whether the results apply to women younger than 65, who make up the bulk of hormone users, said Dr. Victoria Kusiak of Wyeth Pharmaceuticals, makers of Prempro pills used in the study.
The notion that hormone supplements are good for the mind has been around for at least a decade. Doctors have speculated that the body’s own estrogen protects against cell damage and improves blood flow.
One possible explanation for the new findings is that hormone supplements raise the risk of strokes – and strokes are known to cause brain damage and contribute to dementia, said the research team led by Sally Shumaker, a public health professor at Wake Forest University.
Nevertheless, the increased risk of dementia is very small, said Marilyn Albert, head of the Alzheimer’s Association’s scientific advisory council and a Johns Hopkins University neurology professor.
Age remains the single greatest risk factor for dementia, and the study suggests that a 65-year woman on estrogen-progestin pills “would have the increased risk profile of a 70-year-old woman not taking hormone replacement therapy,” Albert said.
The results come from the Women’s Health Initiative Memory Study, which involved 4,532 women who used Prempro for an average of more than four years. It was funded in part by Wyeth.
Probable dementia was diagnosed in 61 women 40 in the hormone group and 21 taking placebo pills.
Wyeth estimates that 1.2 million women are still taking Prempro pills, down from about 3.4 million before the WHI study was halted last summer. Other types of hormone supplements include patches and creams.
An arm of the government study involving estrogen-only supplements in women who have had a hysterectomy is continuing. Estrogen alone is not recommended for women with intact wombs because it increases the risk of uterine cancer.