In the Journals

Menopausal hormone therapy benefits the brain

Taking menopausal hormone therapy shortly after menopause begins can help maintain the brain’s thinking and memory skills and reduce memory loss, according to research published in Neurology.

“Based on findings from observational studies, the timing hypothesis posits that estrogen may preserve neurologic function and decrease the risk of dementia when administered early in menopause; however, the effects may be neutral or even harmful if estrogen is initiated later in life,” Kejal Kantarci, MD, MS, from Mayo Clinic, and colleagues wrote.

Kantarci and colleagues conducted a randomized, placebo-controlled trial to investigate how menopausal hormone therapy affects brain structure and cognition. The researchers enrolled 75 healthy women aged between 42 and 56 years who were 5 to 36 months past menopause.

Participants were randomly assigned to receive either 0.45 mg of oral conjugated equine estrogen (oCEE) per day, 50 g of transdermal 17beta-estradiol (tE2) per day or placebo pills and patch for 4 years. Those in the menopausal hormone therapy groups also received 200 mg of oral progesterone per day for 12 days every month. The researchers performed MRIs and cognitive tests that measured memory and thinking at baseline, after 4 years of menopausal hormone therapy and 3 years after menopausal hormone therapy was discontinued. Most participants (n = 68) also underwent positron emission tomography (PET) scans.

Data showed that participants receiving oCEE had higher increases in ventricular volumes compared with those receiving placebo during the 4 years of treatment. However, 3 years after the discontinuation of treatment, ventricular volumes were not different between the two groups.

There were similar increases in white matter hyperintensity volume among participants receiving oCEE and tE2, but only the increases in the oCEE group were statistically significantly greater than placebo.

Compared with placebo, dorsolateral prefrontal cortex volumes were better maintained over the study period among participants taking tE2. Women in the tE2 group also had lower levels of amyloid plaque deposits related to Alzheimer’s disease and memory loss.

The menopausal hormone therapy groups and the placebo group had similar rates of global cognitive change.

“We found that one form of menopausal hormone therapy taken soon after menopause may preserve brain structure in the portion of the brain responsible for memory and thinking skills,” Kantarci said in a press release. “It may also reduce the development of amyloid plaques that can build up and lead to memory loss.”

“More research is needed to determine the biological reasons behind brain changes during menopausal hormone therapy,” she added. “Future research is also need to better define just how the different hormonal products, pills vs. skin patches, affect the brain.” – by Alaina Tedesco

Disclosure: Kantarci reports serving on the data safety monitoring board for Takeda Global Research & Development Center, Inc., being funded by the NIH and receiving research support from Avid/Eli Lilly Company. Please see study for all other authors’ relevant financial disclosures.

Taking menopausal hormone therapy shortly after menopause begins can help maintain the brain’s thinking and memory skills and reduce memory loss, according to research published in Neurology.

“Based on findings from observational studies, the timing hypothesis posits that estrogen may preserve neurologic function and decrease the risk of dementia when administered early in menopause; however, the effects may be neutral or even harmful if estrogen is initiated later in life,” Kejal Kantarci, MD, MS, from Mayo Clinic, and colleagues wrote.

Kantarci and colleagues conducted a randomized, placebo-controlled trial to investigate how menopausal hormone therapy affects brain structure and cognition. The researchers enrolled 75 healthy women aged between 42 and 56 years who were 5 to 36 months past menopause.

Participants were randomly assigned to receive either 0.45 mg of oral conjugated equine estrogen (oCEE) per day, 50 g of transdermal 17beta-estradiol (tE2) per day or placebo pills and patch for 4 years. Those in the menopausal hormone therapy groups also received 200 mg of oral progesterone per day for 12 days every month. The researchers performed MRIs and cognitive tests that measured memory and thinking at baseline, after 4 years of menopausal hormone therapy and 3 years after menopausal hormone therapy was discontinued. Most participants (n = 68) also underwent positron emission tomography (PET) scans.

Data showed that participants receiving oCEE had higher increases in ventricular volumes compared with those receiving placebo during the 4 years of treatment. However, 3 years after the discontinuation of treatment, ventricular volumes were not different between the two groups.

There were similar increases in white matter hyperintensity volume among participants receiving oCEE and tE2, but only the increases in the oCEE group were statistically significantly greater than placebo.

Compared with placebo, dorsolateral prefrontal cortex volumes were better maintained over the study period among participants taking tE2. Women in the tE2 group also had lower levels of amyloid plaque deposits related to Alzheimer’s disease and memory loss.

The menopausal hormone therapy groups and the placebo group had similar rates of global cognitive change.

“We found that one form of menopausal hormone therapy taken soon after menopause may preserve brain structure in the portion of the brain responsible for memory and thinking skills,” Kantarci said in a press release. “It may also reduce the development of amyloid plaques that can build up and lead to memory loss.”

“More research is needed to determine the biological reasons behind brain changes during menopausal hormone therapy,” she added. “Future research is also need to better define just how the different hormonal products, pills vs. skin patches, affect the brain.” – by Alaina Tedesco

Disclosure: Kantarci reports serving on the data safety monitoring board for Takeda Global Research & Development Center, Inc., being funded by the NIH and receiving research support from Avid/Eli Lilly Company. Please see study for all other authors’ relevant financial disclosures.