Matyi JM, et al. Menopause. 2019;doi:10.1097/GME.0000000000001405.
Estrogen exposure influences cognitive status in late life
Longer endogenous estrogen exposure and use of hormone therapy are associated with higher cognitive status in late life, especially among older women when compared with younger women, according to findings published in Menopause.
“Women who had longer reproductive windows and those who took HT had higher cognitive ability in late life compared to those who had shorter reproductive windows and who did not take HT,” Joshua Matyi, MS, a doctoral candidate in psychology at Utah State University, told Endocrine Today. “The degree of difference between these two groups is very small; however, our results are in contrast with other research that shows an increased risk for dementia when taking HT. Also, our study shows support for the ‘critical window’ hypothesis, such that women who initiated HT closer to menopause had higher cognitive status in late life compared with those that initiated later.”
In a longitudinal, population-based study, Matyi and colleagues analyzed data from 2,114 white women (mean age, 75 years) who were dementia-free at baseline participating in the Cache County Study on Memory in Aging, with the first wave beginning in 1995. Three triennial waves of dementia assessment were performed during 12 years of follow-up. Participants completed a women’s health questionnaire, asking questions regarding reproductive history and HT use. Endogenous estrogen exposure was calculated as the time of reproductive window (age at menarche to age at menopause), adjusted for pregnancy and breastfeeding. HT variables included duration of use, HT type and time of HT initiation. Researchers administered a modified version of the Mini-Mental State Examination (MMSE) at follow-up visits to assess cognitive status, and used linear mixed-effects models to examine the relationship between estrogen exposure and MMSE score.
Within the cohort, mean years of endogenous estrogen exposure was 32.99 years. Surveys revealed 833 women were never-users of HT. Researchers observed that the largest decrease in HT use was between the third and fourth waves, when 86% of users stopped.
“This reduction in HT use chronologically coincided with the FDA ‘black box’ warning placed on HT after the WHI,” the researchers wrote.
Researchers found that endogenous estrogen exposure was positively associated with cognitive status (P = .054). In addition, longer duration of HT use was positively associated with cognitive status (P = .046) and interacted with age; older women had greater benefit compared with younger women.
The timing of HT initiation was associated with MMSE scores (P = .048), with higher scores for women who initiated HT within 5 years of menopause vs. those who initiated HT at 6 years or more after menopause. Women who used estrogen continuously or within 5 years of menopause had mean scores that were 1.02 and 1.23 points higher than nonusers of HT. In contrast, those who initiated HT later had mean scores that were 0.64 points higher vs. nonusers.
“As this was an observational study, I believe the clinical implications are broad,” Matyi said, “First, reproductive health has shown an effect on cognitive health in late life. Second, individuals who initiate HT derive the greatest benefit for cognitive health when initiated closer to menopause rather than later. When considering HT, the benefits and risks should be reviewed by a reproductive health specialist.”
– by Regina Schaffer
For more information:
Joshua Matyi, MS, can be reached at Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322; email: firstname.lastname@example.org.
Disclosures: The National Institute on Aging funded this study. The authors report no relevant financial disclosures.