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23 June 2004
Estrogen Therapy May Increase Dementia Risk 
Older women who use estrogen-alone hormone therapy could be at a slightly greater risk of developing dementia, including Alzheimer's disease (AD), than women who do not use any menopausal hormone therapy, according to a new report from the Women's Health Initiative Memory Study (WHIMS). The researchers also found that estrogen alone did not prevent cognitive decline in these older women. The findings appear in the Journal of the American Medical Association. "These studies further support last year's recommendations that menopausal hormone therapy should not be used to prevent cognitive decline or dementia in older postmenopausal women," stated Judith A. Salerno, Deputy Director of the National Institute on Aging (NIA). "Women should follow the Food and Drug Administration's recommendation that those who want to use menopausal hormone therapy to control their menopausal symptoms should use it at the lowest effective dose for the shortest time necessary." WHIMS is a substudy of the Women's Health Initiative (WHI) Hormone Trial. The WHI Hormone Trial using estrogen plus progestin was stopped early in July 2002 when researchers found an increased risk of breast cancer, along with greater risks of heart disease, stroke, and blood clots, and determined that these risks outweighed the benefits of reduced risks of hip fracture and colorectal cancer. In May 2003, WHIMS investigators reported the results of the estrogen plus progestin part of their memory substudy. They found that estrogen plus progestin increased the risk of probable dementia in women 65 and older and did not preserve cognitive function. Almost half of the dementia cases in the estrogen-alone study - 46% in older women using estrogen alone and 47% of those in older women using the placebo - were Alzheimer's disease. Similarly, in the estrogen plus progestin study, 50% of the cases in older women using estrogen plus progestin and 57% of those in older women using placebo were classified as AD. As with the earlier WHI and WHIMS reports, these increases in risk must be viewed in perspective. Significant increases in risk are important for public health officials who are concerned with large groups in the population, where a small increase could have health implications for millions of people. For an individual woman, however, the increased risk is still quite small. Additionally, these findings relate to women age 65 and older taking this particular estrogen-alone hormone therapy. The cognitive risks and benefits for younger women using PremarinTM or other estrogen formulations are unknown. Any younger woman who is considering menopausal hormone therapy because of her menopausal symptoms should talk to her doctor about how the various Women's Health Initiative study findings relate to her own medical history and treatment.
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