HRT in Early 50s Has No Impact on Women's Memory, Thinking: Study

Women aged 50 to 55 who take hormone therapy to relieve the symptoms of menopause can expect no benefit or risk to their memory or other thinking skills due to the treatment, according to new research.

The study was done to evaluate more closely the effect of the hormone treatment on women during the years menopause typically begins. An earlier study, the Women's Health Initiative Memory Study, found that the hormone treatment produced deficits in thinking ability when given to women 65 years old and older. And other WHI research has found that hormone therapy can increase the risk of breast cancer, heart disease and stroke but protect against osteoporosis, the brittle bone disease. Based on that research, many experts now suggest that the hormone therapy be taken, if needed, to relieve menopausal symptoms on a short-term basis.

In the new study, the focus was on women who begin hormone therapy between ages 50 and 55, the time period during which menopause typically begins, and evaluate the effect on thinking skills. "We found no long-term harm on cognition when these drugs were prescribed when women were 50 to 55," said Mark Espeland, a professor of public health sciences at Wake Forest School of Medicine in Winston-Salem, N.C. The study was published online June 24 in the journal JAMA Internal Medicine. Espeland and his team compared women who were given either combination estrogen and progesterone treatment or estrogen alone (which is given in women who have had a hysterectomy). About half of the more than 1,300 women assessed were randomly assigned to take hormone therapy, while the other half were on placebo therapy.

During the follow-up period of about seven years, the women took tests of memory, verbal fluency and other skills during telephone interviews. Nearly 1,200 completed the second and final assessment. Overall, Espeland said, no sustained benefit or risk to brain functioning was found. Test scores of the women on hormone therapy were similar to the scores of those on placebo. For women on estrogen alone, verbal fluency was affected, he said, but that may be a chance finding. Deciding whether to prescribe hormone therapy always involves weighing benefits and risks, said Dr. Jennifer Leighdon Wu, a gynecologists at Lenox Hill Hospital in New York City. She was not involved in the study but reviewed the findings.

"For women 50 to 55, we can probably take cognition out of the equation when weighing risks and benefits," Wu said. "In the past, we used to think hormones would keep brains young and [help women] continue to have better brain function," she said. However, later research disputed that thinking. Now, Wu said, the new research suggests that for women aged 50 to 55, hormone therapy "is not going to preserve or worsen cognition." The bottom line? Preserving memory and other thinking skills, Wu said, "is not a reason to start hormone therapy or avoid hormone therapy."

Francine Grodstein, associate professor of medicine at Brigham and Women's Hospital and Harvard Medical School, who wrote a commentary accompanying the study, said, "I think the primary message here is reassurance." It probably won't be the last study to examine the issue, Grodstein said. Even so, she said, "To me the most important finding of this study is to reassure younger women if they need to take hormone therapy to treatmenopausal symptoms there is no obvious harm to brain health." The study was primarily supported by the U.S. National Institute on Aging. One researcher reported research grants to her institution from a variety of pharmaceutical makers.