One of my clients sent me the link to the recent study published in the BMJ (British Medical Journal) on the correlation between menopausal hormone replacement therapy (HRT) and dementia. (BTW-I love when you ladies and gents send me things like this. It keeps me on my toes and shows me that you’re paying attention too)!
Of course, I have few things to say about the study. First off is, Oops, they’ve done it again! They’ve made a clear conclusion that HRT is associated with a higher risk of dementia and Alzheimer’s. If all you read is their conclusion statement and do not read the actual study (and who has time for that-right?) you’ll be, in my opinion, misled.
The biggest problem with this study and most HRT studies and trials, for that matter, is that in order to understand what they’re really talking about, we have to go back to the basics, which I can’t go into here, but is very important!
If you haven’t already watched my presentation on ‘Pulling Back The Curtain on HRT’, please click HERE to watch. I go into the basics and explain the different types of estrogens and progesterones and why there’s so much conflicting information and opinion on the benefits and risks of HRT.
It’s a must see in order to have a better understanding of HRT, how to decipher new reports and news in the media and to become an advocate for yourself in this arena which is important because there’s a shortage of medical professionals who have been trained well in HRT.
Back to the BMJ report. This study was done on 55,890 women in Denmark from 2000 to 2018. All of the women included in the study had their uterus intact which meant there was not a comparison study between HRT using estradiol only and HRT using estradiol and progestin and placebo which is a bit short-sighted and limiting, in my opinion.
The real elephant in the room for this analysis is that the observed risk of dementia in the Danish HRT users is with the use of an oral estradiol and synthetic progestin, both of which are already known to have risks. Neither of these are what most women, at least in the US, are usually prescribed. This is important to note!
Again, this all may sound very confusing which is understandable. I encourage you to watch my webinar to become less confused.
My conclusion of the study: The BMJ report of the Danish study is very misleading. And there needs to be further analysis of their data.
- Do we have a fairly sizable study on the beneficial effects of transdermal estradiol and progesterone on brain health? Not yet.
- Do we know the very beneficial action progesterone has on the brain? Yes we do. We know that it is neuroprotective, promotes neurogenesis of myelin repair, and reduces inflammation. All of which play a role in the prevention and progression of dementia and Alzheimer’s.
- Do we know about the warnings that have accompanied the use of progestins (the form of progesterone used in the study)? Yes, these warnings have been around for a long time! (look at the inserts of BC pills) Progestins have been associated with an increased risk of strokes and vascular constriction which translates into vasoconstriction of the brain and decreased function.
- We need to have a large clinical trial to evaluate the benefits of transdermal estradiol and either transdermal progesterone (not progestin) and/or oral progesterone before conclusions like this can be made about the benefits and risks using this type of HRT. Many inferences have been made based on past studies and trials and there will continue to be many known-unknowns until this happens. If only someone would fund it!!!
- Even the Danish study authors suggests that there needs to be more research to clearly make a cause and effect connection between the use of this type of HRT and dementia.
- I’m happy to read that most doctors who already prescribe HRT will not be changing how they approach HRT as a result of this report.
So those are my thoughts. I welcome your concerns, thoughts, and am open to discussion!
Here’s the link to the BMJ study: https://www.bmj.com/content/381/bmj-2022-072770
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