hormone replacement


Study: Hormone Therapy May Not Hurt — Or Help — Menopausal Brains


Here’s the good news for women on hormone therapy for menopause: A new study suggests it will not increase your risk of dementia or otherwise hurt your brain health.

Now here’s the bad news for women on hormone therapy: It doesn’t look like it will improve your brain health either.

I think of this as the period of the Great Shake-Out on hormone therapy. First came the Fountain of Youth period, with some doctors handing out estrogen and progestin like candy to women during and after menopause.

Then, about a decade ago, came seminal Women’s Health Initiative findings that hormone therapy could carry daunting risks, including higher rates of heart attacks, dementia and cancer in older women.

Research led to a new hypothesis, the “Window of Opportunity” theory: That if women started hormone therapy earlier, more like in their fifties than in their sixties or seventies, they might reap benefits with fewer risks. For heart disease, there’s extensive evidence that is indeed the case.

Now, the “WHIMSY” study — for Women’s Health Initiative Memory Study in Younger Women — just out in the journal JAMA Internal Medicine, does seem to bear out somewhat the earlier-window theory when it comes to brain health. At least when it comes to avoiding harm.

Dr. Fran Grodstein of Brigham and Women’s Hospital, who researches the long-term health effects of hormone therapy but was not involved with this latest study, wrote in a commentary accompanying the paper:

Dr. Fran Grodstein of Brigham and Women's Hospital (Courtesy)

Dr. Fran Grodstein of Brigham and Women’s Hospital (Courtesy)

“Approximately 10 years ago, the Women’s Health Initiative Memory Study (WHIMS) found that postmenopausal hormone therapy in older women caused nearly two-fold increases in dementia risk, worse rates of cognitive decline over time, and decreased brain volume on magnetic resonance imaging, compared with placebo treatment.”

But the new study, which looked at over 1300 post-menopausal women who started taking estrogen in their fifties, found no such heightened risks after seven years.

It didn’t find any brain benefits either, though.

Dr. Grodstein sums up: Continue reading

Daily Rounds: Supreme Court Hears Vaccine Case; Keeping Patients On Drugs; Radiologist Downsizing; Hormones And Kidney Stones; Losing Your Memory In Retirement

Supreme Court to Consider Vaccine Case – NYTimes.com “The safety of vaccines is at the heart of a case expected to be heard on Tuesday by the United States Supreme Court, one that could have implications for hundreds of lawsuits that contend there is a link between vaccines and autism. “(The New York Times)

Express Scripts Seeks to Keep Patients on Drugs, Reduce Health-Care Costs – Bloomberg “Express Scripts Inc., one of the largest managers of prescription drug benefits in the U.S., introduced a program designed to cut medical costs by identifying the chronically ill patients most likely to neglect medicines within a year. Computer models that tag the potentially noncompliant will let St. Louis-based Express Scripts contact patients before they stop taking drugs.” (bloomberg.com)

Running a hospital: First bend in the health care cost curve Radiologists are losing their jobs, writes Beth Israel Deaconess Medical Center Chief Paul Levy: “Recent trends in radiology imaging portend a dramatic and rapid reduction in this segment of a hospital's business plan,” he writes. “Our Chief of Radiology summarizes our experience — common to other hospitals as well: ‘The biggest hit has been in CT, the modality we are most dependent on for revenue. We are about 10% down in CT cases from last year, due to a combination of patient and physician fears about radiation exposure, more prudent ordering of studies by physicians, leakage out of the medical center, and the introduction of physician incentive programs (to minimize the amount of imaging) by some insurers.'” (Running A Hospital)

Hormones linked with kidney stones in older women – Boston.com “Among more than 24,000 postmenopausal women taking either hormones or dummy pills, those using hormones were 21 percent more likely to develop kidney stones over about five years.” (Boston Globe)

Memory Decline Accompanies Earlier Retirement, Study Finds – NYTimes.com “The implication, the economists and others say, is that there really seems to be something to the “use it or lose it” notion — if people want to preserve their memories and reasoning abilities, they may have to keep active.” (The New York Times)