Who should you trust on menopause, HRT and dementia?
It has been another rollercoaster week in the menopause space following the publication of a new study on hormone therapy in the British Medical Journal. The study suggested HRT increases the risk of dementia.
It's the season, it seems, for the media to get women fearing HRT, and feeling confused about how to treat menopause symptoms, once again.
In May 2022, many menopausal women in the UK were sent into a panic in the opposite direction. They were convinced they needed HRT for brain health following a Channel 4 TV documentary, Sex, Mind and the Menopause.
In the documentary, a claim was made that long-term use of HRT reduces the risk of dementia, Alzheimer’s and other neurodegenerative diseases by up to 80%.
This claim was based on a 2021 observational study that reviewed the medical records of almost 380,000 women aged 45+. The records were taken from two states in the US. Average follow up time was 5.1 years.
In this blog post from 2022, which covered the confusion caused by the Channel 4 documentary, I pointed out the inherent problem with the conclusions of the study: how could you suggest that dementia, Alzheimer’s and other neurodegenerative diseases were impacted by HRT (which is taken at midlife), when you’ve studied women who were aged 45+, with a follow-up time that was so short?
In addition, how could the study be encouraging long-term use of HRT, when randomized controlled trials had indicated that long-term use of HRT increased risks of other diseases and conditions?
In medicine, large randomized controlled trials (RCTs) are the gold standard to determine the benefits and risks of any medical treatment. As we can learn from this paper by renowned Stanford professor John P. A. Ioannidis and his colleagues, even RCTs, which are often funded by the pharma companies marketing the drug under investigation, have their limits. But large RCT’s can also be designed to meet high standards.
In May 2022, there were other observational studies, such as this one from the UK, that concluded that HRT had no impact.
The honest conclusion regarding HRT and dementia, especially with regards to modern forms of bioidentical HRT, would be to state that in light of current research, the impact is unknown. This is indeed what Dr Paula Briggs and Professor Joyce Harper stated in a recent article in the Mail on Sunday.
However, there is a so-called menopause revolution that has been going on in the UK for the last few years. While raising awareness of perimenopause and menopause, and menopause in the workplace, another purpose of the revolution is to increase the number of women on HRT. This is being done by getting women to fear menopause and pushing out ideas that HRT offers health benefits beyond what science has actually shown to be true.
If you wonder how I can make such a statement with confidence, you need to look no further than the Concluding Report of the UK’s All-Party Parliamentary Group on Menopause. I write about that here.
In May 2022, in the storm created by the Channel 4 documentary, women started sharing their newly-created fears around brain health on social media.
If a woman had someone in her family suffering from a neurodegenerative disease, it was perhaps easy to conclude that she should act quickly to avoid the same fate.
How many women then started taking HRT based on the unscientific claims made in the documentary? We don’t know. We do know that HRT use in the UK is on the rise.
The latest research on HRT and dementia, published in The British Medical Journal in June 2023, is a Danish study. Between the years 2000 to 2018, researchers investigated the medical records from all Danish women who were between the ages 50-60 in the year 2000. This covered the records of over 60,000 women. The study found a correlation between the occurrence of dementia and short- and long-term use of HRT. The study suggested the longer HRT was used, the higher the risk.
In the UK, the same menopause revolutionaries who claimed the 2021 observational study from the US offered conclusive evidence of HRT preventing dementia, went out on social media to sound words of caution around the Danish study because (just like their preferred American study), this latest study is observational. They also suggested that since the HRT used by women in the study was likely an older type of oestrogen-progestin therapy, women using the more modern bioidentical versions of HRT need not worry (even though this is an assumption without a randomized controlled trial to back it up).
The mini social media campaign to “beware of the Danish study” screams hypocrisy to anyone who cares to remember what happened just over a year ago. It would be nice if menopausal women could be shown information without applying double standards: you simply cannot claim one observational study as truth because it suits your stance on menopause treatment (or even helps line your pockets), and another as false because it doesn’t.
At the same time, headlines such as “Women on HRT are more likely to get dementia, study suggests” which appeared in The Times on 29 June 2023, just added to the panic around how women can safely support themselves through menopause.
So, who should we trust on HRT and dementia? Until there is a long-term, large RCT conducted to investigate the issue (free from financial interests) each woman will have to trust herself. I would also recommend that she research how long-term health is created and maintained naturally during menopause and beyond.
The Danish researchers concluded: “Further studies are warranted to determine whether these findings represent an actual effect of menopausal hormone therapy on dementia risk, or whether they reflect an underlying predisposition in women in need of these treatments.”
In other words: could women who experience more severe menopause symptoms (leading them to take HRT) also be more likely to experience dementia?
If we embrace this concluding statement, which seems fair, perhaps we can look at how we can have a less challenging menopause. Wouldn’t fewer symptoms requiring less medical intervention be an ideal goal?
I’d encourage women to look at menopausal and post-menopausal women around them, especially those in their family.
In a recent conversation with Krysta Francoeur, Founder & CEO of Wild Remedies, we looked at the patterns of menopause in her family. Krysta had noticed that her mother was experiencing a much more difficult menopause than her aunt, even though the two women are sisters. Krysta’s mom is a nurse who works night shifts. This can create stress in the body that might well be one of the factors making her menopause more difficult.
Sleeping out of sync with our circadian rhythm can create imbalances in our body that can make menopause more challenging. Poor sleep has also been identified as a factor that might increase a person’s risk of dementia.
In fact, all the pillars of health that when in place can ease our journey through menopause, also have been shown to have an impact on the risk of dementia. Beyond good sleep, these include diet, the ability to manage stress, exercise, detoxification, and brain training (which can help improve cognitive function from midlife and beyond).
We don’t need to wait for a large randomized controlled trial to tell us if we need HRT to preserve brain health. Why don’t we take inspiration from the people who live in Blue Zones (where dementia is almost non-existent)? Why wouldn’t we want to start looking after our health now in natural ways, and have an easier time through midlife change, too?
Choosing a natural route through menopause has an additional benefit: you don’t need to get on the rollercoaster news cycle of HRT is good/bad for you. It’s such a relief and an empowering choice.
If you would like to find out how I can support you in reaching good health and well-being through menopause and beyond, naturally and simply (and without side-effects!) CLICK HERE to find a range of options.
Illustration above: Portrait of Madame Ginoux by Vincent Van Gogh (Public Domain)