About that Danish dementia-HRT study
let's talk true truth, shall we?
I have a few things to say about the new dementia study published in the British Medical Journal this week, which found that taking hormone therapy was associated with a significantly higher risk of dementia.
Could it be that women who have the most severe symptoms – the ones who are more likely to seek out hormone therapy – are at greater risk for the kinds of vascular problems that lead to dementia? As in, is there something more sinister happening in base-level biology in these women? There are very early indications of this in the current research, but it also makes good common sense. I was on a panel in NYC this week with retired American ob-gyn and Alloy chief medical officer, Dr Sharon Malone, and this ‘hot flashes aren’t funny, they could be serious’ line of inquiry was her parting call. One of the only professionals I’ve heard to it. (She also agreed to be on the podcast!)
When will the research community wake up and start studying bioidentical synthetic hormones versions separately? Most studies just lump everything together, including oral synthetic versions, which pass through the liver – initiating a range of other biochemical reactions. Researchers in this study said “oral administration was by far the most common route for estrogen and progestogen administration” and does not separate out progesterone, the bioidentical version. It’s mind-boggling.
The progesterone-tin-togen issue (read here for my latest recap), aka the way risk signals seem to rest in synthetic progestogens over bioidentical progesterone remains pretty much elephant in the room in most analysis. The researchers in this BMJ study acknowledge it, writing: “The effect of the progestogen component in menopausal hormone therapy on the risk of dementia also remains uncertain.” They also write that based on previous research observations of a higher dementia risk associated with combined estrogen/progestogen versus estrogen only, one theory is that progestogens might “intensify a potential neurodamaging effect of estrogen”. (Why though, are so few people recognizing that it might be a problem all by itself? I have a podcast coming up with Vikram Talaulikar, British ob-gyn and associate specialist at the reproductive medicine unit in University College London Hospitals, and we tackle this subject.)
This is a large observational study and it doesn’t prove causation. Other studies have suggested HRT prevents dementia. This is why those without an agenda and products to sell report accurately that the data is mixed and inconclusive.
Due to the above situation, based on the most recent assessments of all the data available, no guiding body (aka menopause society) in the world recommends taking hormone therapy to prevent dementia, or for that matter, avoiding it for fear of increasing risks.
Anyone who tells you that taking hormone therapy prevents dementia is cherry-picking studies to confirm their own bias. It’s amazing not-in-a-good-way to see the number of doctors and journalists in media and social media this week be this irresponsible, using the word “debunked” and criticizing methodology or study design. These are the same people who have no problem green-screening findings of a study they like, with all the same limitations they will criticize in a study they don’t like, and doing it repeatedly.
As the highly reasonable, imminently qualified and uncompromised British endocrinologist Dr Annice Mukherjee wrote on social media this week: “I will certainly not be telling any of my patients to stop their HRT based on this study.”
Editor’s note
I’m in New York after attending the Perry Journal book launch and Shaping the Future of the Menopause Transition panel, and Omisade Burney-Scott (Black Girl’s Guide to Menopause) Menopause Multiverse Cocktail Hour. It was magical, soul-filling and head-spinning, and I’ll speak more about it in coming issues. But for now, this: the world is turning, and people are lovely, and I can see that the problems and the fighting that get amplified online and in the media aren’t nearly so terrible in the real world. I’ve looked up from my phone and my computer this week, and it was necessary. I hope that you can too.