The Lancet Commission on dementia does not recommend menopause hormone therapy to prevent dementia
Your weekend roundup of hopefully helpful things
The 2024 update of the Lancet Commission on dementia tackled menopause hormone therapy (MHT) as a preventative for dementia for the first time this summer. (I don’t blame you if you haven’t heard about this, or this news makes you go whaaa? I’ll explain)
Their post-menopause conclusion after a meta-analysis of almost two dozen studies? They do not recommend MHT to prevent dementia. In fact, the authors say hormone therapy is actually associated with a small but statistically significant increased risk of dementia. This goes for estrogen-only therapy too.
The writers concluded: “Overall, it is unclear whether menopause and HRT are causally related to dementia risk. There is some evidence that oestrogen-only therapy, long durations of treatment, and older age at initiation of HRT, might increase dementia risk.”
Other than the obvious, here’s why this is important:
» First off, it doesn’t mean if you take hormone therapy, you’ll get dementia. Science doesn’t work like that. But it does call into question all those people who are telling us that if we take hormone therapy, we won’t get dementia.
» It’s a reminder that it makes sense to pay attention to what specialists on diseases outside the menospheric echo chamber are saying.
» If the Lancet Commission on dementia doesn’t recommend hormone therapy to prevent dementia, and no menopause society or guiding body in the world does either, what are so many people confidently speaking everywhere from panels to Reels – doctors included – on about?
» It’s a pretty good window into what sometimes happens when evidence that contradicts a prevailing narrative – ie ‘hormone therapy prevents dementia’ – comes along. Crickets.
When I wrote about the Lancet Commission on dementia’s 2024 update in August, I focused on their overall dementia prevention guidelines. (I also used the same photo. Because I LOVE IT.) However, in my excitement about sharing that information, I missed a very important piece in which they historically tackled the subject of hormone therapy. My bad.
So did almost everyone else, it turns out, in the media and on social media. So far I’ve only been able to find one hard-to-understand, without-a-byline article in the Daily Mail that was reprinted on MSN. There doesn’t appear to have been a press release, so there’s that. It could just be a sort of collective oversight. Laziness. Maybe the chill of inconvenient findings? Perhaps all three. It’s just a pretty significant finding, that’s all. Strange no one picked up on it.
You probably didn’t hear about this from the E-maxis (Estrogen maximalists) and DMGs (Doctor Menopause Gurus) on social media, either, the ones who love to post themselves talking in front of cherry-picked studies on green screens (so authoritative!). I know I haven’t seen it. They also never seem to post this one, a review of the medical records of 100,000 women in Taiwan with similar findings, or any of the other research that renders the body of evidence ‘mixed’.
If you have a large social media following and you’ve been telling your followers that hormone therapy will prevent dementia, how likely are you to seek out information that challenges that narrative? Or walk it back based on a new report no one is talking about?
Hotflash inc hot take:
• As with a lot of studies in the menopause space, this meta-analysis does not appear to separate out neuroprotective bioidentical progesterone from whatever (synthetic) progestogens are doing. They are two very different things.
• Also, demonstrating the confusion that reigns with nomenclature, The Lancet document uses the term “hormone replacement therapy”, aka HRT, when they mean “menopause hormone therapy”. HRT is what people who go through premature or early menopause might need to take according to the evidence to improve all their outcomes, at least until the ‘natural’ age of menopause.
Thoughts?
More science stuff
GENETICS + MENOPAUSE TIMING: Two studies have identified new genes that determine when we go through menopause – and why it might happen early. Researchers at University of Exeter Medical School in the UK, in a paper published in Nature, used Biobank data for more than 100,000 women to find nine genes linked to ovarian aging, including five that had never been linked previously. In one example, women with variants in ZNF518A – that’s 1 in 4,000 – went through menopause six years earlier, on average. Meanwhile, a team of researchers from the University of Iceland and deCODE genetics in Reykjavík discovered another new gene variant for early menopause and premature ovarian insufficiency. Their study, published in Nature Genetics, found that two copies of CCDC201 – 1 in 10,000 women – will get you into the transition an average of nine years earlier. As Dr Mary Jane Minken, a gynecologist at Yale Medicine told Woman’s World, it opens the door for other genetics-based research in this area.
And possibly – sooner than we can imagine – CRISPR-style solutions.
GUT + DEMENTIA: Researchers at the University College Cork (UCC) have found evidence that Alzheimer’s symptoms can come from gut microbes. When they transferred fecal microbiota from Alzheimer’s patients to rats, the rats showed evidence of correlating impairments. (This is reminiscent of reports that people who get fecal transplants sometimes start exhibiting characteristics of donors). Scott Anderson from the awesome Psychobiotic Substack does a great breakdown, explaining the while everyone is focused on amyloid beta accumulation as the cause, it does not always equal Alzheimer’s. (Neither do post-menopausal low estrogen levels, by the way)
By the way, he’s starting a series on how to dementia-proof your gut next week.
Sign of the times
British broadcaster Jo Whiley is on the cover of Women’s Health UK – and inside the 59-year-old is talking about how strength training saved her from menopause. Love the headline: Strong. Smart. Cool as f**k… and Jo Whiley is just getting started
It’s happening so quickly now. Ten years ago women above 40 weren’t even on the covers of these magazines. Five years ago they were, but they certainly didn’t mention how they were coping changing hormones on the interviews inside. (I know this was confusing for me, dealing with 20 pounds of inflammation weight and every other perimenopause symptom on top of it.)
Rochelle Weitzner, founder of PAUSE Well-Aging, told me on the Hotflash inc podcast in 2022 that when she launched her skincare company a few years prior (she has since exited), magazine editors in New York told her ‘no one wants to talk about this’.
Then it started. In UK, with celebrities like Davina McCall.
Gwyneth Paltrow, always an early bird for spotting opportunities, got some attention but a lot of flak when talked about how menopause needed a ‘rebranding’ in 2018. The Australian actress Naomi Watts tried to talk about this (I think, I’d love to ask her) in 2020 when she told Women’s Health US about ‘hormonal changes’ to her skin (which she later revealed were related to her very early menopause).
Watts later launched her own menopause company, Stripes. Tracee Ellis Ross (who follows HF inc on IG weeee) spoke about perimenopause to Harper’s Bazaar in 2021. They are even doing it in India this year, where the shame and stigma run deep.
Where we are now? It’s normal – verging on trendy – in many parts of the world for celebrities to talk about how this transition is impacting them.
And somehow, that makes it normal for us too.
Apps: SexyAgeing
One of the many fun things about Hotflash inc is connecting with other women who have turned their perimenopause experience into a helpful product or service. Tracy Minnoch, over in New Zealand, is a personal trainer with an infectious spirit who is doing just that. She’s got a book, My Menopause Memoir, a podcast, SexyAgeing, Her new SexyAging app has everything you need: workouts for gym and home, yoga for mobility and stress reduction, nutrition, period and menopause symptom tracking, community and more. You can sign up just for the workouts, get the whole shebang and also, if you like, one-on-one coaching. Think of it like a menopause health coach in your pocket.
NEWSNEWSNEWSNEWSNEWSNEWSNEWS
» Over in the US, hormone monitoring company Eli Health lit up Times Square with their ad.
» British Columbia will be the first of 10 provinces in Canada – and the first jurisdiction in North America – to provide free hormone therapy
» The Menopause Society announces a new toolkit based on science-based Consensus Recommendations to support people in the workplace
» Great look at this issue from outside the industry (where sometimes the best takes come from), The Grocer.uk: Inside the £16bn menopause market: money spinner or scam?
» This was known and reported when Veozah hit the market (also by me, here), and is typical of what happens when a new drug goes into mass use: FDA adds warning about rare occurrence of serious liver injury with the use of Veozah (fezolinetant) for hot flashes due to menopause
» Speaking of Naomi Watts, her brand Stripes inaugurated September 9th as Hot Flash Day
» There is a major push on to give Australians 12 lieu days a year for a range of things, including coping with perimenopause and menopause symptoms.
» Remember, we are the market: Hormone Replacement Therapy Market Is Projected To Reach $46.5 Billion by 2027
» What do you think of Dr Jen ‘Debunker’ Gunter’s 12 Steps to Evaluate Menopause Content list?
Editor’s note
>> I am loving this clip of American journalist and critic Leon Weiseltier, talking about how much he worries about our sped-up, checklist lives:
>> Nika Talbot, who has such great advice on being a solo publisher on Substack:“Enjoy the little things. The big things will sort themselves out.”
>> Please download the Death Clock AI app and tell me your age. I’m chasing an interview with the founder and aiming to write about this later this week.
AMx
One last thing: Would like to get yourself or your brand in front of 5,700+ women, including practitioners and founders across the spectrum of the midlife and menoverse? We are choosy about who we work with and flexible for those who are aligned. Email me and find out how you can get an off-the-top introduction: amcqueen@hotflashinc.com
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It would have been nice if they had separated out those women with hot flashes and night sweats that wrecked their sleep and did a controlled study on them. I'd bet the women who received MHT that controlled their vasomotor symptoms and allowed them to sleep would do better than those who receive no MHT and develop chronic insomnia, a risk factor for dementia.