After many years, books, documentaries and campaigns to educate women – and doctors – about the benefits of HRT, the goalposts seem to be moving again. HRT may help prevent Alzheimer’s disease in millions of women at risk of developing Alzheimer’s, according to a new study. Should HRT be used as a preventive health measure rather than just a drug of choice for hot flashes, brain fog and joint pain?
r Louise Newson, GP and menopause specialist, believes there are good reasons for giving it earlier, certainly in perimenopause. “We give statins to prevent heart disease,” she says. “When people are at risk of heart disease or high blood pressure, we don’t wait until they have a heart attack before treating them—we often prescribe statins or antihypertensive drugs. Why shouldn’t we do the same with women and estrogen?
“When estrogen levels are low – which is the case during menopause and perimenopause – ‘inflammation’ occurs. This increased inflammation increases future risk of diseases such as diabetes, osteoporosis, heart disease, type 2 diabetes and dementia,” explains Dr. Newson. “There is a lot of evidence that estradiol – a type of estrogen – is a powerful anti-inflammatory that improves our brain function, heart health and bone strength, thereby reducing our risk of developing these diseases.”
Rather than viewing HRT as a replacement therapy, Dr. Newson believes it should be considered “hormone-supportive treatment.” “Historically, HRT was synthetic and made from horse urine, and there were understandable concerns about the risk of blood clotting,” she says. “But now we have the new body-identical hormones from yams, which are similar to the hormones produced in our bodies. They’re much safer, especially since they’re taken transdermally through the skin, reducing the risk of clotting.”
while dr Newson might be interested in HRT being considered a preventative health tool, other menopause experts caution. “While these are exciting times and it’s great that we’re starting to think proactively about HRT, the Alzheimer’s study was just an observational study in a small number of women with a particular gene, and we need larger randomized controlled trials and stronger data, before we start prescribing HRT as a preventative health measure for dementia, bone strength or heart health,” says Dr. Naomi Potter, co-author of menopause with Davina McCall and founder of menopausecare.co.uk.
“Current guidelines from the National Institute for Health and Care Excellence state that we should not use HRT just for prevention and that the benefits must outweigh the risks. For example, while the risk of breast cancer is low, your perception of risk may change if you have relatives with breast cancer. Everyone is different and each case needs to be treated differently. It’s not a magic bullet for everyone.”
But dr Potter admits the new research was published in Alzheimer research and therapy makes women consider HRT earlier. “In the past, menopause was diagnosed when your period stopped, but now we know that symptoms can develop up to a decade before your period ends — and that’s when hormonal turbulence begins and women start looking for solutions should,” says Dr. Potter.
Taking HRT at this stage – in the early years of perimenopause around 40 – can have immeasurable benefits. “If you’re 42 years old and have no symptoms, we women can’t just start HRT right now,” says Dr. Philippa Kaye, GP and bestselling author The M word. “But if you do have symptoms, we know it can benefit your health. If you start HRT within 10 years of menopause, i.e. before the age of 60, there is also some evidence that it may protect against cardiovascular disease. There are also the non-quantifiable benefits. When it helps you sleep better, you’re less tired and more likely to exercise, which has long-term health benefits.”
But dr Kaye is happy to add, “There have been conflicting studies on the risks of HRT in terms of breast cancer or risk of stroke in the past, and we need more funding and research so we can have definitive answers on everything.”
dr Kaye believes there should be no stopping period for women already on HRT provided the perceived benefits outweigh the risks. “The biggest risk factor in old age is breast cancer, so it should be decided on a case-by-case basis whether you should continue with HRT,” she says. For postmenopausal women who struggle with vaginal dryness, itching, painful intercourse, and recurring UTIs, and who have stopped or never started HRT, there is always vaginal estrogen. “It’s important to look at the physical and vaginal symptoms separately, and vaginal estrogen is something safe that you can use throughout your life,” says Dr. kaye
For postmenopausal women who didn’t need HRT and are now wondering if they should take it, Dr. Potter’s advice simply: “If it ain’t broke, don’t fix it; as HRT has potential side effects.” © Telegraph Media Group Ltd. 2022
https://www.independent.ie/life/health-wellbeing/health-features/could-hrt-help-more-than-just-menopause-studies-show-the-drug-could-help-prevent-conditions-like-alzheimers-42326996.html Could HRT help more than just menopause? Studies show the drug could help prevent diseases like Alzheimer’s
