Logan, UT—Concerns about the dangers of long-term hormone therapy and endogenous estrogen exposure have been ongoing for decades. Now, a new study makes an argument for them, suggesting they can preserve cognitive status in older women.

An article in the journal Menopause points out that prevalence of Alzheimer's disease (AD) is higher for women and suggests that could be related to sex-dependent effects of the estrogen.

To gain a better understanding, researchers from Utah State University and Binghamton, NY, University examined the association between estrogen and cognitive decline in more than 2,000 older adult women in a 12-year population-based study in Cache County, Utah.

Included in the baseline sample were 2,114 women with a mean age of nearly 72 years who were dementia-free at baseline. Participants completed a women's health questionnaire, asking questions regarding reproductive history and hormone therapy (HT).

At the same time, endogenous estrogen exposure (EEE) was calculated taking the reproductive window—age at menarche to age at menopause—and adjusting it for pregnancy and breastfeeding.

Among the hormone-therapy variables were duration of use, HT type (unopposed; opposed), and time of HT initiation.

To track development of cognitive issues, the researchers administered a modified version of the Mini-Mental State Examination (3MS) at four triennial waves.

Results indicate that EEE was positively associated with cognitive status (beta = 0.03, P = .054), and longer duration of HT use also was positively associated with cognitive status (beta = 0.02, P = .046). Age was a factor, with older women having greater benefit compared with younger women, the researchers note.

“The timing of HT initiation was significantly associated with 3MS (beta = 0.55, P = .048), with higher scores for women who initiated HT within 5 years of menopause compared with those initiating HT six-or-more years later,” the authors write.

Past research has suggested that initiating long-term hormone therapy shortly after menopause reduces risk for development of Alzheimer disease.

“Our results suggest that longer EEE and HT use, especially in older women, are associated with higher cognitive status in late life,” conclude the authors of the Menopause article.

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