Logan, UT—While concerns about use of postmenopausal hormone therapy dominate a lot of the medical discussion, a new study underscores how estrogen has a significant role in overall brain health and cognitive function.

An article in Menopause notes that many studies focused on the prevention of cognitive decline consider the effect of reduced estrogen levels during the menopause transition.

Now, Utah State University–led researchers suggest a cognitive benefit from a longer reproductive window complemented with hormone therapy.

Researchers point out that the prevalence of Alzheimer’s disease (AD) is higher for women, and sex-dependent effects of estrogen could play a role. To try to determine that, the study team 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.

Participants were 2,114 women with a mean age of nearly 75 years who were dementia-free at baseline and completed a women’s health questionnaire. Questions related to reproductive history and hormone therapy (HT).

Researchers calculated endogenous estrogen exposure (EEE) using the reproductive window (age at menarche to age at menopause), adjusted for pregnancy and breastfeeding. Hormone therapy variables included duration of use, HT type (unopposed; opposed), and time of HT initiation.

The study team also administered a modified version of the Mini-Mental State Examination (3MS) in four triennial waves to assess cognitive status.

Results indicate that EEE was positively associated with cognitive status (beta = 0.03, P = .054). Furthermore, longer duration of hormone therapy use was positively associated with cognitive status (beta = 0.02, P = .046) and interacted with age. The authors explain that older women had greater benefit compared with younger women.

“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 6-or-more years later,” the study notes, adding, “Our results suggest that longer EEE and HT use, especially in older women, are associated with higher cognitive status in late life.”

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