BETWEEN hot flushes, brain fog, vaginal dryness and night sweats, you would think women in perimenopause and menopause had enough to deal with.
Now, they are being warned they could be at greater risk of dementia thanks to hormone replacement therapy.
Last week, a Danish study, published in the British Medical Journal, linked HRT with the memory-robbing disease, but leading medical professionals say it did not paint the full picture.
The research, involving more than 60,000 women aged over 60, from 2000 to 2018, has come under fire for failing to prove that HRT causes dementia.
In fact, in the observational study, the Danish scientists were unable to determine why the women were prescribed HRT in the first place, which is a problem when early dementia symptoms like brain fog and memory issues can present in menopause too.
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Dr Sarah-Naomi James, of the MRC Unit for Lifelong Health and Ageing at University College London, said the study “has fundamental limitations”.
She added: “The best way to understand whether HRT medication itself causes dementia comes from clinical trials.
“To date, there is not enough evidence to support a direct link from the medication itself, and this new study alone should not change practice.”
GP and menopause specialist Dr Louise Newson said the study is “disappointing for women”.
She said: “It’s just going to cause more confusion. I’m not sure how helpful it is producing a study based on older types of HRT.
"Observational studies don’t prove cause and effect and, if people don’t know that, you can get hoodwinked quite easily.”
Celebrities including Davina McCall, 55, and Lisa Snowdon, 51, have championed the need for HRT to be more accessible to help manage debilitating symptoms.
And The Sun’s Fabulous Menopause Matters Campaign continues to pressure the Government to provide free HRT on the NHS.
So what’s the truth about HRT and how worried should women be? Dr Newson explains . . .
HOW ROBUST IS THE SCIENCE BEHIND THIS NEW STUDY?
THERE are different types of dementia, such as Alzheimer’s and vascular dementia, which is associated with people with heart disease and raised blood pressure.
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So there are different reasons why people get dementia, and different risk factors for different types. This study lumps dementia all together.
Secondly, there are different types of HRT and, thirdly, it’s an observational study.
Were the people on HRT because they were already confused? Were they even menopausal? Scientists don’t know.
There might be something else people taking that kind of HRT were doing. There are so many unaccounted-for variables.
SHOULD WOMEN BE WORRIED?
THE two main hormones doctors prescribe now are body-identical oestrogen and progesterone.
They are completely different to the synthetic progestins looked at in this study, which other studies show probably increase risk of multi-infarct dementia — a type associated with heart disease.
This study is irrelevant to people who take body-identical hormones — natural hormones that chemically match those women produced when young, which have lower risks and are prescribed on the NHS.
Even people on older types of HRT should be looking at lower-risk alternatives.
Also, it’s not a good-quality study. To make sweeping statements saying HRT increases risk of dementia — you can’t interpret that from this research.
There is also better-quality data to show that women who take body-identical hormones have a lower risk of Alzheimer’s, so we shouldn’t take this one study in isolation and scare women away from HRT.
WHAT DO WE KNOW ABOUT MENOPAUSE AND DEMENTIA?
MANY studies show the longer a woman is without hormones, the greater the risk of dementia.
So women who are young and have an early menopause have an increased risk of dementia if they don’t take HRT.
Often, menopause symptoms are similar to those of dementia. Lots of people come to my clinic with memory problems.
They haven’t got dementia but they’re worried. I couldn’t remember drug names when I was menopausal and found it really hard to recall clinical terms I had known for decades.
That doesn’t mean they’ve got dementia, but we know hormones can help.
It’s important people can consider HRT for symptoms including memory problems as part of perimenopause and menopause.
WHAT ARE THE BENEFITS OF HRT?
HRT has more benefits than risks for relieving symptoms of menopause — such as mood swings and vaginal dryness — and for future health.
There’s good evidence that taking HRT reduces your risk of heart disease and osteoporosis.
With dementia, we haven’t got gold-standard studied evidence saying HRT definitely reduces risk, but we haven’t got any studies that say it definitely increases it when it comes to body-identical hormones.
SHOULD WOMEN TRY LIFESTYLE CHANGES BEFORE HRT?
LIFESTYLE is important, but we also know the earlier women take HRT, the lower their future risk of heart disease and osteoporosis. Also, there is less suffering.
If we’ve got a treatment that’s evidence-based and if it helps women feel better, why deny it to them?
WHAT TO CONSIDER WHEN SPEAKING TO A GP ABOUT HRT
THERE seem to be some people intent on women not getting HRT and I can’t see where this medical gaslighting comes from.
It’s about choice.
Every patient needs to have individualised consultations and, as a menopausal woman myself, I decide based on the available evidence, its uncertainty, the known and possible benefits plus the known and possible risks.
Any decision a woman makes about HRT should be based on balancing benefits and risks.
For too long it was ONLY the risks that were talked about.
WHAT NEEDS TO CHANGE?
WE know dementia affects almost twice as many women as men, and that the longer a woman is without hormones, the greater the dementia risk.
So why don’t we fund proper research looking at body-identical hormones and their dementia risk?
