Hormone replacement therapy may be linked to better cognitive performance in aging women. Digest
Hormonal changes during and after menopause have wide-ranging effects on health. A new cross-sectional study examined whether hormone replacement therapy (HRT) was associated with better cognitive performance in older women.
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The researchers analyzed existing data from 1,374 women aged 60 or older who took part in one of two rounds of a U.S. national health survey. They compared women who reported ever using estrogen, progesterone, or both for menopause with women who reported never using HRT. They also calculated the number of years from each woman's first period to menopause as a rough proxy for the length of her natural estrogen exposure during the reproductive years. The women completed cognitive tasks that assessed verbal learning and memory by having them learn and later recall a list of words, verbal fluency by asking them to name as many animals as possible in one minute, and mental speed, attention, and working memory by having them match numbers with symbols as quickly and accurately as possible.
- HRT was linked to better verbal learning and memory and better verbal fluency, while an initial association with better performance on the task measuring mental speed, attention, and working memory was no longer statistically clear after women with missing survey information were excluded.
- The number of years between the first menstrual period and menopause was initially linked to better verbal learning and memory, but this association also did not hold after women with missing survey information were excluded. There were no clear links with verbal fluency, mental speed, attention, or working memory.
- Exploratory age-based analyses suggested that the apparent separation in cognitive performance between HRT users and non-users was greatest around ages 65 to 70. However, the finding does not mean that starting HRT around ages 65 to 70 would lead to better cognitive outcomes.
Estrogen can cross the blood-brain barrier and bind to estrogen receptors in several brain regions, including the hippocampus, which plays an important role in memory. Estrogen signaling influences several processes involved in brain function, including energy use, inflammatory responses, and blood flow in the brain. As estrogen levels fall after menopause, these processes may change in ways that affect a range of cognitive abilities. Estrogen-containing HRT could partly restore estrogen signaling and help support brain function.
Because each woman was assessed only once, the study cannot prove that HRT caused better cognitive performance or slowed cognitive decline. The survey also did not record the type, dose, timing, or duration of HRT. Taken together, the findings suggest that cognitive health may be worth considering in discussions about HRT and that further research is warranted. In Q&A #61, I discuss whether women should start taking hormone replacement therapy before menopause.