Brain fog — a term encompassing a range of cognitive problems, including memory issues — is a common complaint of women going through menopause.
“There are currently no recommendations to use hormone therapy for cognitive issues, even though brain fog is frequently a reported symptom during the menopausal transition and beyond,” says a coauthor of the study, Liisa Galea, MD, a senior scientist at the center for addiction and mental health at the University of British Columbia in Canada.
Dr. Galea says she and her research team wanted to explore the cognitive effects of hormone therapy using estradiol, the most potent form of estrogen, levels of which drop off dramatically in the body during menopause. The goal was to find out if this therapy improves certain types of memory, and whether it matters what type of estradiol-based hormone therapy a person undergoes.
Here’s what their research shows, plus how it compares with other data on hormone therapy and cognition.
Study Examined the Effects of HRT on Different Types of Memory and Thinking Skills
Among the participants, 4 percent used transdermal estradiol (in which the hormone is absorbed through the skin), either through patches, gels, vaginal rings, creams, or tablets. Two percent took estradiol-based hormone therapy as pills. The rest of the participants did not use hormone therapy.
All participants completed tests that looked at different areas of memory and thinking skills, including:
- Episodic memory: The ability to remember words and events
- Prospective memory: The ability to remember to do things in the future, like keep appointments
- Executive function: Planning and problem-solving skills
Study Found HRT Improved Test Scores for Certain Types of Memory Skills
Data analysis showed that women who had used transdermal estradiol had higher scores on episodic memory tests than those who had never used hormone therapy.
Women who had taken estradiol pills, on the other hand, had better test scores for prospective memory than nonusers of hormone therapy.
None of the therapies examined were tied to higher executive function scores.
The findings suggest that hormone therapy in various forms may help with cognitive issues tied to menopause, says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine in Chicago, who was not involved in the study.
“This study is further proof that there is no one ‘best’ kind of hormone therapy,” she says. “It really depends on what you’re trying to accomplish.”
Why Does Hormone Therapy Improve Cognitive Health?
The study is observational, which makes it difficult to determine why there’s a link between hormone therapy and better cognitive scores. “You have to look at who is taking hormone therapy and why,” Dr. Streicher says.
“Are the people who are taking it symptomatic and that is linked with an impact on cognition? We don’t know.”
One potential explanation for HRT’s effect on memory may, at least in part, involve sleep improvements. “We know that hormone therapy helps hot flashes and usually sleep,” says Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine in New Haven, Connecticut. Insomnia is common during menopause, in part because of symptoms like night sweats.
“As many women will tell you, sleep deprivation isn’t really helpful for good cognitive function,” says Dr. Minkin, who wasn’t involved in the new research. “I have always thought that giving women a decent night’s sleep can make a big difference.”
The Study Has Some Limitations
The study mostly included women who were white and had higher incomes, so the findings may not be applicable to everyone.
Neither did it look at hormone therapy dose, how long the women took it, or the timing of their hormone therapy.
Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, California, stresses that the findings don’t address whether hormone therapy lowers the risk of brain changes often related to memory loss, such as dementia or Alzheimer’s disease.
“While these studies looking at hormone levels and memory loss are interesting, they are not convincing and don’t prove that hormone therapies are neuroprotective, or will prevent or delay the onset of Alzheimer’s dementia or vascular dementia,” he says.
Galea agrees. “It is not yet known whether this has any implications for dementia risk later in life,” she says.
“Future research should be done to follow hormone levels in women who develop memory loss long after menopause to see if these hormone [therapies] can be protective, or if a gender-specific treatment for dementia or memory loss can be targeted in ladies as they age, rather than one medication for memory loss for both women and men,” Dr. Segil says.
Hormone Therapy for Menopause Has Gotten a Bad Rap
The original study also didn’t parse out how old women were when they started hormone therapy, which further interfered with the conclusions.
Hormone therapy in menopause has also been linked with better bone and joint health, along with a lowered risk of the vaginal dryness that’s common in menopause, Streicher says.
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