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The latest hormone hype

Fear-mongering about menopause is alive and well.

Fear-mongering about menopause is alive and well.

A recent online ABC News report about a new study on menopause and the brain begins with the story of middle-aged Pam, a “high-powered business consultant with experience in banking” who felt like she was “losing her mind” in the years before menopause. She couldn’t even muster the neural strength to pass a mortgage-lending test, she claimed.

Although no proof is offered, the implication of the anecdote is that Pam’s memory problems are linked to menopause.

Then, later in the article, comes this stunningly giant leap of logic from a doctor:

My approach to [menopausal memory problems] is if you lose your job, your sanity or your husband, you do something about it. I see a lot of women about to lose their jobs because they cannot concentrate, they forget things or they are not sleeping. One of my patients had an auto accident. The consequences are very severe.

Yikes! Menopause is so crazy-making that it can cause you to get divorced, get fired, go insane and crash your car?

And what is the “something” that the doctor wants women to do to avoid these catastrophes? Take hormone therapy (HT), of course.

I feel like we’re back full circle. In the 1960s and 1970s, when HT first took off, it was offered as a protection from the “living decay” of menopause and a way of staying “feminine forever.”

What the study really found
So, does this recent study on menopause and the brain live up to the ABC News report hype? No. In fact, the study’s lead author, Dr. Gail Greendale of the University of California, Los Angeles, has cautioned against reading too much into the findings.

What the study found was that women in the late stages of perimenopause (the decade or so before a woman stops menstruating) performed less well on cognitive (thinking) and memory tests than did other women.

But, interestingly, the differences didn’t involve doing worse on the tests. During the course of the study, all the women improved their scores when they retook the tests — a phenomenon known as the “learning effect.” But the learning effect among women in late-stage perimenopause was less than that of the other women. In other words, they didn’t improve as much.

Furthermore, the sluggishness in the degree of improvement was only temporary. After menopause, the women’s ability to improve their scores jumped back to premenopausal levels.

The study also found that taking hormone therapy (HT) during perimenopause had a beneficial effect on women’s scores, but taking it after menopause had a detrimental effect.

It’s that last finding that has triggered the new round of HT hype.

A cautionary question
So, does this mean you should take HT for a few years right before menopause to keep your intellectual edge?

I’d suggest proceeding with caution. Ask yourself this:

Assuming these findings hold up, is learning less effortlessly than you did in your 30s or than you will again in your 50s (after menopause) worth the known health risks of HT? The risk of having a blood clot starts immediately, and if you continue to take the hormones for more than four years, you also increase your risk of breast cancer, endometrial cancer (if you take only estrogen) and gallbladder disease.

In addition, two studies (abstracts here and here) published earlier this year found that common HT formulations may speed up the loss of brain tissue in women 65 and older, particularly in the hippocampus and frontal lobe. Losing hippocampal tissue is considered a risk factor for dementia. And a 2007 study found that HT (with or without progestin) appears to modestly impair some women’s thinking and memory skills, perhaps because the hormones increase the risk of blockages of blood flow to the brain.

Bottom line: Beware of the hype. Keep asking questions.