I may be boyish, but I'm old enough to know plenty of women who've agonized over whether it's time to begin hormone therapy. Simply put, for most women toughing out menopause is no fun.
There's no question that HT can alleviate the hot flashes, depression and other common menopausal symptoms. And there was a time when HT was believed to do much, much more than that - for example, lower the risks of everything from osteoporosis to heart disease to intellectual decline.
But a major scare ensued in 2002 when the estrogen-plus-progestin trial of the Women's Health Initiative was halted because the health risks of the hormone therapy were found to outweigh the benefits. And several WHI subset studies, including one published in 2004, showed that hormone therapy (whether with estrogen alone or with estrogen plus progesterone mimics called progestins) raised women's risk for dementia. Women abandoned HT in droves.
Now, it turns out, that rush to the exits may have been triggered by an alarm that wasn't exactly false, but maybe should have been more carefully targeted. The women in the 2004 study were all between 65 and 79 years old.
A new study of 1,768 women included many who had begun HT (with or without progestins) within five years after the onset of menopause. Among these women, the risk for Alzheimer's dropped by 30 percent, while those who started HT more than five years after menopause got no such benefit. In fact, if the regimen begun by post-five-year women included progestins, that risk increased.
In an editorial accompanying these findings, Stanford neurologist and public-health policy expert Victor Henderson, MD, MS, flags a different risk: that of assuming that a medical treatment will produce the same results in disparate populations.
Henderson cautions that the new results "do not provide a sufficient foundation for new clinical recomendations." But they do give some comfort to current midlife HT users.