Not ‘panacea nor poison’: No long-term cognitive effects of menopausal hormone therapy
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Key takeaways :
- Cognitive function was similar for women assigned menopausal HT and placebo at 4 years and at 10 years.
- There was no association with type of HT and cognitive function.
PHILADELPHIA — At 10 years of follow-up, women who had been assigned menopausal hormone therapy in the KEEPS study had cognitive function scores similar to those of women assigned placebo, according to a speaker.
Preliminary data from the KEEPS-Continuation study show “no harm, no benefit” of menopausal HT on cognition at 48 months or at 10 years after randomization, according to Carey Gleason, PhD, FABMR, FAPS, associate professor in the department of medicine, division of geriatrics and gerontology at University of Wisconsin-Madison, who presented findings at the Annual Meeting of The Menopause Society.
When the Women’s Health Initiative study was stopped early in 2002, “women were feeling [that] by using hormone therapy, they may have permanently damaged their brain or increased their risk for dementia,” Gleason said during the presentation. “It was a rather uncertain time and abruptly the medication that had been touted as a panacea in many regards became a poison.”
The original KEEPS study was designed to assess cardiovascular outcomes associated with HT particularly when started at a younger age and closer to time of the last menstrual period. Healthy women aged 56 to 71 years (mean age, 65.8 years) were randomly assigned to receive oral conjugated equine estrogens plus progesterone, transdermal 17--estradiol plus progesterone or placebo for 48 months.
Assessment at 4 years showed similar cognition for all groups.
“Women have menopausal symptoms; 25% of women describe severe to moderate symptoms,” Gleason said. “So, if we can acknowledge that for some women [the] menopausal transition is symptomatic, especially around cognition and mood, that for those women who are opting to use hormone therapy there were no short-term cognitive effects.”
In KEEPS-Continuation, Gleason and colleagues assessed long-term cognition, mood and neuroimaging data for 299 women (41%) from the original study at 8 to 14 years (mean, 9.57 years) after randomization.
The goal of the continuation study was to answer: “For women who had opted to use [HT] for a short term, what does it do to my brain years later when I'm at increased risk for dementia?” Gleason said.
The researchers used linear latent growth models with distal outcomes to assess change in cognitive performance from baseline and across KEEPS visits.
The strongest predictor of cognitive performance — verbal learning and memory; auditory attention and working memory; visual attention and executive function; and speed of language and mental flexibility — for women in all groups in KEEPS-Continuation was cognitive performance in KEEPS, Gleason said. There was no association between long-term cognitive function and type of HT or placebo.
“In thinking back again to some of the abrupt switch that had confounded care of women during the menopausal transition, ... my recommendations are that we view [menopausal HT] not as a panacea nor as a poison, and that it’s just another option in the armament of treatments for women who are as experiencing severe menopausal symptoms,” Gleason said.
Gleason acknowledged that limited diversity and the healthy study population, for example, women with diabetes were ineligible, were limitations of the KEEPS studies.