Having problems with message search?
Today, many of you read about an article in the Journal of the American Medical Association (JAMA) which reported that PremPro (Premarin plus Provera) doubled the risk of Alzheimer's Disease. This was in contrast to numerous other studies which showed that estrogen 'protects' women from getting Alzheimer's Disease. Estrogen's benefit has been demonstrated in previous research from Johns Hopkins University (http://www.smh.com.au/articles/2002/11/06/1036308371485.html), Columbia-Presbyterian Medical Center (http://cgi.cnn.com/HEALTH/9608/15/nfm/alz.estrogen/), and research from the National Institute of Health (NIH) (http://www.nih.gov/news/pr/jun97/nia-18.htm) . . . just to list a few (click the web addresses to read those articles).
Today's article differs from previous studies in that the women studied were all 65 years of age or older "at the start." This is very different from the usual patient when they begin their hormones. Earlier research was on more typical patients who started hormone therapy at the onset of menopause - usually around age 50. Also in some previous research it was stated that, "current use did not appear to affect risk (beneficially) unless the use exceeded 10 years," which was not the case for any of today's patients. In addition questions regarding the negative effect of the second (progestin) hormone, given along with estrogen, remain unanswered.
Because of this and other research, I would hesitate to 'start' any patients on hormone therapy who are 65 years of age or older. However I still believe the majority of the research demonstrates a benefit if you take your estrogen "continuously" from the onset of menopause. (There is evidence that this "take it continuously without an extensive break" logic also applys to the women who get heart disease, and to a lesser degree, stroke.) It may be that if your body is deficient in estrogen for 2 to 6 years or more, and then you restore higher estrogen levels, this may be what causes the harm. No one knows for sure. Research continues on this theory.
Also getting estrogen through the skin or vagina (the estrogen patch or ring) is definitely a more natural way to get estrogen into your blood, and may avoid or reduce some of these long term risks. Again, no one knows for sure.
Below is a summary of the latest article:
Hormone Use Found to Raise Dementia Risk
Wed May 28, 9:00 AM ET Add Top Stories - The New York Times to My Yahoo!
By DENISE GRADY The New York Times
Wed May 28, 9:00 AM ET Add Top Stories - The New York Times to My Yahoo!
By DENISE GRADY The New York Times
Hormone therapy doubled the risk of Alzheimer's disease and other types of dementia in women who began the treatment at age 65 or older, a large study has found. The latest finding is based on a four-year experiment involving 4,532 women at 39 medical centers. Half took placebos, and half took Prempro, a combination of estrogen and progestin, the most widely prescribed type of hormone therapy.
In four years, there were 40 cases of dementia in the hormone group, and 21 in the placebo group. Translated to an annual rate for a larger population, the results mean that for every 10,000 women 65 and older who take hormones, there will be 45 cases of dementia a year, with 23 of them attributable to the hormones. Researchers said the risk to individual women was slight, and that even though the numbers worked out to a doubling of the risk, 23 cases for every 10,000 women should not be cause for alarm.
"A small number doubled is still a small number," said Dr. Samuel E. Gandy, vice chairman of the medical and scientific advisory council of the Alzheimer's Association, and director of the Farber Institute of Neurosciences at Thomas Jefferson University in Philadelphia. Still, Dr. Shumaker said, women 65 and older who are taking Prempro or other hormone combinations should discuss why they are taking the drugs with their doctors and decide whether to quit.
Because the women in the study were 65 or older, it is not known whether the findings apply to younger postmenopausal women. It is not known, either, whether the results apply to women who take other hormone combinations or estrogen alone. Women who take estrogen alone are being studied separately. The new study suggests that what goes on in the body is much more complicated than what happens in laboratory rats and test tubes. Even if hormones have some good effects on brain cells, Dr. Shumaker said, those benefits may be offset by harmful effects.
She said that it was not known how the combination therapy might increase the risk of dementia, but one possibility was that it increased the risk of blood clots and clogged tiny blood vessels in the brain, which might injure brain cells and contribute to Alzheimer's disease and a condition called vascular dementia.
Some researchers have suggested that hormone therapy may help protect the brain if women take it around the time of menopause, when natural hormone levels plummet, instead of waiting until age 65. They think there may be a "critical period" in which hormone therapy can protect brain cells from the sudden withdrawal of hormones and that once the period is over the damage is done and it is too late.
Dr. Gandy said that some of the most promising earlier results on hormone therapy and the brain came from studies of estrogen alone, and that the progestin in the combination pills might cancel out estrogen's good effects. He said that another part of the Women's Health Initiative, still in progress, was studying women who take estrogen alone. That study is scheduled to be completed in 2005.
The above is not meant to be medical advice. Please read the attached Disclaimer, Etc.
Best wishes. Dr. Rehert
Offline 
Send Email