Human Reproduction Update Advance Access originally published online on March 2, 2007
Human Reproduction Update 2007 13(3):329; doi:10.1093/humupd/dmm002
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Cognitive function and menopausal hormone therapy
Clinical Research Centre of Wome
s Health
Charité-Universitätsmedizin Berlin
Campus Benjamin Franklin
Hindenburgdamm 30, D-12200 Berlin, Germany
E-mail: martina.doeren{at}charite.de
The subject of cognitive function and the potential role of menopausal hormone therapy (MHT) was addressed by a narrative structured review (Genazzani et al., 2006
). This is an important issue, as demographic changes in European populations and worldwide imply that growing numbers of women are potentially prone to the risk of developing cognitive decline including dementia if preventive and therapeutic measures cannot be developed. It is a pity that a Cochrane review on this subject was obviously not considered for this review (Hogervorst et al., 2002). In this systematic review, based on meta-analytic techniques, the authors demonstrated that both estrogen-only (ERT) and estrogen-progestin therapies (EPT) were not beneficial as regards to overall cognitive function of healthy post-menopausal and women with bilateral oophorectomy alike. This review was published before results were available from the Wome's Health Initiative and Wome's Health Initiative Memory Study (Shumaker et al., 2003; Espeland et al., 2004; Shumaker et al., 2004; Rapp et al., 2003; Resnick et al., 2006).
Whether there could be a ‘critical window’, regarding age of women, to potentially administer MHT for the benefit of cognition is a highly relevant matter. Hogervorst et al. (2002) assessed 15 double-blind randomized placebo-controlled trials of ERT or EPT, administered for at least 2 weeks to healthy women of any age who had undergone natural or surgical menopause. However, at the time the study was conducted, no trials providing long-term data were available. Nine of these trials included women below the age of 50 years. Thus, there are at least short-term data available regarding effects of exogenous hormones on cognitive function in women as young as 29 years, 33 years, or in their 40s, the latter being included in seven of nine studies. Studies including older women found no evidence of benefit from treatment with MHT as did studies including young(er) women.
At this point in time it would be helpful to synthesize all available trial data, as several large double-blind randomized placebo-controlled trials providing longer-term data are available for data extraction, suitable for a comprehensive review on this subject
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Espeland MA, Rapp SR, Shumaker SA., et al. for the WHIMS Investigators. (2004) Conjugated equine estrogens and global cognitive function in postmenopausal women. Womens' Health Initiative Memory Study. JAMA 291:2959–68.
Genazzani AR, Pluchino N, Luisi S., et al. (2006) Estrogen, cognition and female ageing. Human Reprod Update (advance access published on November 29, 2006; doi:10.1093/humupd/dml042).
Hogervorst E, Yaffe K, Richards M., et al. Hormone replacement therapy to maintain cognitive function in women with dementia. Cochrane Database Syst Rev. 2002;(3):CD003799. Review.
Rapp SR, Espeland MA, Shumaker SA., et al. for the WHIMS Investigators. (2003) Effect of estrogen plus progestin on global cognitive function in postmenopausal women. The Womens' Health Initiative Memory Study: a randomized controlled trial. JAMA 289:2663–72.
Resnick SM, Maki PM, Rapp SR., et al. for the WHIMS Investigators. (2006) Effects of combination estrogen plus progestin hormone treatment on cognition and affect. J Clin Endocrinol Metab 91:1802–10.
Shumaker SA, Legault C, Kuller L., et al. for the WHIMS Investigators. (2004) Conjugated equine estrogens and incidence of probably dementia and mild cognitive impairment in postmenopausal women. Womens' Health Initiative Memory Study. JAMA 291:2947–58.
Shumaker SA, Legault C, Rapp SR., et al. for the WHIMS Investigators. (2003) Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. The Womens' Health Initiative Memory Study: a randomized controlled trial. JAMA 289:2651–62.
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