Extended Hormone Therapy During Menopause Aids Cognition

Emerging research suggests a longer period of estrogen replacement therapy provides a prolonged cognitive benefit. However, investigators acknowledge that the risk-to-benefit balance of hormone therapy use is complicated and must be individualized.

Research has determined that estrogen has a significant role in overall brain health and cognitive function. This knowledge has fostered various studies on the prevention of cognitive decline as related to reduced estrogen levels during the menopause transition.

The new study suggests a cognitive benefit from a longer reproductive window complemented with hormone therapy. The study, “Lifetime estrogen exposure and cognition in late life: The Cache County Study,” appears online in Menopause, the journal of The North American Menopause Society (NAMS).

Because women comprise two-thirds of the 5.5 million cases of Alzheimer disease in the United States, researchers have long suspected that sex-specific factors such as estrogen may contribute to women’s increased risk for the disease. Moreover, multiple studies have suggested a role for estrogen in promoting memory and learning.

In this newest study involving more than 2,000 postmenopausal women, researchers followed participants over a 12-year period to examine the association between estrogen and cognitive decline.

More specifically, they focused on the duration of a woman’s exposure to estrogen, taking into account such factors as time of menarche to menopause, number of pregnancies, duration of breastfeeding, and use of hormone therapy.

Investigators concluded that a longer duration of estrogen exposure is associated with better cognitive status in older adult women. Furthermore, they documented that these beneficial effects are extended with the use of hormone therapy, especially in the oldest women in the sample.

Women who initiated hormone therapy earlier showed higher cognitive test scores than those who started taking hormones later, providing some support for the critical window hypothesis of hormone therapy.

“Although the assessment of the risk-to-benefit balance of hormone therapy use is complicated and must be individualized, this study provides additional evidence for beneficial cognitive effects of hormone therapy, particularly when initiated early after menopause.

This study also underscores the potential adverse effects of early estrogen deprivation on cognitive health in the setting of premature or early menopause without adequate estrogen replacement,” says Dr. Stephanie Faubion, NAMS medical director.

Source: The North American Menopause Society (NAMS)

Menopause Symptoms Linked to Chronic Pain

New research suggests that estrogens, a group of hormones that play an important role in the normal sexual and reproductive development in women, also affect pain sensitivity.

Investigators discovered the association between menopause symptoms and chronic pain from a study of more than 200,000 records from the Veterans Health Administration.

Experts note that women are more likely than men to report common chronic pain conditions such as back pain, fibromyalgia, arthritis, and osteoarthritis. Women with these conditions additionally report greater pain severity and pain-related disability than their male counterparts.

Although the causes of chronic pain risk are not well understood, prior research has discovered that the risk for common conditions that cause or exacerbate pain is highest in midlife women. This is a time when estrogen levels are fluctuating and women are entering peri-menopause or post-menopause.

Scientists are aware that common changes related to menopause and aging include weight gain and decreased physical activity. Both factors can contribute to the development of chronic pain as can impaired sleep and negative mood. Each condition is known to affect symptom sensitivity and pain tolerance.

In this latest large-scale study of women veterans, investigators hypothesized that even after accounting for age and other known risk factors, menopause symptoms would be associated with increased odds of diagnosed chronic pain and chronic pain morbidity.

Study findings showed that women with a higher menopause symptom burden may be the most vulnerable for chronic pain. More specifically, women with menopause symptoms had nearly twice the chance of having chronic pain and multiple chronic pain diagnoses.

Researchers discuss their findings in an article, “Menopause symptoms and chronic pain in a national sample of midlife women veterans,” published online in Menopause, the journal of The North American Menopause Society (NAMS).

“Changing levels of hormones around menopause have complex interactions with pain modulation and pain sensitivity, which may be associated with vulnerability to either the development or exacerbation of pain conditions,” says Dr. JoAnn Pinkerton, NAMS executive director.

“This study suggests that menopause symptom burden may also be related to chronic pain experience.”

Source: The North American Menopause Society