What Menopausal HRT Does To Your Brain

❝There’s been a controversy over hormone therapy use. There was a study back in 2002 called the Women’s Health Initiative, and its results scared everybody out of using estrogen therapy. For a long time, people stopped prescribing and using those therapies, thinking that it was going to lead to negative outcomes. Since then, there’s been a lot of revisiting of those findings and discovering that there were some problems with them❞

~ Dr. Amber Watts

We at 10almonds previously covered the (deeply flawed) WHI study, discussing its (many) faults, here: Cancer & HRT: What’s Safe?

And followed it up with such news as: New Evidence: HRT Doesn’t Increase Cancer Risk Even If You Have The Genes For It

But that’s all about cancer. What about the brain?

Sooner or later…

Should we put off menopausal HRT for as long as possible?

Or should we hurry to get it as soon as it becomes clinically relevant?

The first thing to understand when it comes to HRT and brain health, is the critical role that sex hormones play in Alzheimer’s pathogenesis and progression.

We wrote about that, here: Alzheimer’s Sex Differences May Not Be What They Appear

But HRT’s effects on the brain are more far-reaching than just that, as explained in our article: Your Brain On (And Off) Estrogen

To answer the “sooner or later” question, researchers (Dr. Robyn Honea et al., wherein the “et al.” includes as second-listed author the Dr. Amber Watts we quoted up top), analyzed 459 women aged 65–80 and found that greater lifetime exposure to female hormones, particularly estrogen, was associated with brain structures generally linked to healthier brain aging.

This was true even from quite small doses: women who had used hormonal birth control had larger gray matter volumes in parts of the temporal, occipital, and frontal lobes compared with those who had never used it.

In particular, women who used both hormonal birth control earlier in life and menopausal hormone therapy later in life showed greater brain volume in parietal and temporal regions, along with thicker cortex in areas including the posterior cingulate, a region often affected early in Alzheimer’s disease.

Not only was it found that women who experienced menopause at a later age, resulting in longer exposure to female hormones, had greater cortical thickness in several brain regions vulnerable to Alzheimer’s disease, but also, people who underwent early surgical removal of the ovaries (thus creating a surgically-induced early menopause) definitely benefited from early exposure to hormone therapy, too.

As for why this happens?

❝Estrogen is neuroprotective. It’s beneficial for white matter integrity. It helps protect neurons and strengthens neural connections.

It is also important for vascular function. One of the things we get wrong about estrogen is people think of estrogen as this thing that has to do with reproduction. But really, estrogen is very important for a lot of different body systems. It’s important for the brain, it’s important for the heart, it’s important for bone density, and it’s important for the immune system.❞

~ Dr. Amber Watts again

A refreshing read, in times when even the use of hormonal birth control, let alone menopausal HRT (which involves much higher doses than those needed for contraceptive purposes), is often demonized, including (invariably unsourced) claims of being harmful to the brain.

You can read the paper in full, here: Lifespan exposure to hormone therapies and structural brain morphometry in older women

Want to learn more?

You might like this book we reviewed:

The Menopause Brain – by Dr. Lisa Mosconi

Take care!