Read the updates further down …

In the May 26 Issue of Neurology magazine, the results of a recent study of menopause and memory loss have been reported and media sites are picking up the story around the world. 

It is  not clear how many of those reporting have actually read the study findings versus how many (like us) are re-reporting on media articles.  And that is an issue.  Why?  Because reading the various media reports, you can see quite different conclusions are being drawn about hormone replacement therapy.

The study, undertaken by the University of California,  is the largest done to date on the subject of menopause and memory. According to various reports, the UCLA researchers looked at processing speed, verbal memory and working memory  in 2,362 women who were 45 to 57 years old when first tested. They were followed for more than four years.

The UK Daily Telegraph quotes Dr Gail Greendale of the University of California, who led the study, as saying: “Sixty per cent of women state that they have memory problems during the menopause transition. The good news is that the effect of perimenopause on learning seems to be temporary. Our study found that the amount of learning improved back to premenopausal levels during the postmenopausal stage.”.

Anyone who has read Dr. Winnifred Cutler’s book on Hormones and Your Health published in April 2009 will know that previous studies revealed otherwise. According to her research, memory is impacted by menopause and its effect is by no means temporary.  She highly recommends use of estrogen prior to menopause to counter-act this.  Not surprisingly, this study also found that taking estrogen or progesterone hormones before menopause helped verbal memory and processing speed.  So here they are all in agreement – hormone replacement is good for menopausal memories  provided it is taken prior to menopause.

Where the waters are being muddied is the findings that taking estrogen after 65 can have negative impacts on brain function. Some are reporting this as a need to stop taking estrogen at that age.  Whereas the real message is that it is too late to start taking estrogen at that age. 

Bottom line?  While it is not yet a given that memory loss is a temporary transitional effect of menopause, researchers agree that hormone replacement therapy protects your memory provided you commence therapy during peri-menopause.

Update 10 July 2009:

We asked Dr. Winnifred Cutler, author of the newly released and highly recommended book Hormones for your Health to review this study and advise on how it effects her own recommendations given in her book regarding both cognitive memory and use of HRT.  She very kindly replied:

Thanks for sending me the  Greendale et al, 5/09 paper published in Neurology.

 

Nothing described within it differs from my conclusions in the book. Here are a few tidbits you might find interesting, which come from the paper itself.

• The kinds of hormones (Prempro vs estradiol and sequential progesterone) are never specified for the postmenopausal women who, apparently began using their HRT after a hiatus of some years when their hormone levels were low and they did not take any HRT.  Given the era, it is likely they were Prempro users if intact but hysterectomy and ovariectomy women were included but not reported separately. These would have been less likely to use a progestin given the current practice in the US at the time.
• Many participants started with maximum verbal memory score precluding improvement over time
• Hormonal disruptions during the perimenopause are shown to cause some decline in function that is small and temporary
• The functions tested are speed tests using a paper pencil and do not get at intellectual capacity, nor the kinds of thinking like “executive function” issues described in the book
• Whatever changes the authors  did note in their annual tests from years 4 through 8 of the ongoing research were very subtle, small, and while of possible interest for future research would preclude any global conclusions be drawn. But media make hay out of esoteric research which, as you know from my book, is inclined to oversimplify and thereby lack accuracy.
• Stopping hormones led to a drop in test score over time (figure 1)
• But figure one showed all other groups improved on retests, as is expected when women take the same test each year, 4 years in a row.
• While figure 2 shows a downhill slope in 4 of the groups and an uphill slope for the other 4 in the measure tested (immediate recall of a list of words I guess) the figure also shows that those scores 4 years later tended to even out.  In other words those groups that had a high average the first time, tended to decline a bit and those that started with a lower avg score tended to rise a bit.  This fact limits the interpretability of the findings.

So all in all, with this study published after Hormones and Your Health  if I had included this study in the book, it would not have changed any of my conclusions.

Sincerely yours,

Winnifred Cutler, PhD
President and Founder
Athena Institute for Women’s Wellness

Update 2 July 2009:

Having read so many superficial articles on this subject with conflicting views and conclusions, I purchased the research paper myself. Here are my notes.

Background

Some pertinent definitions:

• Pre-menopause:  women with regular periods
• Early Peri-menopause: irregular periods but no missed periods for more than 3 months
• Late Peri-menopause: No periods for 3 to 11 months (meaning they could in fact have reached menopause)
• Post menopause: No period for 12 months or surgical menopause (not necessarily the same thing as some hysterectomies include removal of ovaries).

No pre or peri–menopausal woman on birth control or HRT were allowed into the study.

The only group where members who used HRT was post-menopause. The type of HRT (synthetic or bio-identical) was not defined. 

Tests and their results:

1. Processing Speed (SDMT): Pre-menopause and early Peri showed the same improvement in cognitive processing speed. Late peri-menopause did not show improvement. But it was only marginally different from pre-menopause. Performance improved post-menopause.

2.  Verbal Memory (EBMT-immediate): immediate recall did not change during any MT stage or during post-menopause current hormone use.

3.  Verbal Memory (EBMT-delayed): Pre improved but early and late did not. But again the different was only marginal compared to Premenopause. Post menopause improved but not amongst HRT users.  

4. Working Memory (DSB):  Working memory was the same for every phase and unaffected by HRT use.

Discussion extracts: 

“The disturbance in cognitive performance during perimenopause was subtle, manifested as lack of improvement over time rather than overt decline.  …  Limitations of the study include the small cognitive battery and that many participants started with maximum verbal memory scores, precluding improvement over time (meaning many got 100% to begin with and therefore could not “improve”)”. 

On the subject of HRT, they concluded “early hormone initiation would benefit cognition but late initiation would be detrimental”.  This means that starting HRT as soon as you reach menopause  would benefit cognition but started late might have the opposite effect.  No mention is made of how long you should use HRT or if using it over 60 or 65 was detrimental to your health so media reports suggesting there was are incorrect.

Bottom line again?  Any memory issues were subtle and time limited.  If you plan to use HRT you should do it early, as in as soon as you reach menopause (if not as early as your first hot flash).  

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