Should surgical menopausal women be treated with estrogens to decrease the risk of dementia?

Hormone treatment to improve or maintain cognitive function in postmenopausal women has always been a contentious issue. In the late 1980s and 1990s, there was brief enthusiasm for hormones to be a potential prophylactic treatment for dementia, based on findings from cell culture, animal, small treatment, and observational studies.¹

However, the tide turned when a large randomized placebo-controlled study (the Women's Health Initiative Memory Study or WHIMS) found an increased risk for dementia already after 1 year of combination hormone treatment in women over 65 years of age.^1,2 This study also confirmed earlier reported increased risks with long-term hormone treatment for dangerous adverse events, such as cardiovascular disease, stroke, and breast cancer.² The use of hormone treatment dropped by a third and NIH guidelines² recommended that hormones, when indicated for severe perimenopausal symptoms, should be prescribed at the lowest dose for the shortest period possible to reduce these risks. So how long should surgically menopausal women, who often report severe menopausal symptoms, be treated?

In this issue of Neurology®, the Mayo Clinic team in Minnesota reports that surgical menopause overall increased the risk of dementia or cognitive impairment by 45% in a large observational follow-up study.³ When unilateral oophorectomy was performed before 41 years of age, there was an almost doubled risk and when it was done before 34 years of age, this risk was more than four times higher. For …