Donna G. Hurlock, M.D., P.C.  
     
     

May 28, 2003
Here we go again with more "information" from the Womens Health Initiative. This time the Post headlines read "Hormone Replacement Linked to Dementia". What is should read is "Waiting Until Women Are 20 Years Past Menopause To Start Hormone Replacement is Linked to Dementia". Once again, this is not news. More women in the WHI WHO STARTED TAKING HRT AT THE AVERAGE AGE OF 71 developed dementia that those who did not take estrogen. This is not a surprise because giving an agent which is a known mild promoter of clots to women who surely had some preexisting vascular damage in the brains blood vessels is likely to clot off a few vessels and thus damage the brain. Remember 50% of these women had been smokers in the past or present and 71 year old smokers don't tend to have very healthy blood vessels. Perhaps we should conclude that the decision to wait until age 71 to start HRT was a sign of preexisting dementia in the study's designers!
In contrast, women who start HRT at the right time, i.e., at the onset of menopause, like 95+% of my patients have done, can expect to get anywhere from 30-80% reduction in Alzheimers rates. To back this up, I have attached a chart showing a summary of the results of 19 other studies on this subject. To understand how to read the chart, if the dot is on the left side of the vertical line, the results show protection. In contrast, if the dot is on the right side of the line, harm is suggested. You should note that the first couple studies on this list , just like the wonderful WHI, started HRT at a much advanced age. In contrast all the later studies observed women who had started HRT early in menopause.
So please, when reading articles about HRT results, always make sure you know how long the subjects have been without estrogen before it is added. In general, it's been estimated that if a woman has been estrogen deficient for 10 years before starting HRT, there's already been so much vascular damage that HRT will have minimal benefits. And if the vessels are already severely damaged and constricted, you can get harm by causing microscopic clots in microscopic vessels. Bottom line: 1) Never allow your vessels to be without estrogen for 10 years or more, and 2) Don't expect any useful information to come out of studies like the WHI that purposely excluded freshly menopausal women from their subject pool and instead recruit old, fat, ex-smokers as "healthy menopausal women". They're not being truthful about who they studied and I think that's a tremendous disservice to the newly menopausal women of this country. Perhaps we should all write to Oprah in protest.