I’m writing this Friday’s website article from Tel Aviv. My daughter’s twins, born at 32.5 weeks are maturing and gaining weight in the NICU at Tel Hashomer and I’m privileged to be able to spend time there helping her and the terrific staff care for them. I will return to LA the end of next week. Between baby feedings and family, there has been little time to look at the medical literature but I did glance at a few of my usual cites and found an extraordinarily interesting article in the Journal of Alzheimer’s Disease. (Yes, there seems to be a journal on every disorder, and no I don’t read through them but was directed to this from one of the gyne sites that I peruse.)
It’s known that a rapid decline of estrogen, especially with surgical or chemical menopause has been associated with an increased risk of Alzheimer’s disease in women. A group of Mayo Clinic researchers set out to investigate whether there was physical evidence that amyloid deposition (the hallmark of Alzheimer’s disease) could be impacted by estrogen therapy in the early years of menopause. They followed 68 women ages 42 to 59 who participated in the Kronos Early Estrogen Prevention Study. PET scans were done to assess amyloid deposits in their brains three years after the women were treated with estrogen or a placebo. Of the 68 women, 21 received estrogen via a skin patch, 17 received estrogen orally as a pill and 30 received a placebo. They found that amyloid deposition was lower in the women who received the estrogen patch compared to those who were given the placebo. This effect was most apparent in women with a genotype that made them high risk for developing Alzheimer’s (APOE e4). The oral form of estrogen was not associated with lower amyloid deposition.
This is a very small study but if larger studies are done and the results are similar it has the potential to change how we prevent Alzheimer’s disease in women. According to the primary researcher, “it also may have a significant impact on women making the decision to use hormone therapy in the early postmenopausal years.”
Estrogen therapy in early menopause has been shown to decrease bone loss and the development of atherosclerosis. Transdermal estrogen is considered to be safer than oral estrogen because it has less potential to cause clot formation. It is probably time to change the general fear of estrogen that has impacted therapy for so many women since the 2002 WHI study. We have to remember that this study reported on the use of Premarin in women who were, on average, 15 years post menopausal and who were without menopausal symptoms! Like everything in life, politics and medicine, the pendulum can swing.