Women who use postmenopausal hormone therapy containing estrogen shortly after menopause are less likely to experience cognitive impairment as they age, according to research published in the January/February 2005 issue of Menopause, the official journal of The North American Menopause Society (NAMS).
Also in this issue is research showing that many women use complementary and alternative therapies (known as CAM therapies) during the menopause transition but that menopause-related symptoms do not influence their use of those therapies. In a third article, a clinical research trial reports that two popular antidepressants were not effective in treating hot flashes, despite some preliminary evidence to the contrary. (Highlights and comments on each study are presented below. Full abstracts of these articles are presented at the end of this press release.)
Cognition study. For this study (Bagger et al), investigators in Denmark evaluated cognitive function in 343 women 5 to 15 years after they received estrogen-containing therapy (or placebo). Among estrogen recipients, most used the therapy for 2 or 3 years. The investigators found that estrogen users had a 64% decreased risk of suffering substantial cognitive impairment compared with nonusers. However, mean scores on the cognitive function test were not different between the two groups.
“The study on estrogen and cognitive impairment raises the possibility that using estrogen-containing therapy for a few years during the menopause transition may actually prevent cognitive impairment later in life, which could potentially lower the rate of Alzheimer’s disease,” according to Isaac Schiff, MD, Editor-In-Chief, Menopause. “However, it must be stressed that this is just one study — there is much to be learned before it can be claimed that estrogen therapy provides cognitive benefits.”
CAM therapies. The study by Bair and colleagues evaluated the use of CAM therapies among a large, multiethnic sample of midlife women, 84% of whom were either perimenopausal or postmenopausal. During the 2-year study period, 77% of the women used some type of CAM therapy, which included herbal remedies such as teas and homeopathy, nutritional remedies, such as vitamins and supplements, physical methods such as acupuncture and massage, and psychological methods such as meditation and relaxation techniques.
Among the factors studied for their influence on CAM use, menopause status or menopause-related symptoms, such as hot flashes, were not found to have an effect on use. Interestingly, CAM users were more likely to visit a conventional healthcare provider than nonusers. The data came from more than 3,000 women who participated in the highly respected Study of Women’s Health Across the Nation, also known as the SWAN study.
“This study shows that in this population of generally healthy, well-educated women, the use of CAM therapies is rather widespread,” Dr. Schiff said. “These are women who want safe and effective therapies that fit into their lifestyle. But they still visit their healthcare provider, which gives clinicians an opportunity to discuss their therapeutic choices.”
Antidepressants study. Two selective serotonin-reuptake inhibitors (SSRIs), citalopram and fluoxetine, were evaluated for their effectiveness in alleviating menopause-related symptoms, primarily hot flashes, in 150 women (Suvanto-Luukkonen et al). At the end of the 9-month study, both placebo recipients and women taking an SSRI had significant improvements in relief of menopauserelated symptoms, including hot flashes — improvements that were statistically the same. Citalopram and fluoxetine, government-approved antidepressants, are better known by their respective brand names of Celexa and Prozac.
“This study raises questions regarding the use of SSRIs to treat hot flashes, because many of the studies that did show a benefit were shorter in length than this study,” Dr. Schiff said. “It also raises the question of the placebo effect in hot flash trials. In many of these studies, placebo recipients who expect a benefit from their therapy often do as well as those receiving a drug.”
Citations, abstracts, and contact information follow. For the complete articles, go to www.menopausejournal.com or contact McKinney Advertising & Public Relations.
Bagger YU, Tanko LB, Alexandersen P, Qin G, Christiansen C, for the PERF Study Group. Early postmenopausal hormone therapy may prevent cognitive impairment later in life. Menopause 2005;12:12-17.
NAMS is North America’s leading nonprofit organization dedicated to promoting women’s health through an understanding of menopause. The Society’s membership of more than 2,000 includes experts from medicine, nursing, sociology, psychology, pharmacy, anthropology, epidemiology, nutrition, education, and basic science ? helping NAMS to be the preeminent resource on all aspects of menopause to healthcare providers and the public.
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