Endocrine Abstracts

We recently reviewed the evidence for neurological effects of premature ovarian insufficiency (Hogervorst 2014, ESHRE in press) to provide guidelines for ESHRE.

Several observational studies reported that an early age at menopause increased risk for dementia and was associated with worse cognitive function and dementia pathology.

However, sex hormone treatment up to the natural age at menopause could off-set this risk. It is currently not clear how long hormone treatment can be maintained. Cell culture studies suggest that estrogen treatment can accelerate pathology but maintains healthy neurons.

Large treatment trials such as WHIMS suggested that adverse hormone effects, such as breast cancer risk and cardiovascular disease do not occur until up to 5–7 years after initiation of hormone treatment. Negative effects of hormones on brain function have not been shown in recently menopausal women. Our Cochrane reviews have shown that these negative effects of combination hormone therapy on cognition have mainly been found in women over the age of 65 years.

Our other reviews (Clifford 2009) suggest that midlife lifestyle changes such as exercise, cessation of smoking, and healthy diets to reduce metabolic syndrome and consequent risk for cardiovascular disease and dementia in later life are particularly important for women (Hogervorst 2012).

In sum, limited evidence suggests that hormone treatment for POI up to the natural age at menopause combined with healthy lifestyle changes may reduce risk for dementia in later life. In addition, treatment should probably not be continued if cardiovascular risk increases (diabetes mellitus and atherosclerosis) to reduce risk for dementia. Women at risk for both cardiovascular disease and dementia (who carry the APOE epsilon 4 genotype) do not seem to benefit from hormone treatment but we did not find that other polymorphisms associated with estrogen synthesis or metabolism affected risk (Thornton 2010).