Quick update on major women's health topics

Dementia: Estrogen supplements may not be beneficial for older women.

The question: In women, cognitive problems increase after menopause, when the body's natural estrogen supply wanes. Does taking an estrogen supplement alter this decline?

This study analyzed the effect on memory of hormone supplements taken by 7,479 older women for seven to nine years. The women were among the 27,000 participants in the women's health initiative (whi) study of hormone therapy and had been randomly assigned to take a daily supplement of estrogen (premarin, 0.625 milligrams), combined estrogen and progestin (prempro, 0.625 milligrams estrogen, 2.5 milligrams progestin) or a placebo. All were dementia-free at the start of the study. Periodic interviews, examinations and neuropsychological testing revealed that women who took estrogen alone had a 49 percent higher risk of dementia than those taking a placebo. The study also reiterated results released last year that women taking the estrogen-plus-progestin combination had a 105 percent increased risk of dementia.

Who may be affected by these findings? Older post-menopausal women. More women than men have dementia, at least in part because women generally live longer than men.

Caveats: The whi estrogen-plus-progestin study was stopped earlier than planned because the increased risk for heart attack, stroke and breast cancer outweighed the benefits of decreased risk for colon cancer and bone fracture. The estrogen-only study was also interrupted because of an increased risk for stroke and no reduction in heart disease risk. Women in the study ranged from 65 to 79 years old; whether the findings apply to other age groups was not determined. Different doses of estrogen or methods of administration also might affect the results. Medical experts emphasize that the increases in risk for any one woman remain quite small. Wyeth pharmaceuticals provided the supplements and placebos and partially funded the research. Two authors consulted for or received grants from various pharmaceutical companies.

Bottom line: Older women concerned about cognitive decline may wish to consider options other than estrogen.

Find this study: June 23/30 issue of the journal of the american medical association; abstract available online at www.jama.com.

Learn more about dementia at http www.4woman.gov and at www.niapublications.org.