Should you do hormone replacement? When should you start? It is too late to start? How long should you do it for? These are all real, valid questions, and will vary from person to person. There seems to be growing consensus that hormone replacement needs to be started early, around the time of menopause, to have the best effect. Some studies, like the WHI study (NOTE: please take this study with a grain of salt. Many of its original findings have been modified) indicate that HRT can be detrimental. It is important to note that the average age of the WHI study was 63, and many of the women had additional medical issues. But there does seem to be growing evidence that doing estrogen hormone replacement does not reverse change, it helps slow the progression and may prevent.
We at Biohackr Health in San Francisco and Palo Alto are fans of hormone replacement for women in perimenopause and menopause. We offer testing of levels, bioidentical hormone pelleting, and traditional HRT through our telehealth visit- personalized hormone therapy options for you.
What is the window theory?
The window theory is that there is a “window of opportunity” to get the benefit of hormone replacement. This window is during perimenopause or the first five years right after menopause. Why the window? Again, it seems to be about prevention and slowing the aging process. Looking at dementia risk and what studies have shown us:
- A longer time before menopause hits is associated with better cognitive function and lower risk of dementia. The risk of dementia decreased 0.5% for every additional month of estrogen exposure before menopause.
- Alzheimer patients show a straight line relationship between alpha estrogen receptors and cognitive function. Estrogen keeps you from losing the estrogen receptors. (They think this is why there is a window- once the receptors are lost, starting estrogen cannot resurrect them)
- One study showed a 26% reduction in dementia when HRT was started at 48.7 yo, vs an Increased risk of dementia of 48% when started at age 76.
- Alzheimer studies which showed estrogen reducing risk of dementia were in younger women
- The theory is that estrogen has a positive and protective role in the brain, so if you start early, there will be less neural damage during the initial postmenopausal years. It improves cerebral blood flow. It lowers the amyloid beta deposition seen in Alzheimers.
- One study concluded “Women exposed to extended hypoestrogenic phases would likely suffer irreversible brain damage leading to cognitive defects due to the prolonged cerebral blood flow compromise. At that point, estrogen would not be beneficial.”
One study concluded, citing 4 supporting studies, “One thing is for sure, given the multiple studies displaying mostly negative effects or no effect of starting hormone therapy at an older age, it is currently not recommended to prescribe estrogen therapy to women >65 years of age for the prevention or treatment of Alzheimers, especially if they already suffer from some degree of cognitive impairment.”
How long should you do it for? The data here is mixed.
- Lab animal studies showed neurogenesis with short term estrogen therapy, but then it halted.
- 2009 randomized controlled trial looking at brain MRIs after 4-6 years of HRT showed reduced hippocampal sizes in older women. They concluded a short estrogen course may have been better
- A 2021 systematic review showed hormone therapy protected against Alzheimer dementia with use beyond 10 years, irrespective of when it started.
- 2023 cohort study showed women who had long term estrogen therapy had lower limbic age related brain changes. These changes are found in 88% of women with Alzheimer disease
What about progesterone? If you have a uterus, you need to do estrogen and progesterone. There is some evidence that progesterone blocks some of the estrogen benefits.
How can Biohackr Health help?
Are you in perimenopause? Menopause? Evaluate if you are a candidate for hormone replacement.
We do testing and have advisors to discuss. If you want a deeper dive to discuss your specific medical background (do you have a history of breast cancer? blood clotting? heart disease?) meet with our telehealth clinicians who can guide you to testing and treatments catered to you.
We offer many ways to do hormone replacement therapy for our Bay Area patients. In our San Francisco and Palo Alto clinics we offer bioidentical hormone pelleting, with the pellets individually catered to you, as determined by lab testing. If you want more traditional hormone replacement therapy, you can do a telehealth visit with our clinicians to get prescription HRT.
We are fans of estrogen hormone replacement therapy. Hormone replacement has been shown to prevent dementia, in addition to helping with bone health, heart health, skin quality, and more- it isn’t just about the “menopause” symptoms of hot flashes and weight gain. Again, as these studies of the window theory of HRT show you need to start HRT early.
Come in to our Pacific Heights / Cow Hollow SF location on Union St. or our downtown Palo Alto location on Bryant St for further information.
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MEDICAL STUDIES:
Many of the studies cited are summarized here.
