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To Take or Not Take Hormone Replacement Therapy Years After Menopause?

I admit it – I am concerned about my brain health.  I have greater risk due to my genetics, family history, and a really bad concussion when I was younger (and several hard knocks to my head when I used to snowboard).  But new research is helping us to understand why people get Alzheimer’s Disease (AD) in the first place; and Dr. Dale Bredesen along with practitioners that he has trained are demonstrating reversal of AD in some patients.  This is encouraging and exciting! Dr. Dean Ornish is also getting ready to conduct the first randomized controlled trial to determine if the progression of early to moderate Alzheimer’s disease can be reversed by a comprehensive lifestyle medicine program, without drugs, devices, or surgery.

Two BIG questions for many women who are at increased risk for AD: do I take Bioidentical Hormone Replacement Therapy (BHRT) to protect my brain?  And when do I start taking it? This is also a question I am pondering as I enter my later perimenopausal years.

There is no question that estrogen (specifically estradiol) is protective to the brain. See my previous blog on the protective mechanisms of estrogen.

There is some debate about when to start BHRT to protect the brain (and cardiovascular health and the bones).  The timing hypothesis evolved from a large clinical trial and proposes that if a woman is not on estrogen and is 65 years or older, she will NOT benefit from HRT, especially if she already has cardiovascular issues. Dr. Ann Hathaway, Bredesen trained practitioner and also women’s hormone expert, disagrees.  This timing conclusion is based on research that used oral estrogen in the form of premarin and progesterone in the form of medroxyprogesterone. See her YouTube video on this topic here.

Dr. Hathaway has found that topical bioidentical estradiol (patch or cream) and topical or oral real progesterone yield totally different results.  But at the time there is no large-scale study to counteract the current timing hypothesis. However, there ARE smaller studies and research out there that do demonstrate the benefits of taking BHRT several years after menopause to protect the brain. Check out the research of Dr. Natalie Rasgon. Dr. Rasgon looks at PET scans of menopausal women’s brains on HRT and the brains of women who discontinue HRT for a two year period. Fascinating!

And please don’t forget that hormone production and balance is dependent on so many factors, including diet, sleep, stress management, GI Health, and LIVER health.  And happiness!  When balancing your hormones, you really have to look at all these factors. In fact, you may want to address these factors BEFORE doing hormone testing to get an accurate picture of your hormones.

Of course, there are other hormones that are important to brain health including testosterone, progesterone, and thyroid hormone.  If you have never had your hormones tested and you are in your late 30’s or 40’s, I suggest testing them to get a baseline.  If you are in your 50’s or older and have not had your hormones tested in a couple of years and are concerned about AD, cardiovascular disease, or osteoporosis, I highly suggest working with a good integrative hormone doctor to evaluate your current state of hormones.

My Revitalize Your Brain program offers a starting point for you to look at all these factors, including basic hormone testing!  If you are ready to take charge of your brain health and need direction, please schedule your complimentary strategy session here! 

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