Intended for healthcare professionals


Menopausal hormone therapy and cognition

BMJ 2019; 364 doi: (Published 06 March 2019) Cite this as: BMJ 2019;364:l877

Linked research

Use of postmenopausal hormone therapy and risk of Alzheimer’s disease in Finland

  1. Pauline M Maki, professor1,
  2. Lucille M Girard, patient representative2,
  3. JoAnn E Manson, professor34
  1. 1Departments of Psychiatry, Psychology, and Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL, USA
  2. 2Participant, Women’s Health Initiative, West Warwick, RI, USA
  3. 3Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MI 02215, USA
  4. 4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MI, USA
  1. Correspondence to: J E Manson jmanson{at}

Evidence is reassuring for women needing a few years’ treatment for menopausal symptoms

A linked study (doi:10.1136/bmj.l665) by Savolainen-Peltonen and colleagues in this week’s The BMJ explores associations between menopausal hormone therapy and risk of Alzheimer’s disease.1 Two thirds of patients with Alzheimer’s disease are women.2 Given the lack of effective treatments for the disease and estimates that prevalence will triple by 2050, medical and public health efforts focus on primary prevention, including risk factors and preventive strategies that pertain especially to women.2 Among these factors, considerable attention has been given to the role of menopausal hormone therapy, which was associated with a 29% reduction in Alzheimer’s disease in meta-analyses of observational studies3 but with a doubling of the risk of all cause dementia with estrogen plus progestin in the Women’s Health Initiative Memory Study (WHIMS),4 the only randomised trial of postmenopausal hormone therapy for prevention of Alzheimer’s disease.

These opposing findings have been the focus of much research and discussion. A key consideration is the age at initiation of menopausal hormone therapy, which in the general population …

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