Saturday, September 01, 2007

Estrogen for neuroprotection

My Dad died with Alzheimer's some years back, and now my Mom is checking out with multi-stroke dementia. As a result, my interest in neuroprotection--i.e. strategies to bring all neurons to the finish line along with the rest of me--is stronger than ever. A new study from the Mayo Clinic confirms my belief that estrogen is an important part of my save-the-brain program.

After the Women's Health Initiative rocked the menopausal set with the news that hormone therapy may increase risk of dementia, neurobiologists were disturbed that these results did not fit with hundreds of studies on cells, lab animals, and humans that suggested otherwise. They conjectured that estrogen has a different effect on healthy brain cells compared to its effects on brains already gummed up with the effects of Alzheimer's or compromised blood supply.

Dr. Walter Rocca and his Minnesota colleagues identified a group of women who had their ovaries removed before age 50 twenty or more years earlier. The incidence of dementia in those women who did not receive estrogen post-oopherectomy was 10% compared with a 6.6% rate in the sub-group who did take estrogen after surgery. The researchers concluded that estrogen replacement therapy is beneficial to brains in this younger population.

Per Dr. Rocca: Where and when estrogen switches from being protective to harmful is the next big question. One of my patients would say most definitely that the benefits extend to the after-50 newly menopausal set. She is a media spokeswoman for a large organization. Prior to starting estrogen, we began to work her up for early dementia as she lost the ability to find the right word at the right time during press releases. We called off the work-up, however, after she began estrogen therapy and regained her ease at interviews. And that's just one of many stories I have to support the estrogen-brain connection.


KGMom said...

So HRT is possibly recommended? I was on HRT for a couple of years, and when the original news came out about increased cardiac problems etc. my doctor had me stop.

Femail doc said...

There has certainly been a 180 degree turn again with respect to prevailing opinion. At least with respect to women just entering menopause.

The ongoing decision thereafter becomes a weighted one. Estrogen promotes cell growth, division, and function. That's good for every cell in your body except your breast tissue and your uterine lining. While those areas should grow and prosper in preparation for a pregnancy, there comes a point in life when they are better left to dry up and sink down your chest. If breasts and endometrial uterine tissue are subjected to ongoing estrogenic stimulation, the risk of cancer begins to rise after several years. The uterine effects can be counteracted by use of progesterone, the breast effects are actually amplified by concurrent use of progesterone.

So every woman will have different factors to weigh. I favor HRT for myself due to neuro- and bone protection. Another woman might have a family history of breast cancer, or just a fear of it that makes ongoing HRT use uncomfortable for her.

Researchers are working on solutions such as non-feminizing estrogens that have a favorable effect on bone, brain, vascular tissue, but do not affect breast or uterine tissue. One such molecule is 17-alpha estradiol. I hope they hurry up with this line of research!

Mauigirl said...

Me too! I'm a firm believer in "better living through chemistry" and don't like to have any discomfort if I can at all help it!

I am not on HRT overall but do use Estrace Cream for obvious reasons. I am thinking of asking my doctor for the Estring instead. Any thoughts on those choices? Luckily I have no other symptoms of menopause (no hot flashes, etc.) except the one that Estrace works on!

Anonymous said...

I was recently diagnosed with a paradoxical embolism and DVT and had to stop HRT. In two months time I am experiencing hot flashes and very painful intercourse that lubricants don't help. My hematologist says no estrogen cream, and I can only use HRT if I agree to Coumadin for life, a HUGE commitment. I've been on it for 8 weeks and it just won't stabalize. It's all over the map. The arthritis in my spine and knee have flared without the anti-inflammatories I used to take, and severely limited my mobility. Epidurals are off the table unless orchestrated with Lovanox each time. I'm MISERABLE! I also have to have a PFO and ASA repaired if I hope to get off Coumadin. It seems like I'm being told "Choose your poison." I wish there was a safe way to alleviate the menopausal symptoms without Coumadin.