Menopausal hormone therapy and dementia: nationwide, nested case-control study.

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  • Additional Information
    • Source:
      Publisher: British Medical Association Country of Publication: England NLM ID: 8900488 Publication Model: Electronic Cited Medium: Internet ISSN: 1756-1833 (Electronic) Linking ISSN: 09598138 NLM ISO Abbreviation: BMJ Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : British Medical Association
    • Subject Terms:
      Alzheimer Disease*/epidemiology ; Menopause* ; Estrogens*/adverse effects ; Estrogens*/therapeutic use ; Progestins*/adverse effects ; Progestins*/therapeutic use; Humans ; Female ; Case-Control Studies ; Denmark/epidemiology ; Middle Aged ; Aged
    • Abstract:
      Objectives: To assess the association between use of menopausal hormone therapy and development of dementia according to type of hormone treatment, duration of use, and age at usage.
      Design: Nationwide, nested case-control study.
      Setting: Denmark through national registries.
      Participants: 5589 incident cases of dementia and 55 890 age matched controls were identified between 2000 and 2018 from a population of all Danish women aged 50-60 years in 2000 with no history of dementia or contraindications for use of menopausal hormone therapy.
      Main Outcome Measures: Adjusted hazard ratios with 95% confidence intervals for all cause dementia defined by a first time diagnosis or first time use of dementia specific medication.
      Results: Compared with people who had never used treatment, people who had received oestrogen-progestogen therapy had an increased rate of all cause dementia (hazard ratio 1.24 (95% confidence interval 1.17 to 1.33)). Increasing durations of use yielded higher hazard ratios, ranging from 1.21 (1.09 to 1.35) for one year or less of use to 1.74 (1.45 to 2.10) for more than 12 years of use. Oestrogen-progestogen therapy was positively associated with development of dementia for both continuous (1.31 (1.18 to 1.46)) and cyclic (1.24 (1.13 to 1.35)) regimens. Associations persisted in women who received treatment at the age 55 years or younger (1.24 (1.11 to 1.40)). Findings persisted when restricted to late onset dementia (1.21 (1.12 to 1.30)) and Alzheimer's disease (1.22 (1.07 to 1.39)).
      Conclusions: Menopausal hormone therapy was positively associated with development of all cause dementia and Alzheimer's disease, even in women who received treatment at the age of 55 years or younger. The increased rate of dementia was similar between continuous and cyclic treatment. Further studies are warranted to determine whether these findings represent an actual effect of menopausal hormone therapy on dementia risk, or whether they reflect an underlying predisposition in women in need of these treatments.
      Competing Interests: Declarations of interest: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. NP, EAH, and AM declare no competing interests. LSM reports receiving grants from health insurance “Danmark”, The Danish Cancer Society’s Scientific Committee, and Novo Nordisk for research unrelated to the present study. LSM reports being Vice Chair of Danish Society for PharmacoEpidemiology and representative for Nordic PharmacoEpidemiological Network. CT-P reports receiving grants from Bayer and Novo Nordisk for research unrelated to the present study.
      (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Comments:
      Comment in: BMJ. 2023 Jun 28;381:1404. (PMID: 37380188)
      Erratum in: BMJ. 2023 Jun 29;381:p1499. (PMID: 37385647)
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    • Accession Number:
      0 (Estrogens)
      0 (Progestins)
    • Publication Date:
      Date Created: 20230628 Date Completed: 20230929 Latest Revision: 20231003
    • Publication Date:
      20240829
    • Accession Number:
      PMC10302215
    • Accession Number:
      10.1136/bmj-2022-072770
    • Accession Number:
      37380194