New data: Hormone replacements may defend against Alzheimer's
New data: Hormone replacements may defend against Alzheimer’s
Experts warn: Too soon to push estrogen therapy as a panacea
A new study adds substance to the hope that estrogen replacement therapy can protect women from Alzheimer’s disease.1 We already know it protects hearts and bones as women age. In light of all this, you’d think women’s health professionals should urge our middle-aged clients to stop dallying with the pros and cons and start taking their hormones today. At that suggestion, a co-author of the study, Ann Morrison, MS, RN, CS, waves a giant red flag.
"We still have no basis for telling women they should take estrogen therapy" in order to prevent Alzheimer’s disease, contends Morrison, clinical nurse specialist and researcher at the Alzheimer’s Disease Research Center of Johns Hopkins University School of Medicine in Baltimore. "We do have a lot of biological evidence to support estrogen’s beneficial effect on the brain," and the estrogen interaction with the brain is an active research area now, Morrison says.
Women have desperately high stakes in such research, write Morrison and associates, because "the disorder afflicts twice as many women, in part because of the shorter life expectancy for men." She adds, "We certainly hope it [estrogen] will prevent or delay Alzheimer’s, but we don’t know this yet."
What Morrison and her colleagues found in their latest investigation is a reduced risk of the dreaded disease, which progressively erases memory and a person’s self-care faculties. The findings reveal that women who used estrogen were 54% less likely to develop Alzheimer’s than those who did not.
It’s the observational nature of the study that raises Morrison’s caution. Though promising, it reports the experience of women who used or did not use estrogen therapy according to personal choices and health providers’ advice. Morrison says randomized trials will help women’s health professionals better understand whether estrogen is an Alzheimer’s preventive.
Even though estrogen replacement indisputably reduces heart disease and osteoporosis, that’s no cut-and-dried case for advising clients to use hormone supplements, Morrison says.
"What about the woman who has had breast cancer?" she says. "If she stays away from estrogen therapy but stays up on her antioxidants, she could reduce her heart and bone disease risks to those of her neighbor who’s on hormone therapy." (For guidelines on explaining the benefits and risks of hormone therapy, see story, p. 112.)
Instead of posing either-or propositions, alert women to the continual need for evaluating hormone supplements.
"We don’t know whether a close relative is going to develop heart disease or breast cancer or Alzheimer’s next year," Morris says.
Women deserve facts from their providers
The data and long-term outcomes are still emerging from different menopause management techniques. Responsible professionals will convey that message to their clients, insists Debbie DeAngelo, RNC, BSN, health educator at the Hamot Health Connection in Erie, PA.
"They resent being pigeonholed into classes of people who should or should not take hormones," DeAngelo says. "They come to their providers to be educated."
Some women turn to DeAngelo’s facility in frustration after being fed up with providers who say, "Yes, you need hormones," or "Stay away from hormones."
"That’s not enough for the woman who wants to make up her own mind," she contends.
Opinionated providers destroy communication and trust with such women and thus thwart the efforts to deliver good care, DeAngelo says.
"I tell women to share with their doctors when they take over-the-counter medications and supplements," she reports, "but some refuse. They say they don’t want to be ridiculed by providers who pooh-pooh complementary therapies."
Conventional or complementary?
"Should I use pills or herbs?" women ask. According to Morrison, the answer to this question is, "What do you want from hormone supplementation?"
The mysteries and vagaries of feminine biochemistry should dissuade any provider from advocating one way over the other, she adds.
"Right now, we only have research on the prescriptive hormones," DeAngelo observes. "The herbal therapies haven’t been widely tested in this country. And whether any of them prevent Alzheimer’s is a story yet to be told."
Laurel Lee, CNM, MSN, a certified phytotherapist (plant-based) at Everywoman’s Health in Portland, OR, sees women who couldn’t tolerate the bloating, mood swings, and continued menstrual bleeding from the prescription progestin, Provera (manufactured by Pharmacia & Upjohn Co. in Kalamazoo, MI). Others have a history of breast cancer or a longstanding preference for complementary therapies.
Lee and DeAngelo are quick to caution that the complementary option takes considerable legwork because each woman’s body chemistry requires different herbal and dietary supplement combinations. As plant-based estrogens are weaker than their prescriptive, so users must fortify them with sound diets and exercise. "Botanical therapies can be time-consuming," Lee explains, "and you have to be regular with them."
She admits that her confidence in conventional hormone supplementation was slow to come. "I was reluctant to get on the bandwagon to endorse conventional hormone replacement therapies until I saw the results from the PEPI study," she says, referring to the postmenopausal estrogen/progestin interventions trial.2 The trial confirmed the positive effects of estrogen supplements in reducing heart disease after menopause. (For more information on the PEPI study, see Women’s Health Center Management, October 1996, pp. 117 and 119. For consumer-education brochures, see two inserts in this issue addressing hormone replacement therapy as it relates to heart disease and menopause.)
Estrogen therapy isn’t for everyone
Not everybody meets the criteria for complementary hormone supplementation, Lee observes. She advises women with obvious heart disease and osteoporosis risk factors to consider conventional therapy. Among them are those who smoke, are obese, or have missed menstrual periods for several months at a time.
Other natural candidates for conventional therapy, according to DeAngelo, are women who "don’t want to monkey around with studying and trying herbal combinations until they find the right ones for them. And they don’t mind taking a pill."
Providers should address complementary therapies with all their clients, she stresses. For that reason, DeAngelo maintains a referral list of local herbalists. "We think over-the-counter herbs and dietary supplements can’t hurt us. But women need to understand the interactions with the other prescriptive medications they are using." (For referrals in your region, call the American Herbalists Guild, listed in the source box at right.)
"I’m not one to say that any hormone supplementation is bad," Lee says. "It depends on your lifestyle and what you’re willing to do to improve the quality of the next 40 years of your life."
She points out to her clients the personal responsibilities and uncertainties of menopause.
"It reminds me of labor," she says. "You can do all the right things, but you don’t know what kind of labor you’ll get. It’s the same with menopause. In the end, you have to work with the hand you’re dealt."
Today’s midlifers are going to revolutionize menopause management as they did labor and delivery during their childbearing years, predicts Lee. Women are demanding to know what kind of estrogens are going to be easiest on the uterus, she says, and they won’t stop until scientists find a way to eradicate any breast cancer risk associated with estrogen supplements.
Meanwhile, "we need to know what to tell all women about the latest in menopause management," says Morrison. "Estrogen isn’t good; it isn’t bad. No, estrogen is complex. We haven’t begun to understand everything it does for our bodies."
The real reason women use estrogen supplements eludes scientific measurement, she says.
"It’s a quality of life issue. We take it because we want to feel better. Estrogen helps a lot of women regulate their midlife sleep disturbances. It improves skin texture and slows hair loss. And, let’s face it," Morrison says, "women would rather have more hair on their heads than on their chins! That angle is just not there in the studies, but we have to bring it into our discussions of when and why to use estrogen."
References
1. Kawas C, Resnick S, Morrison A, et al. A prospective study of estrogen replacement therapy and the risk of developing Alzheimer’s disease: The Baltimore longitudinal study of aging. Neurology 1997; 48:1,517-1,521.
2. Writing group for the PEPI trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: The postmenopausal estrogen/progestin interventions (PEPI) trial. JAMA 1995; 273:199-208. ß
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