This is Your Brain on Hormones

By John R. Lee, M.D.
From the John R. Lee, M.D. Medical Letter – July/August 2003

Research from the Women's Health Initiative shows that conventional HRT increases women's risk of Alzheimer's and dementia

The bad news about conventional hormone replacement therapy (HRT) has been all over the news for the past year, as results of the Women’s Health Initiative (WHI) trickle out. Last summer the big news was that conventional HRT (e.g. Premarin, an estrogen, and Provera, a synthetic progestin – also known as PremPro) increased the risk of breast cancer, stroke, heart disease, and gallbladder disease. Now the latest revelation is that not only does conventional HRT not help with Alzheimer’s disease and other types of dementia in women, it actually doubles the risk of getting dementia in women over 65.

This research from the WHI was published in the May 28 Journal of the American Medical Association (JAMA) and is based on a four-year experiment involving 4,532 women. Half took placebos, and half took PremPro, a combination of estrogen and a progestin. In four years, there were 40 cases of dementia in the hormone group, and 21 in the placebo group. If we extrapolate that out to the real numbers of women who were taking conventional HRT before last summer, that’s 68,000 additional cases of Alzheimer’s annually, caused by a misguided approach to hormone replacement.

Here’s what I wrote about HRT and Alzheimer’s in this newsletter back in 1998:

“Estrogen has been promoted by the drug companies as a remedy for Alzheimer's but until recently they were all short-term studies or they failed to consider other obvious risk factors. A recent study reported in the Journal of the American Geriatric Society (July '98) found that women whose own estrogen was higher did not have better cognitive function or a lower risk of cognitive decline (senility), and in fact, some of the women with higher estrone levels did worse on cognitive tests.

“There's no doubt that estrogen has a beneficial effect on the brain at normal levels, but I believe that as soon as estrogen dominance or excess occurs, the benefit is lost.”

Here’s what I wrote in this newsletter about HRT and Alzheimer’s in 1999:

“In April, TV news programs around the U.S. aired a clip reporting that a Journal of the American Medical Association (JAMA) study found that estrogen supplementation improved memory in menopausal women. In fact, the study found that estrogen supplementation increased brain activation patterns, but the authors clearly reported that, “Estrogen did not affect actual performance of the memory tasks.” (emphasis added). Thus, the study merely confirmed what has been long known, namely that estrogen increases brain cell membrane excitability. But it did not show, contrary to the TV news report, that estrogen supplementation improved memory in menopausal women.

“It is well known that estrogen increases brain cell membrane excitability. In balance, this has a beneficial effect on the brain. A deficiency of estrogen can lead to depression, and an excess can lead to anxiety and poor sleep. Most postmenopausal women are making plenty of estrogen in their fat cells and don’t need supplemental estrogen for good brain function.

“It is also known that progesterone has a calming effect on brain cell membranes. In fact, in physiologic doses it allows the brain to concentrate, or focus better. In excess it can cause lethargy or sleepiness, which is often reported when women use oral progesterone. Women using physiologic doses of progesterone notice that their brain performance for memory or for tasks that require concentration is improved; they also note better sleep and less anxiety.

“The JAMA study merely reaffirms the fact that excess estrogen can increase brain cell excitability without increasing brain performance. In other words, being hyper, anxious and sleep deprived does not make you smarter. If you think you might be estrogen deficient, it’s a good idea to get a saliva hormone test to find out for sure.”

Here’s what we wrote about HRT and the brain in this newsletter in 2000:

“A few years ago, a very small study showed that estrogen increased “brain excitability” in older women, and this was widely and inaccurately reported by the media as proof that estrogen could help treat Alzheimer’s victims. Suddenly everything we read about estrogen claimed, without qualification, that it was good for Alzheimer’s and/or brain function.

“A recent study done at the University of California at Irvine, and published in the Feb 22, 2000 issue of JAMA (Journal of the American Medical Association) helps debunk the estrogen-Alzheimer’s myth. Researchers studied 120 women with mild to moderate Alzheimer’s. They were either put on “high” estrogen, “low” estrogen, or a placebo every day for a year. The women were given a variety of cognitive tests, and those taking estrogen fared slightly worse than the placebo group in a rating of dementia.

“The researchers concluded that, ‘Overall, the results of this study do not support the role of estrogen in the treatment of Alzheimer’s.’”

Don’t Throw the Baby Out with the Bath Water

The irony of this evidence on hormones and Alzheimer’s is that estrogen and progesterone really can help brain function. I have seen or heard of literally hundreds of cases in the past twenty five years where older women who were cognitively impaired began using progesterone cream and regained their brain function. Progesterone in and of itself is good for the brain, and it also keeps estrogen receptors functioning. I have also heard over and over from estrogen-deficient menopausal women over the decades that their brains work better when they’re using a little estrogen. There are good, solid, physiologic and biochemical reasons for this. So why does conventional HRT do more harm than good?

  • The dose of estrogen is too high. Excess estrogen causes over-excitation of the brain, which damages the brain and causes insomnia and anxiety. Excess estrogen also increases the risk of blood clots. This may not show up as an actual stroke, but can damage tiny blood vessels in the brain, which interferes with brain function.

  • The estrogen is combined with medroxyprogesterone acetate (Provera), a progestin with a long list of nasty side effects, some of which include negative effects on brain function. There is no reason for a menopausal woman to ever take a progestin. Estrogen should always be combined with progesterone.

Thank you for reading this article by Dr. Lee! As this article makes clear, a great way to reduce your risk of developing dementia is to balance your hormones, especially progesterone and estrogen. Sadly, many people have lower than normal levels of progesterone, especially older women who have gone through menopause. This may put them at greater risk for dementia.

This is why we recommend you test your hormone levels regularly to ensure that your reproductive hormones are in in balance. We encourage you to click on the test tube image to learn more about and order one of our hormone tests. If you are unsure about which hormone test to take, take our free Hormone Balance Test to learn more about the hormone imbalances you may have and which of our laboratory tests would be best to take.

If you decide, based on hormone tests and your symptoms, that you need to increase your progesterone levels, an excellent way to do so is by using one of the natural progesterone creams that we recommend. Click on the button below to go to the JohnLeeMD.com Product Shop, where you can purchase our recommended progesterone creams at some of the best prices on the Internet!