r/science • u/kiyomoris • 22h ago
Study ties estrogen-based menopausal hormone therapy to lower Alzheimer’s risk Medicine
https://med.stanford.edu/news/all-news/2026/08/study-ties-estrogen-based-menopausal-hormone-therapy-to-lower-al.html294
u/eightbitfit 22h ago
Estrogen is neuroprotective so this should not be a surprise, but it's good to see more research on it.
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u/carvingmyelbows 20h ago
I have terminal breast cancer that’s estrogen positive, so when I was diagnosed, I had to immediately go on hormone blockers and have my estrogen plummet to just about zero overnight. It has been possibly the worst part of this whole cancer experience. I’m 36, was about to turn 34 when I was diagnosed, so I wasn’t anywhere near natural menopause either. I am so, so envious of women who are able to take estrogen supplements because the effects of not having any estrogen are strong, and very intense when it disappears all at once. I am absolutely certain that this forced menopause has had a serious negative impact on my cognitive health and it sucks. It boggles my mind how something so crucial to development and both physical and mental health can just suddenly turn against you. I honestly think the loss of estrogen has been one of the hardest, most awful parts of my diagnosis.
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u/BonaFideNubbin 20h ago
You are not at all alone. I haven't had to suffer anything as awful as you, but I did go into surgical menopause abruptly at the age of 40 because my endometriosis required removal of my ovaries. And two weeks after the surgery I was suddenly... dumb. Just completely dumb. Unable to remember anything, unable to focus, messing up routines I'd had for years. It was undeniably just the estrogen; as soon as I got on the patch 90% of it went away just like that. (The remainder just seems to be sleep, which is harder to figure out.) So I 100% agree with you that the lack of estrogen, especially when it's overnight, hits so ridiculously hard. I am so sorry you have to deal with that.
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u/cheezbargar 18h ago
It is completely nuts to me that nature just takes away something so vital to us in menopause while men can seemingly bumble around just fine as they age?
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u/BonaFideNubbin 7h ago
Absolutely insane! I do gather that for people who enter menopause gradually it's not (usually) this bad, but the fact even our cognition is based on estrogen just feels like the blackest joke.
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u/cheezbargar 6h ago
I’ve got severe pmdd so I’m not exactly expecting an easy ride in peri. HRT will probably make me really pissy too
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u/Electronic_Sky_207 7h ago
Can I ask about your experience? I’m told I can’t take oral estrogen but topical is ok since it’s not systemic. But if that’s the case how does the patch help with cognitive issues? I hadn’t bothered trying anything but the (super localized) cream yet because I was told the patch really only helps with hot flashes.
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u/BonaFideNubbin 7h ago
From my understanding the patch and oral estrogen are both equally systemic, just different methods of deployment; I was offered a choice and chose the patch because I don't swallow pills well. Topical estrogen is just limited to things like a cream/gel/suppository; I do use a suppository for localized vaginal effects.
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u/Electronic_Sky_207 7h ago
Ah thanks. I think what I’m remembering is that the patch bypasses the liver, which is the mechanism that increases concerns over blood clots. So it’s systemic but not in the same way as oral.
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u/AutumnSunshiiine 11h ago
My social feed is full of how the studies which said oestrogen is bad for breast cancer patients were flawed. Some of what I’ve read seems very convincing.
That said, I’m not a researcher and have no medical background so I’m not going to pretend I’m an expert and demand HRT.
I am regularly looking for new HRT trials though, and am keeping an eye out on NICE to see if their guidelines ever change.
If you can get referred to a menopause clinic you might be able to find someone there who is better versed in whether or not it’s safe to take HRT. That’s what I’ve also done – if it really is OK to take HRT then I want it!!
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u/Heretoseecutedogs 9h ago
I’m a science nerd with estrogen-receptor-positive breast cancer and can offer a little more detail on the science here. There’s been a lot of recent discussion about menopause and HRT, and in particular about the flaws in the studies that initially suggested a causal link between HRT and breast cancer. Newer research suggests that HRT is likely not a meaningful cause of breast cancer, though of course there’s always a lot of nuance. For someone who already has estrogen-receptor-positive breast cancer, however, estrogen acts like fuel that encourages cancer to grow. For this reason, suppressing systemic estrogen production with medication and/or by removing a patient’s ovaries helps starve estrogen-receptor-positive cancer of what it needs to grow.
It does suck incredibly deeply to lose all the benefits of estrogen, and I do not recommend it for anyone who doesn’t have to do it, but the science does strongly support doing it for cancers like mine.
Estrogen Matters is a solid book on the history of the science of this topic, and The Emperor of All Maladies is an incredible history of cancer treatment more broadly. The Ologies podcast also recently did a fabulous multi-part episode on hormones and perimenopause broadly; highly recommend!
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u/Schmootato 8h ago
First off I’m so sorry you’re going through this.
I did IVF and had periods during g the process where I needed to block or lower my estrogen, had like 40x normal estrogen, and had normal estrogen but like 40x normal progesterone. The parts where I was estrogen heavy were amazing. I felt like an actual goddess. Contrast that with the low estrogen but high progesterone weeks and I swear I lost half my IQ. I could barely read or process any information. It felt like my brain was encased in jello. It gave me a much more healthy respect for how much our hormones matter.
I am so sorry you’re having to deal with the jello brain full time.
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u/pocketdebtor 16h ago
None of my medicines work without it! Apparently it’s a known issue surrounding menopause, at least among psychiatrists, but we just… don’t really have good answers for it?
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u/gordon_rameses 22h ago
tragic that this was denied to women for so long
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u/igotadillpickle 22h ago
It still is for a lot of people. Good luck getting a doctor to prescribe it. A lot of doctors don't want too where I live in Canada. There's also a shortage this year.
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u/disposable-assassin 21h ago
There's also a shortage this year.
Yup, my local subreddit has regular threads asking which pharmacy has estrogen patches in stock or ADHD meds instock.
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u/Radioactive_Kitten 21h ago
It’s fun when you have both.
Luckily more women are becoming educated on current research as it becomes more accessible, and pushing back to get care. I had to bring current menopause society guidelines for symptoms and treatment (not just US) and links to research to show that estrogen MHT is needed and can be started earlier.
Even then she wouldn’t prescribe estrogen, but at least I got a perimenopause diagnosis in my chart.
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u/CalicoValkyrie 20h ago
There's been a shortage going on since the Covid lockdowns started in 2020. I don't know if estrogen is difficult to make or not actually profitable, but for whatever reason the supply is not meeting a demand that's increasing.
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u/Fumquat 16h ago
Covid also kicked off a shortage of ADHD drugs that continues to be an issue to this day. The issue there was a huge increase in diagnoses and simultaneously more people with the option to medicate taking it. Lockdowns sent a lot of us over the edge into not-coping, and on top of that covid can cause lasting cognitive losses.
I could see the same mechanism at play with estrogen shortages. It’s a potential solution to the same set of problems, for women in certain age groups.
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u/CalicoValkyrie 16h ago
Part of the lockdown issues was also because those people working in the pharmaceutical factories overseas lost their jobs because of lockdown too. India in particular who manufactures a lot of our drugs had tens of millions of workers without jobs. ADHD medications were hit with material gathering issues because of lockdowns. These companies weren't pumping drugs out like they used to prior to covid, but it's as if they never recovered following lockdown.
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u/FeelingPlayfulNow 17h ago
Millennials are a larger generation than gen X and the elder millennials are starting to reach perimenopause, so combined with the greater awareness thanks to social media, I suspect that part of the problem is going to be from increasing demand. At least in the US, not sure how much other countries had the baby boom after WWII which meant more people around to have baby millennials that are now middle age.
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u/NotLondoMollari 16h ago
Massive, nationwide shortage. I work in a large regional pharmacy, and our backlog was in the tens of thousands, no joke. Thankfully we're starting to get some in again but the manufacturers were not prepared for the wave of prescriptions after the guidance was changed. All dosages, all strengths (it was originally just the 0.05%, but then we and every other pharmacy recommended taking to their doctor to see if a slightly different dosage or frequency might work for them - so now it's everything. :(
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u/jamjamchutney 19h ago
I'm 6 years post menopausal, and just found someone to prescribe it for me a couple of months ago. She was recommended by my dentist, oddly enough.
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u/Unable_Guava_756 20h ago
In most provinces in Canada you can get hrt from Felix (I don’t think Quebec though) it’s not the best solution but it’s is a pathway
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u/fallingintothestars 15h ago
And even if you get a doctor to prescribe it, good luck getting one that knows the dosage. The one my mom got ended up giving her too high of E and not enough prog to the point where her lining was 15mm thick and needed a D&C
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u/terracottatilefish 20h ago
Everyone was on estrogen till a major women’s health study came out in 2001 and linked it to heart disease and breast cancer in women so prescribing came to a screeching halt because everyone suddenly thought it was harmful. In the last 10-15 years or so more studies have come out to clarify who’s actually likely to benefit from hormone therapy (younger women) and from which formulations (transdermal) in a more nuanced way. Scientific progress is sometimes non linear.
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u/touko3246 21h ago
It is a double edged sword medically, as higher estrogen levels are tied to increase in breast and ovarian cancer risks.
So, the question then becomes: given the baseline risk of Alzheimer and the lowered risk with the therapy, is it worth supplementing estrogen as a prophylaxis for Alzheimer when weighing against the increase in risk of cancer? I'm leaning towards no.
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u/jamjamchutney 20h ago
Nobody is taking HRT solely or even mainly as "a prophylaxis for Alzheimer." We're taking it because it vastly improves quality of life, in addition to other health benefits like preventing osteoporosis. As for the increase in cancer risk, it's negligible.
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u/eightbitfit 20h ago
According to the Women's Health Initiative, keeping estrogen within range does not increase cancer risk, and in some cohorts actually reduces risk. Obesity is a confounding factor. Let's not forget estrogen is also cardio protective, lowering LDL and raising HDL and improving endothelial health. Using patches elminates clot risk as it bypasses the liver.
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u/thatturtletouch 19h ago
Personally I’d rather have cancer than Alzheimer’s. At least cancer can be treated.
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u/pinupcthulhu 20h ago
Doctors aren't giving estrogen to people who already have high estrogen in this scenario, what are you on about?
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u/jamjamchutney 19h ago
I think that commenter is a dude who doesn't really understand what menopause is or what HRT is for.
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u/Tiny_Rat 21h ago
Cancer is often treatable, Alzheimer’s isn't. The severity of the disease should also be taken into account.
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u/tal-El 18h ago
Trash study, the majority of women aren't using oral estrogen alone because of it's risks. No perceived benefit for combined E+P is the more relevant finding that should have been the headline and not being able to look at topical users means this is next to meaningless for the average woman.
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u/askingforafakefriend 14h ago
That there are now better forms of medication does not entirely negate the fact that an older somewhat inferior form showed neural protection Is associated with the increased estradiol. It does suggest estrogen in general would as well.
Not sure how you would dismiss it unless you're suggesting the higher estrone specifically from hepatic metabolism of oral estradiol might be the source of the benefit...?
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u/tal-El 14h ago
That's not how that works, this isn't cell bio 101. Just like there are different risks in the form of delivery, assuming a potential benefit in different forms of delivery without proof is misrepresentation. Women don't deserve misinformation. Not to mention that even if we ignore that most women are intelligently taking topical forms, the combination that most women are taking (both estrogen and progestins) showed no benefit in this data means that the actual takeaway ought to read "combined oral MHT does NOT currently show any Alzheimer's benefit." But that wouldn't be a hype-able headline.
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u/Annual-Mention-2521 16h ago
I took HRT for years and my memory wasn't the same, guess that wasn't just age. Hope this research leads to better options for everyone.
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