Hormone Replacement Therapy and Brain Health | The Truth About HRT and Cognitive Function

Is HRT shrinking your brain?

Let’s uncover the truth about hormone replacement therapy and cognitive health. 

Hormone replacement therapy is really the cornerstone for managing the symptoms of both perimenopause and menopause. HRT can alleviate hot flashes, night sweats, insomnia, and prevent bone loss. Emerging research has shown that there may be some shrinkage of the hippocampus in the brain from using certain types of hormone replacement therapy long term. 

The large study looked at women from the United Kingdom who were current HRT users compared to past users and never users.

An older brain age relative to chronological age was noted in current users, but not past users or never users.

The study is limited in the forms of hormone replacement therapy that were used.

The researchers did acknowledge that hormone replacement therapy is neuroprotective when initiated close to menopause rather than starting later in life. They also noted the difference biochemically between oral hormone replacement therapy and transdermal or vaginal hormone replacement therapy.

Hormone delivery mechanisms affected the brain differently.

When one of my patients became concerned about her own brain health, I went over the study with a fine tooth comb. My conclusion is that the brain age gap seen in the current slightly older hormone replacement therapy users was due to three things. 

1. These women had unhealthier lifestyles leading to neurodegenerative damage. 
   
   
2. These women started hormone replacement therapy later, not in the window of optimal brain recovery at the initiation of menopause. In other words, they probably did already have some early, early signs of cognitive decline. 
   
   
3. The overwhelming majority, used synthetic progestin, not bioidentical progesterone, and conjugated oral estrone, not estradiol. Only 2% of those studied use bioidentical hormone replacement therapy.

Studies show estradiol is protective for your brain.

Estradiol like progesterone is neuroprotective. Estradiol helps stimulate brain growth factor, which helps nerves to rejuvenate. Progesterone helps stimulate myelin sheath production, which protects the neurons like insulation so that the firing of the neurons allows for healthy cognition. 

Large meta-analysis has shown that newer types of HRT seem to decrease the risk of dementia, especially if initiated early in menopause. The use of HRT reduces the risk of diseases that increase the risk of dementia like cardiovascular disease.  

HRT is most protective when initiated early in menopause, during perimenopause, and within the first couple years of going through menopause.

Synthetic progestins have been associated with neurodegenerative disease, as estrogen-only therapy is neuroprotective as compared with estrogen combined with progestin. Synthetic progestin is not the same as bioidentical micronized progesterone. 

Older types of menopausal hormone replacement therapy included the use of conjugated estrogens which are derived from pregnant mare’s urine. Conjugated equine estrones (CEE) are actually waste products so your liver must convert CEE into usable forms for you as a human female, and those forms tend to be inflammatory or carcinogenic, definitely not good for the brain. 

That’s why I prefer for my patients to use bioidentical hormone replacement therapy as it chemically mimics what your ovaries used to make. 

So how can you protect your brain if you choose to use hormone replacement therapy during menopause? 

1. Choose bioidentical hormone replacement. I recommend estradiol in a transdermal or sublingual form and bioidentical micronized progesterone in a transdermal form. I created Gen-Pro™, a bioidentical micronized progesterone, that has a high absorption rate through the skin.
   
   
2. Support your hypothalamus. Taking Genesis Gold® through perimenopause and into postmenopause is by far the most effective way to protect your brain. Your hypothalamus is the controller of your cognition, emotions, and hormone regulation. An unsupported hypothalamus becomes dysfunctional during the hormonal decline of menopause affecting your brain function. Without an optimally functioning hypothalamus, the rejuvenation of nerve cells declines. Your hormones, including adrenal hormones, become imbalanced. You do not produce enough hormonal growth factors to rejuvenate brain tissue as you age. The hypothalamus controls aging, metabolism, and cognition. For those with signs of dementia adding Sacred Seven® amino acids to Genesis Gold® can really boost the healing of the hypothalamus and help to restore brain function.
   
   
3. Adopt a healthy lifestyle. The women who had the smallest brain size for their chronological age had the most unhealthy lifestyles. They were consuming high saturated fat diets with very low plant food intake, mostly processed foods. They consumed higher levels of alcohol, lower amounts of water. They were not nourishing their bodies or their brains. They were sedentary and had very poor sleep habits. 

We know the hypothalamus and the brain respond very well to a plant-based diet. I recommend the Mediterranean diet to provide lots of phytonutrients necessary for your brain to function at its optimal level. The plant-based Mediterranean diet has an anti-inflammatory effect, which helps reduce the inflammation caused by stress, illness and age. 

Regular physical activity is so important. Studies show that exercise can actually help to increase cognition. You want to be exercising daily, at least, walking.  Three days a week doing more aerobic activity, like high-intensity training, and a couple days a week doing weight training. 

Reducing stress is so important. Stress increases cortisol levels. High cortisol over time can damage your neurons and decrease your cognition. Gen-Pro can help protect the brain and reduce your stress, but you need to learn and practice stress-reducing techniques like mindfulness, breathing techniques, and meditation.

4. Exercise your brain. Mental stimulation – learning something new like a language, a new skill, playing games that require mental acuity, like puzzles or card games – can all help to stimulate new neuron growth.

5. Monitor your brain health and cognition. Your healthcare provider can administer a Mini Mental Status exam that can help determine your baseline cognition levels. Your healthcare provider can also keep an eye on your general health as well as significant hormone levels. In my free hormone reboot training, you will find my recommended blood work to determine Hormonal Health. 

Remember, hormone replacement therapy and cognitive decline are not inclusive. Your brain needs estradiol and progesterone. It needs thyroid hormone and growth hormone. It needs your body to be in balance with low levels of inflammation.  So make sure that you are protecting your hypothalamus and brain – nutraceutically, with Genesis Gold® and Sacred Seven®. Using bioidentical hormone replacement therapy like estradiol sublingually or transdermally, and Gen-Pro™ can help to maintain your brain health and cognition through menopause. 

Not all delivery mechanisms are the same. If you have a high risk for breast cancer or other estrogen-related cancers, vaginal estrogen is a safe way to use estradiol or estriol. Transdermal progesterone is also safe for most patients.

When used appropriately bioidentical progesterone and estrogen can support cognitive function and brain health. 

Here’s my expert recommendations for perimenopausal, menopausal, and postmenopausal women:

1. Be sure you’re supporting your hypothalamus. Genesis Gold® four grams for each 50 pounds of body weight, taken daily. If you have any gut issues start with Sacred Seven® amino acids, five grams per day. If you’re already showing signs of cognitive decline, then add Sacred Seven® amino acids to Genesis Gold® for extra hypothalamic and brain support. 
   
   
2. Make sure your hormones are balanced. If you’re symptomatic, you’re not in balance. If you’re in perimenopause or within a few years of entering menopause, starting BioIdentical Hormone Replacement Therapy is most protective for your brain. In perimenopause, I start with Gen-Pro™ during the luteal phase (the two weeks between ovulation and menstruation). Then add bioidentical estradiol, either sublingually or transdermally, according to your symptoms and definitely once you’re menopausal (meaning no more periods and FSH over 30). It is important that you use at least 100 milligrams of micronized progesterone per one milligram of estradiol. Even if you’ve had a hysterectomy, I recommend using progesterone because it helps with nerve regeneration by stimulating myelin sheath growth.
   
   
3. Follow the other four pillars of hypothalamic health. Besides nutraceutical support, follow a plant-based diet. Get regular physical exercise. Be sure you practice good sleep hygiene. Practice stress reduction techniques. please join us in our hormone reboot training for deeper insights on Hormonal Health and cognitive wellness.

My menopausal patients who follow these recommendations notice more mental clarity and better focus. 

Time to take control of your brain health. Let’s find the right balance together.

If you have any questions, please join me in my Hormone Support Group. You can get access by signing up for my free Hormone Reboot Training.

Resources:

https://elifesciences.org/reviewed-preprints/99538v1