No improvement in cognition with post-menopausal hormones

Menopausal hormone therapy (MHT) given to recently postmenopausal women in the US for up to four years does not improve cognition, but may have some positive benefits for some mood symptoms, according to a study published by Carey Gleason and colleagues from the University of Wisconsin, Madison, USA, in this week's PLOS Medicine.

The researchers reached these conclusions by conducting a randomized placebo-controlled clinical trial (the KEEPS-Cog trial), including 693 recently postmenopausal women living in the US who were randomly assigned to receive either oral estrogen pills and progesterone, or transdermal estradiol patches and progesterone, or placebo pills and patches. Over 4 years of follow-up, the researchers found no beneficial effects of treatment on cognition or on symptoms of clinical depression. However, women treated with oral estrogen pills and progesterone (but not those treated with transdermal estradiol patches and progesterone) showed improvements in some mood symptoms, as measured by the Profile of Mood States instrument, compared to women in the placebo group.

Importantly, these findings provide no information about the effects of MHT beyond 4 years and, because most of the women in the study were white, well-educated and at low risk of cardiovascular disease, may not be applicable to the general postmenopausal population of the US and of other countries. Moreover, because MHT improved menopausal symptoms in the women receiving hormones, the trial was not truly double-blinded. However, despite these and other study limitations, the researchers suggest that their findings could now be used to help women make more informed decisions about whether to use MHT to manage their menopausal symptoms.

The authors say: "Overall, the KEEPS-Cog findings provide valuable information to women considering the various options for managing menopausal symptoms."