While death rates from cancer, heart disease and stroke continue to decrease, deaths related to Alzheimer’s Disease increased 38% from 2000-2010. This is an alarming statistic.
Alzheimer’s also adversely affects more women than men, with 68% of people with Alzheimer’s being women. However, there is hope. Recent research has demonstrated that estradiol can decrease a woman’s risk for developing Alzheimer’s and other forms of dementia.
Estradiol is the bio-identical form of estrogen that is most dominant during the reproductive years. When women enter menopause, estradiol levels decrease fairly rapidly to only 10% of the premenopausal level. Estradiol becomes so low in menopause that it is even lower than that of the average male. The dramatic change in hormone levels is what triggers many menopausal symptoms like hot flashes, night sweats, sleep abnormalities, mood changes, and memory difficulties. For many years, hormone replacement therapy has been used to treat these symptoms. Now we know that the natural, bio-identical hormone estradiol can do even more.
Studies have shown that estradiol increases brain-derived neurotropic factor, which helps neurons (nerve cells in the brain) regenerate and grow. Estradiol can help repair neuronal injury, and prevents the hippocampus from shrinking, an area of the brain responsible for memory. When someone has Alzheimer’s, they develop plaques in the brain made of beta amyloid protein. Estradiol can reduce levels of beta amyoid protein and improve its clearance from the brain. It can also decrease inflammation triggered by beta amyloid. In Alzheimer’s, the combination of beta amyloid and inflammation is most harmful.
It is important to note that the benefits seen with estradiol are only seen with natural estradiol. These positive benefits are not seen with synthetic estrogens. Whereas natural estradiol can lower inflammation, synthetic estrogens (like those found in Premarin®) increase inflammation and blood clots. The route that estradiol is taken is also important. Transdermal (in patches and creams) and subcutaneous (in pellets) estradiol have better results than oral estradiol. Oral estradiol does not lower inflammation.
Women who take estradiol should balance its effects with progesterone. Like estradiol, it is important to take the natural form of progesterone, not a synthetic. Synthetic progestins have a negative effect on the brain and can reverse the numerous benefits of estradiol. Natural progesterone can also help protect the brain. In addition, natural progesterone can protect against breast cancer, improve sleep, lower anxiety, lower blood pressure, and lower cholesterol.
Women who have a family history of Alzheimer’s, carry the APOE4 gene, have a history of major depression, or have early menopause are at greatest risk for cognitive decline. These women benefit most by starting bio-identical hormone replacement early, within 5 years of entering menopause. Women can sometimes be hesitant to start hormone replacement if they have heard things in the news about breast cancer and heart disease associated with hormone therapy. It is important to note that increased risks of breast cancer or heart disease have only been seen with synthetic hormones. Natural, bio-identical hormone replacement therapy, on the other hand, has the potential to decrease overall mortality and improve longevity. It is important to see a provider trained in this type of hormone replacement therapy to get the best results.
Martha E. Wittenberg, MD, MPH
Doctors at the Institute for Progressive Medicine are leaders in their field, providing safe and natural hormone replacement therapy for over two decades. Multiple delivery systems are available as each patient is different.