Menopausal Women More Prone to Brain Lesions and HRT Won’t Help, Study Indicates

New neurological study also finds premenopausal women and men have similar lesion rates

Ruth Schuster
Ruth Schuster
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A 3-D digital illustration of the human brain.
A 3-D digital illustration of the human brain.Credit: Rawpixel.com/Shutterstock.com
Ruth Schuster
Ruth Schuster

Hormone replacement therapy is a wonder and a delight for some women, famously easing certain unfortunate phenomena associated with menopause such as hot flashes and newly painful intercourse. But HRT is not a panacea. Apparently it doesn’t help thwart the development of small brain lesions called white matter hyperintensities, which can be harbingers of worse trouble to come and are more common in menopausal women than in men of the same age, or premenopausal women, a new study published Wednesday reports.

The study was published in Neurology, the medical journal of the American Academy of Neurology, by study author Monique Breteler of the German Center of Neurodegenerative Diseases.

These tiny brain lesions can be observed using scanners, and are linked in some studies to elevated risk of developing Alzheimer’s disease, cognitive decline and/or stroke. They are more common with age, and untreated high blood pressure may also play a role in their development, Breteler explains.

To be clear, if a scan finds you have white matter hyperintensities, that does not necessarily mean you will develop dementia or have a stroke. But the more such lesions one has, the greater the risk may be, she says.

Hormone replacement therapy is prescribed to alleviate certain symptoms of the menopause by replacing hormones that diminish as menopause advances, such as night sweats and vaginal dryness. HRT may increase the risk of breast or ovarian cancer, and it is not recommended for women with untreated high blood pressure.

Back to the point: No difference in the incidence of lesions was found between premenopausal women, and postmenopausal women using HRT. The indication is that whatever other benefits it may bring, including possibly restoration of one’s dampened sex drive, hormone therapy is not protecting the postmenopause female brain, Breteler says.

A separate 2019 paper explains that relatively large white matter hyperintensities have been associated with Alzheimer’s and cognitive decline, but the results are inconsistent – possibly because the damage caused by Alzheimer’s may mask separate effects the lesions have on cognition.

So: men and premenopause women have about the same likelihood of the lesions. Postmenopausal women have heightened likelihood and HRT apparently won’t help with that, her work indicates. “Our results imply that white matter hyperintensities evolve differently for men and women,” Breteler notes.

A scan showing small brain lesions, called white matter hyperintensities.Credit: Jmarchn

White matter hyperintensities, aka leukoaraiosis, are thought to be vascular in origin. Research continues on how they are caused and, therefore, how they could potentially be averted. Meanwhile, it is useful to know that HRT is apparently not the answer.

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