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Effects of hormone therapy on brain structure: A randomized controlled trial
Kejal Kantarci1, Nirubol Tosakulwong2, Timothy G Lesnick2
1From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison. kantarci.kejal@mayo.edu.
Hormone therapy with oral conjugated equine estrogens (CEE) increased brain ventricular volume in postmenopausal women, but did not affect cognitive function. Further research is needed due to small sample size and limited follow-up.
Area of Science:
- Neuroscience
- Endocrinology
- Radiology
Background:
- Menopause is associated with changes in brain structure and function.
- Hormone therapy is a common treatment for menopausal symptoms.
- The effects of different hormone therapy formulations on the brain are not fully understood.
Purpose of the Study:
- To investigate the effects of oral conjugated equine estrogens (CEE) and transdermal 17β-estradiol on brain structure and cognitive function in recently postmenopausal women.
- To compare the effects of CEE and 17β-estradiol with placebo.
Main Methods:
- Randomized, double-blinded, placebo-controlled trial (Kronos Early Estrogen Prevention Study).
- Participants (n=95) received CEE, 17β-estradiol, or placebo for 48 months.
- MRI and cognitive testing were performed at baseline and at 18, 36, and 48 months.
Main Results:
- Ventricular volumes increased significantly more in the CEE group compared to placebo (p=0.01).
- Ventricular expansion correlated with decreased brain volume and increased white matter hyperintensity volume.
- No significant differences in brain structure or global cognitive function were observed between CEE and 17β-estradiol groups.
Conclusions:
- Oral CEE increased brain ventricular volume in recently menopausal women compared to placebo.
- Hormone therapy did not significantly alter global cognitive function in this study.
- Findings require confirmation due to small sample size and limited follow-up duration.
