Can HRT help prevent dementia? dr. MARTIN SCURR answers your health questions
Do you think HRT has a role in treating dementia?
It might be a stupid question, but because it’s so helpful in solving menopausal problems like forgetfulness, it occurred to me that scientists have or could go that route in a trial.
Dinah Price, Caerleon, Newport.
This is a fascinating question and in fact it is something that is currently arousing much scientific interest.
With 5 percent of women over 60 and 10 percent of women over 75 showing some signs of dementia, it is also something of significant public health concern.
As you know, menopause leads to a decrease in the hormone estrogen. There is already ample evidence that estrogen is important for mental function.
For example, estrogen increases production of a chemical messenger, acetylcholine, which plays a vital role in the hippocampus — the area of the brain that is key to learning and memory.
As 5% of women over 60 and 10% of women over 75 show some evidence of dementia, it matters whether HRT has a role in treating dementia (stock image)
Estrogen also affects the chemical system of glutamate, which is also important for hippocampal function.
This helps explain why some women complain of ‘brain fog’ and memory problems during menopause.
According to this logic, hormone replacement therapy (HRT) – in particular estrogen replacement therapy – would help protect the cognitive function of postmenopausal women (and reduce the risk of Alzheimer’s disease in particular).
In the 30 years I have been on HRT, my patients who have taken it have reported finding it improved their mental abilities.
But hard scientific evidence for the idea that estrogen supplementation maintains brain function in postmenopausal women has so far been mixed.
For example, a 2016 study conducted by Stanford University in the US found that it did not improve cognitive performance.
In the 30 years I’ve been prescribed HRT, my patients who have taken it have reported feeling it improved their mental abilities, says Dr Martin Scurr (stock image)
But since research shows that regular exercise and a healthy sleep pattern protect brain function – and since we know HRT has both benefits – I think it may have a side effect in terms of preserving brain function.
In other words, protection against dementia would not be a direct result of HRT, but it could be a secondary outcome.
But what about the risks of HRT?
As readers will know, it has a checkered history after major research linked it to a risk of breast cancer and heart problems. However, those findings were later found to be flawed.
Despite this, women who want the treatment often struggle to get it even now, as some doctors are still hesitant about using it.
There is a small increase in breast cancer risk when women use HRT (it decreases once they stop using it), but the fact remains that HRT is an essential part of health care for many women, even with more research being done for its role in brain health is needed.
You recently mentioned that the frequent need to go to the toilet may have to do with the pituitary gland behind the nose.
I have used the toilet very often and have also suffered from mucus behind my nose for a long time. Are they linked?
Mary Sutherland, Bridgend, Perth.
The pituitary gland secretes hormones that play key roles in various functions throughout the body, including urination.
I can see why you think it’s related to your other problem, but even though the pituitary gland is close to the nose, it’s actually part of the brain (ie it’s inside the skull), while the nasal airways are outside the skull located.
But while there’s no connection between your two symptoms, they both obviously worry you, so I suggest you investigate them further.
Both are common problems and in many cases there are steps that can be taken to resolve them.
Frequent toilet visits are often the result of an infection, so the first step is to have your urine tested at your doctor’s office.
Ideally, a fresh sample will then be sent to a lab, although some GPs prefer to perform a simple urine dipstick test every now and then.
One thing they will look for is excess glucose (sugar) in the urine. This is a sign of diabetes, which is a common cause of excessive urination (polyuria).
Frequent need to go to the toilet is often the result of infection, so the first step is to have your urine tested at your GP (stock image)
Your doctor should only send the sample to a lab if there are other abnormalities, such as traces of blood, protein, or pus.
Any of these should be further investigated as they could be a sign of a urinary tract infection or age-related changes in kidney function.
As for your nasal symptoms, the thick mucus is a sign of chronic rhinosinusitis.
This inflammation of the lining of your nose and sinuses can be due to a number of causes, most commonly allergy.
Your dry mouth at night (mentioned in your longer letter) also indicates this, as the congestion can cause you to breathe through your mouth when you sleep.
The best first solution would be to try a nasal rinse.
You can make this yourself at home by adding a small teaspoon of regular table salt and an equal amount of sodium bicarbonate to a pint of chilled, boiled water.
Keep this in the fridge and use it twice a day for a few weeks – lean over a sink, pour some of the solution into the cupped palm of your hand and sniff it several times into each nostril.
Doing so will break the cycle of inflammation and your symptoms should disappear.
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Answers must be taken within a general context and always consult your own doctor with any health issues.
IN MY OPINION…TEST NHS EMPLOYEES NATURAL IMMUNITY
While I firmly believe that everyone involved in healthcare should get the Covid jab – because I trust the science – rather than make it mandatory, as the government has now done, wouldn’t it be better to to check the immunity of those NHS staff who have not decided to have the vaccine already?
Natural immunity is superior to, and lasts longer than, the immunity gained from Covid vaccinations. So why don’t we test those unvaccinated employees for the presence of antibodies?
If they have this proof of immunity they won’t need to be vaccinated – risking losing their jobs and putting further pressure on the NHS.