I’m 41, with a significant family history of Alzheimer’s and osteoporosis, and I’ve been reading that the drop in estrogen during perimenopause is a contributing factor for both of those things. Is there a potential protective benefit to going on oral contraceptive pills now and then transitioning to HRT? I try to do all the other lifestyle things (good diet, exercise, etc.) but am wondering if I should be thinking about hormones too.
—Lisa, worried about my bones & brain
One of the things we know for sure about estrogen is that it is good for bones. Estrogen is critical for building bone density during adolescence and through our 20s. And the drop in estrogen during the menopausal transition leads to bone loss. How much bone you lose after menopause is related to a number of factors, including genetics. Whether you develop osteoporosis is related to two factors: your peak bone mass — that is, your bone density at its highest point, typically around age 30 — and how much bone you lose.
The one benefit of hormone replacement therapy reported in the Women’s Health Initiative study was a decreased risk of osteoporosis. Additional studies of hormone replacement have continued to show that estrogen replacement decreases osteoporosis risk.
As for birth control pills, they too seem to improve bone density. That said, in healthy women, bone density prior to menopause is relatively stable. The vast majority of bone loss occurs after menopause. So while it certainly won’t hurt to take a birth control pill during perimenopause, there may not be a large benefit.
When it comes to dementia risk, the data regarding estrogen is less clear. It is really difficult to conduct a randomized controlled trial in which you give women in their 50s estrogen or a placebo and then follow them into old age to see if one group develops dementia in greater numbers.
What we do know is that starting estrogen more than 10 years after menopause seems to increase the risk of dementia. Starting estrogen within the first 10 years after menopause does not increase dementia risk. However, the data does not clearly support the idea that estrogen decreases dementia risk when given within 10 years of menopause.
The takeaway: Estrogen, as hormone replacement therapy and in the form of birth control pills, reduces the risk of osteoporosis, but the data regarding estrogen and dementia risk is less clear.
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