estrogens, progestins and dementia in JAMA

"Estrogens" Progestins and Dementia

Synopsis and Overview

This is a short explanation until we can more thoroughly review the minute data of the recent May 28, 2003 JAMA (full pdf) published study. But the reader is referred to our previously detailed discussion of estrogens and heart disease, breast cancer, osteoporosis, endometrial cancer and more. It is the same discussion.

Newer criticisms coming from well respected researchers are finally arising that are not being published in the public press. Please see The Scientist review of August 2003.

Here are the highlights:

The Women's Health Initiative Study (WHI) is a Premarin Provera (PremPro) study -- not an estrogen study. The real study of true bioidentical estrogens and bioidentical progesterone is now possibly doomed.
Relative vs. absolute risk is an issue again. An increase of 20/10,000 to 40/10,000 is a relative double, but in absolute terms, only a 0.2% increase. 2/10 of 1% difference! Real numbers, but an exceptionally small difference.
This study started women aged 65 years and older on hormones. Those well versed in hormonal replacement therapy, know that it is too late to restart hormonal therapy at this age. The study would have had more value with women starting hormonal therapy at age 48-50, just at the crescendo of menopause, not 15 years later when "the memory" of hormonal levels has been lost.
There was a significant fall off in the numbers of participants with each passing year. It would take very complex statistical analysis to determine if the "power" of the study is sufficient in the later years.
Measuring population-based incidence has little relation to prediction. Thus, what is observed in a large population has little relevance to predictive power for any one individual person. A salient point that is lost over and over again in medical studies.

On the second point the study even admits these are very small changes:

"although participants assigned to active therapy were at twice the risk for dementia, the absolute risk is relatively small. ... The increase risk would result in an additional 23 cases of dementia per 10000 women per year. The total number of cases of dementia was small in the WHIMS [ 0.6% ]."

So, let's invert this for clarity. You would be far more re-assured if we stated the observed incidence as: of the study subjects 99.4% did not develop dementia..

Now, please, read our previous discussion and bookmark this page. Return here in a few days.

Then relax! You do not need to make any hasty, ill-thought out decisions. Breathe again ... You have permission to go beyond the sensationalism, media hype and misunderstandings.

Natural hormonal replacement therapy does not stop here...

Philip Lee Miller, MD
Director and Founder, Los Gatos Longevity Institute
author, the Life Extension Revolution