Cognitive effects of hormone replacement therapy in menopausal women

master's thesis

• Title (croatian): Kognitivni učinci hormonskog nadomjesnog liječenja u žena u menopauzi
• Author: Žan Kovačič
• Mentor: Jelena Osmanović Barilar (mentor)
• Committee member: Jelena Osmanović Barilar (predsjednik povjerenstva)
• Committee member: Melita Šalković-Petrišić (član povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pharmacology); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Basic Medical Sciences; Pharmacology

Abstract

INTRODUCTION: Hormone replacement therapy (HRT) is prescribed to women for the treatment of postmenopausal symptoms; however, there remains doubt about what kind of influence does it have on cognition. Previous studies, in animal models and observational clinical data, showed that estrogen could have a positive effect on the aging brain; but large clinical trials, such as the Women’s Health Initiative Memory Studies (WHIMS), showed a negative effect on cognition in older women. We aimed to explore possible reasons for such inconsistency, based on the results of the clinical studies classified according to patient age, duration and type of hormone replacement therapy. ----- METHODS: We carried out a literature search for the period between January 1995 to May 2018 in three databases (PubMed, Embase, Cochrane) using the following keywords: progesterone, estrogen, cognition. Inclusion criteria were the following: randomized controlled trial, cognition test(s), no additional pharmacological manipulations, no phytoestrogens/herbal preparations or selective estrogen receptor modulators (SERMs). ----- RESULTS: After application of the inclusion criteria, a total of 34 (35) articles out of 7,086 were included. Regarding the duration of therapy, 3 studies used acute (≤1 month), 18 subacute (1 month - 1 year) and 14 used chronic therapy (≥1 year). Most of the studies, (20/36) showed that HRT had no effect on cognition; whereas, an additional 6 showed positive influence on verbal cognition in younger women (medroxyprogesterone acetate was not the part of HRT). The remaining 9 studies showed a negative effect on cognition (6/9 done in older patients). ----- CONCLUSION: There is evidence of a positive effect with the use of unopposed estrogen or estrogen/micronized progesterone in younger women, with acute and subacute therapy. There is a negative effect on cognition with the use of conjugated equine estrogen/medroxyprogesterone acetate in older postmenopausal women. The great majority of studies included in our research showed that HRT had no effect on cognition. Future studies should focus on the research effect of natural progesterone and estrogen in younger postmenopausal women.

Abstract (croatian)

UVOD: Hormonska nadomjesna terapija (HNT) se prepisuje ženama za liječenje postmenopauzalnih simptoma, međutim utjecaj na kognitivne funkcije i dalje ostaje nejasan. Istraživanja na životinjskim modelima kao i epidemiološke studije ukazuju na pozitivan učinak HNTna kogniciju, ali su velika randomizirana klinička istraživanja poput Women’s Health Initiative Memory Studies (WHIMS) pokazala negativan učinak HNT-a na memoriju kod žena. Cilj ovog rada je da se nađe objašnjenje za navedene razlike , te smo rezultate studija klasificirali prema ishodu studije, starosti uključenih pacijentica i duljini i tipu HNT. ----- METODE: Pretražili smo tri baze podataka (PubMed, Embase, Cochrane), u razdoblju od siječnja 1995. do svibnja 2018., koristeći slijedeće ključne riječi: progesterone, estrogen, kognicija. Uključni kriteriji su bili: randomizirani klinički pokus, postojanje kognitivnih testova. Dok su isključni kriteriji bili: korištenje drugih lijekova, korištenje fitoestrogena/biljnih preparata ili selektivnih modulatorov estrogenskog receptora (SERMs) ----- REZULTATI: Nakon primjene navedenih kriterija ukupno 34 (35) od 7,086 studija su uključene u naš rad. U svezi sa duljinom liječenja, 3 studije su koristile akutnu (≤1 mjesec), 18 subakutnu (1 mjesec – 1 godina) i 14 kroničnu (≥1 godina) hormonsku terapiju. Većina studija (20/36) je pokazala da HNT nema učinak na kogniciju, 6 je pokazalo pozitivan učinak na verbalnu kogniciju u mlađih žena (medroksiprogesteron acetat nije bio dio HNT). Preostalih 9 studija je pokazalo negativan efekat na kogniciju (6/9 studija je bilo u starijih pacijentica). ----- ZAKLJUČAK: Rezultati ovog rada upućuju na pozitivan učinak akutne i subakutne terapije estrogenom ili estrogenom/mikroniziranim progesteronom na kogniciju u mlađih žena. Negativan učinak je zabilježen pri terapiji s konjugiranim estrogenom/medroksiprogesteronom acetatom u starijih postmenopauzalnih žena. Velika većina studija uključenih u istraživanje ipak pokazuju da HNT nema učinka na kogniciju. Buduće studije bi se trebale usredotočiti na istraživanje učinka prirodnog progesterona i estrogena u mlađih postmenopauzalnih žena.

• Keywords: hormone replacement therapy; HRT; postmenopausal symptoms; progesterone; estrogen; cognition
• Keywords (croatian): hormonska nadomjesna terapija; HNT; postmenopauzalni simptomi; progesteron; estrogen; kognicija
• Language: english
• URN:NBN: urn:nbn:hr:105:874295
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Public note: Pohranitelj objekta unio ključne riječi.
• Created on: 2020-07-13 09:45:58