André G
15, boulevard Ohmacht, 67000 Strasbourg, France.
Gynecol Obstet Fertil Senol. 2021 May;49(5):448-454. doi: 10.1016/j.gofs.2021.03.029. Epub 2021 Mar 20.
The results of the WHI, which reported a doubling of the risk of Alzheimer's disease (AD) and a decline in cognitive function in women who were given menopause hormone therapy (MHT), have raised concerns on the deleterious impact of MHT on the central nervous system. Such as for the cardiovascular system, the very late age of initiation of treatment and the nature of the molecules have led to conclusions that cannot be extended to women in their fifties, at the onset of their menopause which is the usual age of MHT initiation. The molecules, which are used in France, 17-beta estradiol and natural progesterone (or its isomer, dydrogesterone) are very different from the equine conjugated estrogens and medroxyprogesterone acetate used in the WHI. It can now be stated that if MHT is started within the window of opportunity (i.e. before the age of 60 or within the first 10years after the beginning of menopause) no deleterious effect on cognition is observed. Moreover, cognition remains relatively stable at the beginning of menopause since the cognitive reserve as well as the different compensation circuits allow compensation for estrogen deficiency. This does not in any way prejudge a possible positive effect of MHT on AD, which is very difficult to demonstrate, as the age of onset of this dementia is very late, 20 or 30years after the initiation of treatment.
妇女健康倡议（WHI）的研究结果显示，接受绝经激素治疗（MHT）的女性患阿尔茨海默病（AD）的风险翻倍，认知功能下降，这引发了人们对MHT对中枢神经系统有害影响的担忧。与心血管系统的情况类似，治疗开始的年龄非常晚以及所用分子的性质导致得出的结论无法推广到五十多岁、处于绝经初期（这是开始MHT的常见年龄）的女性。法国使用的分子，即17-β雌二醇和天然孕酮（或其异构体，地屈孕酮），与妇女健康倡议中使用的马结合雌激素和醋酸甲羟孕酮有很大不同。现在可以说，如果在时机窗口内（即60岁之前或绝经开始后的头10年内）开始MHT，未观察到对认知有有害影响。此外，在绝经初期认知相对稳定，因为认知储备以及不同的补偿回路能够补偿雌激素缺乏。这绝不是预先判断MHT对AD可能有积极作用，因为这种痴呆的发病年龄很晚，在开始治疗20或30年后，所以很难证明其积极作用。
