בניגוד לדעות הנפוצות, טיפול הורמונלי תחליפי משולב, אשר מבוסס על מתן אסטרוגן,

((combination hormone replacement therapy [HRT], לא רק שהוא לא מגן כנגד הירידה הקוגניטיבית, אלא עלול להכפיל את הסיכון להתפתחות שיתיון (דמנציה) אצל נשים מבוגרות לאחר תקופת המעבר.

נתונים אלו התקבלו במהלך המחקר Women’s Health Initiative Memory Study ,שהוא מחקר משנה למחקר גדול יותר הנקרא ,Women’s Health Initiative אשר הופסק לפני שלוש שנים בעקבות חשש כי הסיכון שהנשים שנחשפו לאסטרוגן + פרוגסטין ילקו בסרטן השד או בשבץ מוחי, יעלה על יתרונות בירידה בתחלואה באוסטאופורוזיס ובסרטן מעי הגס.

חוקרים אמריקאיים מ- Wake Forest University in Winston-Salem, North Carolina, סיימו את פיענוח הנתונים שהתקבלו מיותר מ 4000 נשים מעל גיל 65, שחולקו, באופן עקראי, לקבוצת של טיפול הורמונלי תחליפי משולב (אסטרוגן + פרוגסטין) ולקבוצת אינבו.

תוך כדי מהלך של בערך 4 שנים, 61 נשים (מהם % 66 האלו שנטלו טיפול הורמונלי תחליפי משולב) פיתחו דמנציה. לפי דעתם של החוקרים, טיפול הורמונלי תחליפי משולב באסטרוגן + פרוגסטין עלול לגרום לכ-23 מקרי דמנציה נוספים ל 10.000 נשים במשך שנה.

במאמר נוסף, אשר פורסם ע”י אותה קבוצת חוקרים מ- Women’s Health Initiative Memory Study , באותו גיליון האחרון של Journal of the American Medical Association, נמצא, שאצל נשים אשר נטלו טיפול הורמונלי תחליפי משולב, הירידה הקוגניטיבית היתה משמעותית יותר מאשר בקבוצת אינבו.

למרות שהסיכון האינדיבידואלי הכוללני היה נמוך יחסי בשתי הקבוצות, ” בגלל נזק אפשרי ותועלת נמוכה”, מצינים החוקרים, “לא מומלץ לנשים מבוגרות לאחר תקופת המעבר ליטול טיפול הורמונלי תחליפי משולב באסטרוגן + פרוגסטין”.

הערת העורך חשיבות מחקר זה (המחקר Women’s Health Initiative Memory Study שהוא מחקר משנה למחקר גדול יותר הנקרא Women’s Health Initiative) הינה קודם כל בהעלת המודעות לסיכון האפשרי שטמון בטיפול הורמונלי תחליפי משולב לנשים מבוגרות לאחר תקופת המעבר ובהעדר תועלת ממשית ממנו באותה קבוצה. גם מטפלים וגם מטופלות חייבים להבין שבשיטה אופינית ומודרנית, ישנם גם יתרונות, אך הם חייבים לדעת ולקחת בחשבון גם חסרונות וסיכונים אמיתיים. שלושת המאמרים האלו נותנים המלצות ברורות וחד משמעיות (וזה נדיר מאוד בספרות המדעית!), כך שאפשר להתבסס בהן במהלך עבודה קלינית וגם לצורך תיכנון וביצוע מחקר עתידי.

מאמרי מקור:

Sally A. Shumaker, Claudine Legault, Stephen R. Rapp, Leon Thal, Robert B. Wallace, Judith K. Ockene, Susan L. Hendrix, Beverly N. Jones, III, Annlouise R. Assaf, Rebecca D. Jackson, Jane Morley Kotchen, Sylvia Wassertheil-Smoller, and Jean Wactawski-Wende ; for the WHIMS Investigators

Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women: The Women’s Health Initiative Memory Study: A Randomized Controlled Trial JAMA. 2003;289:2651-2662

למאמר

Stephen R. Rapp, PhD; Mark A. Espeland, PhD; Sally A. Shumaker, PhD; Victor W. Henderson, MD, MS; Robert L. Brunner, PhD; JoAnn E. Manson, MD, DrPH; Margery L. S. Gass, MD; Marcia L. Stefanick, PhD; Dorothy S. Lane, MD, MPH; Jennifer Hays, PhD; Karen C. Johnson, MD, MPH; Laura H. Coker, PhD; Maggie Dailey, PhD; Deborah Bowen, PhD; for the WHIMS Investigators

Effect of Estrogen Plus Progestin on Global Cognitive Function in Postmenopausal Women The Women’s Health Initiative Memory Study: A Randomized Controlled Trial JAMA. 2003;289:2663-2672.

למאמר

Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women’s Health Initiative: A Randomized Trial

Sylvia Wassertheil-Smoller, Susan Hendrix, Marian Limacher, Gerardo Heiss, Charles Kooperberg, Alison Baird, Theodore Kotchen, J. David Curb, Henry Black, Jacques E. Rossouw, Aaron Aragaki, Monika Safford, Evan Stein, Somchai Laowattana, and W. Jerry Mysiw; for the WHIMS Investigators JAMA. 2003;289:2673-2684.

למאמר

Editorial Kristine Yaffe Hormone Therapy and the Brain: Dj Vu All Over Again? JAMA. 2003;289:2717-2719.

למאמר

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