Menopausal hormone therapy and dementia: causal link remains uncertain rather than unlikely

The results of our nationwide nested case-control study of menopausal hormone therapy and the risk of dementia1 align with those of the largest randomised, double blind, placebo controlled trial on the topic, the Women’s Health Initiative Memory Study (WHIMS), which reported an increased dementia rate among women aged 65 years or older randomised to menopausal hormone therapy.2 Our study, designed to tackle limitations and biases of previous studies, consistently showed increased dementia rates across different durations and ages of hormone therapy use in a dose-response manner.1By design, our study cannot determine causality, as stated in the linked editorial by Kantarci and Manson.3 Nonetheless, the evidence underlying clinical implications must be valid and solid. Kantarci and Manson cite evidence hampered by substantial limitations that are not discussed.456Kantarci and Manson cite the WHIMS of Younger Women (WHIMS-Y) as reporting no cognitive effects from hormone therapy, except potential verbal fluency impairment.4 WHIMS-Y was,…
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