Women have a higher overall risk and prevalence of Alzheimer’s disease and certain other forms of dementia, partly because they tend to live longer than men and because of changes in estrogen levels after menopause.A new study by researchers from the University of East Anglia (UEA) and the University of Exeter suggests that hormone replacement therapy (HRT) may be associated with a lower risk of dementia in some women.“Dementia affects millions of people worldwide, with women making up almost two-thirds of Alzheimer’s disease cases, the main form of dementia. As populations age, understanding how sex-specific factors influence dementia risk is increasingly important,” said Prof Anne-Marie Minihane from UEA’s Norwich Medical School, who led the study.HRT Linked To Lower Alzheimer’s RiskThe study, published in the journal Alzheimer’s & Dementia, analyzed health data from more than 180,000 postmenopausal women in the UK.The findings showed:16% lower risk of Alzheimer’s disease among women who had used HRT compared with those who had never used it.10% lower risk of dementia overall was associated with HRT use.26% lower risk of any dementia among women who had undergone surgical menopause and used HRT.16% lower risk of any dementia among women with lower lifetime estrogen exposure due to later menstruation or earlier menopause.Which Groups Benefited More From HRT?The association between HRT use and lower dementia risk was stronger in certain groups. These include:Women who underwent surgical menopause: Those who used HRT had a 26% lower risk of dementia compared with non-users.Women with lower lifetime estrogen exposure: Those who started menstruating later or experienced menopause earlier had a 16% lower risk of dementia with HRT use.APOE4 carriers: The association between HRT use and lower dementia risk was stronger among women carrying the APOE4 gene variant, a known risk factor for Alzheimer’s disease.Women who started HRT between ages 46 and 56: This group experienced the greatest reduction in dementia risk.Timing may matter: The findings support the “critical window” hypothesis, suggesting HRT may offer greater benefits when started closer to the menopausal transition rather than later in life.Could HRT Support Personalized Care?The researchers said the findings add to growing evidence that the effects of hormone therapy on brain health are complex and may vary between women.“While HRT has long been prescribed primarily to relieve menopausal symptoms such as hot flushes and night sweats, this work suggests it may also play a role in long-term cognitive health for some women,” Prof Minihane said.The latest findings build on previous research from UEA, which found that HRT use was associated with better memory, cognition and larger brain volumes later in life among women carrying the APOE4 variant.The team said the findings could help support more personalized approaches to HRT prescribing, taking into account factors such as menopause type, genetic risk, lifetime hormone exposure and age at HRT initiation.Prof David Llewellyn of the University of Exeter Medical School said the findings help identify which women may be more likely to benefit from HRT and when treatment may have the greatest effect.