. 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 May 28;289(20):2651-62. PubMed.

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  1. Reply by Alzforum Editors to Comment by Mikko Laakso

    The election of this paper by Alzforum readers represents an example of where the Milestone status reflects not so much an endorsement of a study, but an acknowledgment that the paper has changed the field in practical terms. In this case, the paper was a setback in the U.S. in that it effectively ended clinical research on HRT and made it more difficult for scientists to obtain funding for clinical, animal, or cell-based research on the effect of various preparations of estrogen or estrogen-like compounds on the aging brain. The Alzforum continues to cover this topic in Live Discussions, news, and commentary. Perhaps this study is more of a “Gravestone” to ongoing research than a true “Milestone.” It did, however, prompt a reorientation toward different compounds and different times of dosing.

  2. I don't understand how this can be a milestone paper. Where is the criticism of the scientific community? This paper is likely to cause great damage among the female population in terms of increased AD in the future. The study setting is questionable. The results only apply to the horse urine estrogen, which seems to have adverse effects not only in AD, but in cardiovascular diseases and stroke. This paper ignores the positive effects of all of the estrogens that are available, which do exert a protective effect against AD (and cardiovascular diseases).

    The message this paper gives is only that the horse urine estrogen should not be used under any conditions. Period. Any conclusions about other estrogen preparations should not be drawn based on this study.

  3. Reply to comment above by Gabrielle Strobel.

    That this paper may well be a gravestone is an apt description. I think this paper and related papers have and will continue to cause untold damage. The WHI studies were designed to address a very specific aim: whether or not the widely used drugs Premarin (pregnant mare urine) and Provera (the synthetic progestin and anti-estrogen) would be beneficial for the heart health of post-postmenopausal women. The studies were a success in discrediting this form of treatment, but it is unfortunate that few have looked beyond the effects of estrogen on the heart. The negative results of the WHI studies should be interpreted within the context of an extensive literature on the biology of the gonadal steroid hormones and their receptors, as well as their mechanisms of action. This has rarely been done.

    Most people, including physicians and journalists, continue to ignore that estrogen and progesterone have beneficial functions for the brain and are not just a source of dementia. The brain is a major target of estradiol and progesterone throughout life. In the brain, estradiol influences higher cognitive functions, mood, pain mechanisms, motor skills, susceptibility to seizures, hot flashes and sleep. As with estradiol, progesterone and its metabolites also protect the brain and have been shown to have sedative, hypnotic, anesthetic, anxiolytic, sleep-modulating, anticonvulsant, antidepressant and antipsychotic effects in animals and humans. In contrast, not only is the synthetic progestin Provera an ineffective neuroprotectant, but it actually antagonizes estrogen-induced neuroprotection and exhibits none of progesterone’s beneficial properties.

    The therapeutic potential of estradiol and progesterone has not yet received a proper scientific evaluation. Too much emphasis has been placed on the negative effects of estrogen on the heart and blood vessels to the exclusion of all other estrogen targets, particularly the brain.