Disorders of Neurologic Function, Mental Health, and the Eye

1. Menopausal ERT appears to help preserve certain cognitive skills immediately after induced menopause [B] and during normal aging [C]. 2. Estrogen therapy begun after menopause may reduce risk of Alzheimer’s disease [C]. In contrast, limited data from RCTs indicate that estrogen alone begun after the onset of dementia does not seem to improve Alzheimer symptoms [B]. 3. In observational studies, ERT does not modify stroke risk in older healthy women [C]. 4. For many neurologic disorders (epilepsy, migraine, multiple sclerosis, and Parkinson’s disease), observational study findings do not indicate an overall positive or negative impact of menopause or HRT on neurologic symptoms or disability [C]. Some sleep disturbances that occur during the climacteric may benefit from ERT [C]. 5. Hormonal changes associated with menopause have shown little direct impact on mood [C]. Although clinical implications are uncertain, limited data suggest a beneficial effect of estrogen on mood [B]. 6. There is little evidence that HRT alters risk for age-related maculopathy, cataract, or dry eye [C]. 7. Few clinical characteristics or diagnostic procedures identify subgroups of women particularly likely to benefit from HRT for the prevention or treatment of disorders of neurologic function, mental health, or the eye [D]. Despite a strong biologic rationale, clinical data are sparse. Thus, recommendations regarding HRT to prevent or ameliorate those disorders are limited. Well-characterized benefits and risks of HRT for other organ systems override considerations of potential benefit for the brain and eye [D]. CHAPTER 12: MENOPAUSE AND DISORDERS OF NEUROLOGIC FUNCTION, MENTAL HEALTH, AND THE EYE