HRT and Dementia: The Magic Pill That Isn’t (Yet)

My mum is 89. Back in the mid-70s she had a full hysterectomy and, according to her, that was the end of it - no HRT, nobody offered it and nobody really asked. That’s just how it was for women of her generation, you had the operation and you were sent home to get on with things.

And she doesn’t have dementia. Far from it! I’m fairly sure she has a photographic memory, she remembers absolutely everything - names, dates, birthdays, even old school friends’ birthdays, and every single thing I’ve ever done and forgotten about (thanks Mum).

I love this photo of the three of us - me, my mum and my daughter. Three generations of women, and three very different stories when it comes to menopause. Mum, who had nothing and was told to get on with it. Me, who went through mine without really understanding what was happening, and who now hears every new headline through my work and online research, the women in my support group and the clients I work with. And my daughter, who I’d really like to have something better than either of us did when she reaches that stage herself.

So when I kept seeing the headlines about women on HRT having a lower risk of dementia, it was Mum I thought of straight away. Because on paper she’s pretty much the exact woman this study says might have benefited most from HRT, and she never had a drop of it.

Now I know one woman doesn’t cancel out a study of 183,450 women, I’m not saying it does. But it did send me off to read the research properly, rather than just the headlines, and the word I kept tripping over was “suggests”.

What the HRT and dementia study actually did

The study is from the University of East Anglia and the University of Exeter, and it was published in August 2026. The first thing to know is that it wasn’t a trial. Nobody was given HRT and then watched to see what happened. The researchers went back through data from UK Biobank, which is a huge health database of people who signed up between 2006 and 2010.

The women they looked at were around 60 on average when they joined. They were asked whether they’d ever used HRT, and then the researchers followed them for about 13 years to see who went on to develop dementia.

What they found was that HRT use was linked with around a 10% lower risk of dementia overall, and 16% lower for Alzheimer’s. The link was strongest in women who’d had a surgical menopause, and in women who started HRT somewhere between 46 and 56.

Which is interesting, genuinely. But it’s not proof of anything, and that’s the bit I really want you to take away from this.

“Linked with” doesn’t mean “caused by”

I’ll explain this one with ice cream, because why not. Every summer ice cream sales go up, and every summer so does sunburn. If you plotted them on a graph they’d move together beautifully. But nobody thinks ice cream gives you sunburn - it’s the sunshine causing both.

That’s all an association is. Two things turning up together. It doesn’t tell you whether one causes the other, or whether something else entirely is going on in the background.

So what this study found is that women who’d used HRT were a bit less likely to develop dementia. It did not find that HRT prevents dementia. It might help. It might make no difference whatsoever, and something else about those women might explain the whole thing. We just can’t tell from this type of research - and to be fair to the researchers, they say that themselves and are asking for proper trials to find out.

What the study couldn’t tell us

The biggest one for me is which HRT these women were actually on. The database simply didn’t record it - not the type, not the dose, not whether it was a tablet or a patch or anything else. If these women were around 60 in 2006, they were born in the 1940s, so my mum’s generation near enough, and most of them would have been taking HRT somewhere in the 80s, 90s or early 2000s. That means the older types, tablets, often oestrogen made from pregnant mares’ urine (yes really), alongside synthetic progestogens. The body-identical HRT that most women are offered now, the patches and gels and micronised progesterone, has only really become the normal choice in the last ten years or so. So this study can’t tell us a single thing about today’s HRT, good or bad.

Then there’s the part that didn’t make the headlines at all. For women who had a natural menopause - which is most of us - the link between HRT and dementia wasn’t statistically significant. The effect came mostly from the women who’d had surgery, and they were more likely to have been given oestrogen-only HRT. Which, again, the study couldn’t measure.

They also couldn’t see how these women actually lived. They did account for things like smoking, weight, blood pressure, cholesterol, diabetes, education and income, which is good. But not alcohol, not exercise, not diet, not sleep, not stress. And it was all measured once, right at the start, and never again. Women who chose HRT back then also tended to be better off and more health-aware in the first place, which the researchers acknowledge too.

And then there’s all the other medication. The only other medicines they accounted for were blood pressure and cholesterol tablets. But there are plenty of everyday medications - some bladder treatments, certain antidepressants, antihistamines, sleeping tablets - that other research has linked to dementia risk. Lots of women who weren’t offered HRT back then were given antidepressants or sleeping pills for their symptoms instead. So were the HRT women protected, or were the women they were compared with carrying a different set of risks altogether? Nobody can say.

It’s also worth knowing the real numbers. Around 2 in every 100 women in the study developed dementia, so a 10% difference on that is a small shift. And other studies don’t agree with this one either - the only proper randomised trial, in the US, actually found a higher dementia risk in women over 65 on the older combined HRT, and another big UK study found no link at all.

None of that makes it bad research. It just means the headlines have run a long way ahead of what it actually shows.

So is HRT the magic pill?

Honestly? We don’t know yet. And I don’t think anyone else does either.

Please don’t read this as me being anti-HRT, because I’m really not. I’ve seen it give women their sleep back, their confidence back, sometimes their marriages back and even their lives, and there’s good evidence from proper trials that it helps protect your bones - although even then, it can’t do the job on its own if your diet and movement aren’t there to back it up. For lots of women it’s absolutely the right choice and nobody should feel guilty for taking it.

But I am uneasy about the way it’s being dressed up at the moment. Hot flushes, brain fog, mood, heart health, and now dementia too - every few weeks there seems to be a new headline, and it’s slowly starting to look like the answer to everything about midlife.

The thing is, dementia takes a very long time to develop. The changes in the brain start years before anyone notices anything, often twenty years or more. So the women starting today’s body-identical HRT in their late forties won’t be able to tell us anything about their brains until the 2040s at the earliest. Until then, every study we’ve got is looking at a different generation, on different hormones, living very different lives. My daughter’s generation will be the ones who finally give us those answers - which feels like a lot to ask of them, when they’re the ones who’ll be going through it next.

And that last bit matters so much. Just think how much has changed since our mums went through menopause - what we eat, how much we sit, how badly we sleep, how stressed we are, how long we work for. If lifestyle turns out to be doing a lot of the heavy lifting here, then a pill was never going to be the whole answer.

What really worries me is this. If something gets sold as the magic pill, the boring basics quietly get forgotten. Why bother with the walk or the veg or the earlier night if a patch is going to sort your brain out for you? That’s the bit that keeps me awake at night (and I’ve worked very hard on my sleep, so that’s saying something!).

HRT may well turn out to be part of the answer for some women. It may turn out to be less than we’d hoped. Either way it was never meant to replace the foundations.

What does this mean for you?

If you’re on HRT and it’s helping, this isn’t a reason to stop. If you’re not on it, it’s not a reason to start just for your brain. That’s a conversation for your GP, with your own history in front of them.

And while you’re there, it’s well worth asking for a medication review, especially if you’re on a few different things. Your GP or pharmacist can look at everything together rather than one prescription at a time. Please don’t stop anything on your own though.

What I would say is that the things this study couldn’t measure - what we eat, how we move, how we sleep, how much stress we’re carrying - are the things we can actually do something about. The Lancet Commission on dementia reckons nearly half of dementia cases worldwide are linked to risk factors we could potentially change. That’s where I’d put my energy, whatever you decide about HRT. And it’s exactly what The Foundation Flow™ is built on - nourish, sleep and peace.

Three generations

Mum has always been an active person and even now she is running local dance afternoons, she is still mowing the lawn and scraping the weeds from her paviours.

I’ve no idea exactly why Mum’s brain is still sharper than mine at 89 (and believe me, it’s not a competition I’m winning). But I do know that no headline would ever have predicted her.

When I look at that photo of the three of us, what I really want for my daughter, and for every woman coming up behind her, is research that actually measures the things that matter. Which HRT, at what dose, for how long. How women are really living - what they’re eating, how they’re sleeping, what else they’re taking. Followed properly, over years, so that when she and her friends reach that point and start weighing up their choices, they’re working with real answers rather than “suggests” and “may”.

Women have waited long enough to be studied properly. Our daughters shouldn’t have to wait as long as we did.

And in the meantime, I’ll keep doing what I can - helping women get their foundations right, whatever else they decide to add on top.

So next time you see “study suggests”, take it for exactly what it is - a suggestion, not a proven fact. And then have a little think about what the study didn’t look at. And if you see a media headline check what it’s actually saying and not what your brain can automatically assume it is saying.

If you’d like some help getting your own foundations in place, the Metamorphosis Programme is a lovely place to start: rhustrand.co.uk/metamorphosis-programme. No pressure at all, it’s just there if you want it.

Rhu x

The study: Squires S, Saleh RNM, Pilling LC, et al. Hormone replacement therapy and dementia risk among postmenopausal women: Identifying responsive subgroups in the UK Biobank. Alzheimer’s and Dementia, 2026. - https://doi.org/10.1002/alz.71679