As you age, you may think about protecting your cognitive health and staying mentally sharp for as long as possible. If you're approaching or going through menopause, you’ve likely heard of hormone replacement therapy (HRT) as a way to ease hot flashes, mood swings, and sleep issues. But what about your brain? Can hormone therapy also help prevent dementia?

The short answer is: it's complicated. Research is mixed, with some studies suggesting that HRT may lower the risk of dementia in certain women, while others show it might increase it—especially in those with specific genetic risk factors. At Genesis Lifestyle Medicine, we know how important it is to make informed decisions. Let’s explore the connection between hormone therapy and dementia and how you can protect your cognitive health as you age.

Can hormone therapy help prevent dementia?

There’s no one-size-fits-all answer. Some evidence points to the possibility that hormone therapy—especially when started at the right time—may offer protective benefits for the brain. Other research shows that in certain women, particularly those with genetic predispositions, HRT may actually raise the risk of dementia-related conditions like Alzheimer’s disease.

That’s why your treatment decisions should be as unique as you are. Understanding your personal health history, hormone levels, and even genetic factors is essential to making the right choice—something we prioritize at Genesis Lifestyle Medicine.

Timing of HRT

Hormone therapy might help protect brain function if started early, ideally around menopause. This is known as the “critical window” or “timing hypothesis.” Starting HRT within this window—typically between 50 and 60—may offer cognitive benefits. However, starting HRT later in life (after age 65) has been associated with an increased risk of dementia in some studies.

Genetic factors

Recent research, including a 2025 study from Liverpool John Moores University, found that women with the APOE e4 gene variant—which is present in about 1 in 4 people and associated with higher dementia risk—had significantly higher levels of Alzheimer’s biomarkers if they used HRT. Interestingly, women without this gene variant did not show the same increase in risk.

Type and dosage of hormone therapy

Not all HRT is the same. The type of hormones used (bioidentical vs. synthetic), the method of delivery (patch, pill, cream), and the dosage influence how your body responds. Some evidence suggests that newer, lower-dose formulations may be safer for cognitive health than older, high-dose versions. We specialize in customized HRT options tailored to your unique needs.

Estrogen and brain health

Estrogen is known to affect many brain functions, including memory, learning, and mood regulation. It also helps maintain the connections between neurons and supports blood flow in the brain. A drop in estrogen levels during menopause can lead to brain fog, forgetfulness, and other cognitive changes. Whether or not estrogen replacement prevents long-term decline is still debated, but it's clear that estrogen plays a role in brain function.

One challenge in studying the HRT-dementia link is that menopause can mimic early signs of dementia. Brain fog, memory lapses, and mood changes may be attributed to menopause when they’re actually early dementia—or vice versa. This can make it difficult to accurately assess the effects of HRT. That’s why working with experienced providers is so important.

Tips to mitigate the risk of dementia as you age:

• Stay physically active: Regular exercise—especially aerobic activity like walking, swimming, or cycling—boosts blood flow to the brain and has been linked to a reduced risk of cognitive decline. Aim for at least 150 minutes per week.
  
• Eat a brain-healthy diet: A Mediterranean-style diet rich in fruits, vegetables, whole grains, fish, and healthy fats (like olive oil and nuts) may help protect against dementia. Limit processed foods and sugars, which may increase inflammation.
  
• Prioritize quality sleep: Your brain needs restful, consistent sleep to clean out toxins and consolidate memory. Aim for 7–9 hours each night and treat any sleep disorders, like insomnia or sleep apnea.
  
• Stay mentally and socially engaged: Keeping your mind active with reading, puzzles, or learning new skills can help build cognitive reserve. Maintaining strong social connections also supports brain health and emotional well-being.
  
• Manage chronic conditions: High blood pressure, diabetes, obesity, and high cholesterol can all increase your dementia risk. Work with your provider to keep these conditions under control through lifestyle changes and, when necessary, medication.
  
• Consider genetic testing and personalized care: Knowing whether you carry dementia-related genetic markers like APOE e4 can help you and your provider make more informed decisions about HRT and other preventive strategies.

Your next step toward personalized cognitive wellness

Whether you’re considering hormone therapy for menopause or wondering how to reduce your dementia risk, you deserve care that’s personalized, science-based, and supportive. At Genesis Lifestyle Medicine, we offer comprehensive assessments, hormone therapy options, genetic testing, and brain-healthy lifestyle guidance—all tailored to your individual needs.

Your cognitive health is just as important as your physical and emotional well-being. Schedule a consultation and take control of your aging with the expert support of the Genesis Lifestyle Medicine team.