Hormonal Contraceptives and Alzheimer's Disease

Hormonal contraceptives are commonly prescribed in this day and age of medicine. Despite that, many of the long-term effects on the body are not understood. Researchers at University of Wisconsin- Madison conducted a study on the effects of hormonal contraceptives on cognition later in life. In this study, they compared how two groups of women, one who had never taken hormonal contraceptives (which they called “never users”) and another who had at some point taken hormonal contraceptives (which they called “ever users”), performed on cognitive tests of different types. These tests aimed to assess performance in 5 domains: Verbal Ability, Visuo-Spatial Ability, Working Memory, Verbal Learning & Memory, and Speed & Flexibility. In addition to looking at the effect of exposure to hormonal contraceptives, they sought to determine if the duration of exposure itself had an impact on cognition.  Ultimately, they found that even brief use of hormonal contraceptives can help protect cognition, with even more impactful protective effects the longer a person used them.  

Between the groups of never and ever users, they found that those who had used hormonal contraceptives for any duration of time scored higher in tests of Speed & Flexibility and Visuo-Spatial Ability, as opposed to those who had never used hormonal contraceptives. This finding aligns with other research that has shown that Speed & Flexibility seems to improve with higher levels of estrogen, contained in hormonal contraceptives. However, the researchers were surprised that use of hormonal contraceptives also increased scores in Visuo-Spatial Ability. Research has shown that this cognitive domain seems to be responsive to androgens, like testosterone, a hormone present in lower levels in women compared to men. However, it’s possible that the progesterone (a precursor steroid that is converted into several hormones, including both estrogen and testosterone) in some contraceptives is responsible for this effect on Visuo-Spatial Ability.  

Knowing that hormonal contraceptives might protect against dementia brings us closer to finding ways to help decrease the incidence of Alzheimer’s Disease. Additionally, it provides a way to help decrease the disparity between Black and white women when it comes to AD prevalence, according to a paper written by Georgia State University researchers, who found that rates of hormonal contraceptive use are lowest among Black women compared to women from other racial backgrounds. With Black women disproportionately affected by Alzheimer's Disease, addressing this difference in use of hormonal contraception use may be one way to help Black women benefit from its protective effects on cognition. Overall, findings from both studies suggest that hormonal contraceptives might play a role in protecting against cognitive decline and may further inform the mechanisms behind the development of the disease as a whole. 

Article of Interest:

Egan KR, Gleason CE. Longer duration of hormonal contraceptive use predicts better cognitive outcomes later in life. J Womens Health (Larchmt). 2012;21(12):1259-1266. doi:10.1089/jwh.2012.3522

Georgia State University Article:

Misiura MB, Butts B, Hammerschlag B, Munkombwe C, Bird A, Fyffe M, Hemphill A, Dotson VM, Wharton W. Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease. Neurotherapeutics. 2023 Jul;20(4):1019-1036. doi: 10.1007/s13311-023-01408-x. Epub 2023 Jul 25. PMID: 37490246; PMCID: PMC10457280.