使用激素替代疗法（HRT）能否保护女性的大脑健康并预防痴呆症？这一争议仍在继续。多项研究考察了绝经和激素治疗对大脑以及痴呆症风险的影响。
Will using hormone replacement therapy (HRT) preserve a woman’s brain health and protect her from dementia or not? The debate continues. Various studies have looked at the effects of menopause and hormone treatment on the brain – and dementia risk.
有些研究认为，HRT对老年女性的大脑健康没有影响，作用是中性的；另一些研究则认为，它会增加痴呆症风险。
Some have suggested that HRT has no impact on brain health in older women, and that it has a neutral effect, while others have suggested that it increases dementia risk.
但较新的研究显示，使用激素治疗与痴呆症风险降低存在正相关性。女性采用何种激素治疗，以及在绝经过程中的何时开始使用，似乎都会影响结果。
But newer research shows a positive correlation between the use of hormone therapy and a lowered risk of dementia. What type of hormone therapy a woman uses and when she is introduced to it along her menopause journey seem to make a difference.
近期的研究之一来自美国斯坦福大学。该研究发现，50岁以上接受单纯雌激素激素治疗的女性，在死后脑部分析中呈现阿尔茨海默病病理改变的可能性低35%。
Among the recent studies is one from Stanford University, in the United States, which found that women over 50 who used oestrogen-only hormone therapy had 35 per cent lower odds of exhibiting Alzheimer’s pathology when their brains were analysed postmortem.
《阿尔茨海默病与痴呆症》于2026年8月发表的一项研究对英国超过18万名绝经后女性进行了分析，结果发现，服用HRT——在美国也称为绝经期激素治疗（MHT）或激素治疗（HT）——的女性，罹患任何类型痴呆症的风险低10%，被诊断为阿尔茨海默病的可能性也低16%。
A study published in Alzheimer’s & Dementia in August 2026 examined more than 180,000 postmenopausal women in the UK and found that those taking HRT – also known in the US as menopause hormone therapy (MHT) or hormone therapy (HT) – had a 10 per cent lower risk of developing any type of dementia and were 16 per cent less likely to be diagnosed with Alzheimer’s.
《美国医学会杂志》（JAMA）于2026年发表的另一项研究发现，绝经发生得越早，女性日后出现认知衰退的可能性就越大。这也包括接受过“手术绝经”的女性，即切除卵巢（卵巢切除术，通常同时进行子宫切除术），这种手术常用于治疗生殖系统癌症。
Another 2026 study published in The Journal of the American Medical Association (Jama) found that the earlier menopause set in, the more likely women were to experience cognitive decline later in life. This included women who had undergone “surgical menopause” – the removal of the ovaries (an oophorectomy, frequently accompanied by a hysterectomy), often performed to treat reproductive cancers.
这些女性更有可能表现出白质高信号更快的累积——这些在脑部核磁共振成像上可见的小型、类似中风的病灶，是组织损伤的信号。研究人员认为，围绝经期和绝经期间频繁出现的潮热，可能是这种潜在血管应激的关键生物标志物。
These women were also more likely to show faster accumulation of white matter hyperintensities – small, stroke-like lesions visible on brain MRIs that signal tissue damage. Researchers suggest frequent hot flushes during perimenopause and menopause may serve as a key biomarker for this underlying vascular stress.
雌激素通过支持健康的血管功能和调节大脑葡萄糖代谢，帮助抵御此类损伤。由于大脑是人体能量需求最高的器官——尽管仅占体重的2%，却消耗了约20%的血液葡萄糖——雌激素水平的下降直接损害了其主要的能量来源。
Oestrogen helps guard against such damage by supporting healthy blood vessel function and regulating brain glucose. Because the brain is the body’s most energy-demanding organ – consuming roughly 20 per cent of its blood glucose despite accounting for just 2 per cent of body weight – oestrogen’s drop directly compromises its primary fuel source.
这就是为什么研究人员认为，如果在最佳时间窗口内开始，激素疗法可能具有保护大脑的作用。然而，具体的配方与时间同样重要：仅含雌激素——仅对已接受子宫切除术的女性安全。其风险较低，且与大脑健康益处之间的关联最为显著。
This is why researchers view hormone therapy as potentially brain-protective – if started during an optimal window. However, the exact formulation matters as much as the timing: Oestrogen-only – safe only for women who have had a hysterectomy. It carries lower risks and shows the strongest link to brain health benefits.
联合疗法（雌激素+孕激素）——对于有子宫的女性是必需的，以防止子宫内膜癌。
Combined therapy (oestrogen + progestin) – required for women with a uterus to prevent endometrial cancer.
生物同质性激素替代疗法——经皮雌激素（贴片或凝胶）结合天然孕酮，模拟人体自然激素，比旧式合成口服药片具有更安全的特征。
Body-identical HRT – transdermal oestrogen (patches or gels) combined with natural progesterone mirrors the body’s natural hormones, offering a safer profile than older synthetic oral pills.
那些早期经历手术绝经并立即开始激素疗法的女性，从更为显著的效果中受益。该群体的痴呆风险降低了26%。此外，在较年轻年龄（46至56岁之间）开始激素替代疗法的女性，比晚年才开始治疗的女性，患痴呆的风险更低。
Those who had a surgical menopause early and were introduced to hormone therapy immediately afterwards benefited from even more profound effects. The risk of dementia in this group fell by 26 per cent. And women who started HRT at younger ages – between 46 and 56 years old – had a lower risk of developing dementia than those who started treatment later in life.
许多人，包括女性在内，往往没有意识到绝经是一个由大脑主导的过渡过程，这也是它影响身体几乎每个系统的原因；雌激素受体广泛存在于女性生殖器官之外——包括心脏、血管、骨骼、肠道、皮肤和大脑。
Many people, women included, often don’t appreciate that menopause is a brain-driven transition, which is why it affects nearly every system in the body; oestrogen receptors are found far beyond a woman’s reproductive organs – in her heart, blood vessels, bones, gut, skin and brain.
雌激素的功能就像一把钥匙，插入这些受体“锁孔”中，开启或关闭身体机能。
Oestrogen functions like a key that fits into these receptor “locks”, switching bodily functions on or off.
围绝经期雌激素水平下降可引发多达40种症状，约80%的女性会受到影响。有些症状广为人知，如阴道干涩和性欲减退。还有一些则不那么为人所知：心悸、冻结肩、干眼症和持续性潮热。
Up to 40 symptoms can result from oestrogen declines during menopause, with symptoms affecting roughly 80 per cent of women. Some are widely recognised, such as vaginal dryness and loss of libido. Others are less expected: heart palpitations, frozen shoulder, dry eyes and persistent hot flushes.
这些潮热不仅让人不适，还会扰乱睡眠，进而可能导致抑郁——而抑郁本身就是痴呆症的一个重要风险因素。值得注意的是，女性一生中患抑郁症和阿尔茨海默病的风险大约是男性的两倍，研究人员仍在努力全面解释这种关联。
These hot flushes are not just uncomfortable; they also disrupt sleep, which can contribute to depression – itself a significant dementia risk factor. Notably, women face roughly twice the lifetime risk of both depression and Alzheimer’s disease compared with men, a correlation researchers are still working to fully explain.
苏珊·贾米森医生是一位整合医学医生，1994年在香港创办了一家开创性的女性健康诊所，多年来一直以生物同质激素替代疗法（HRT）帮助女性度过更年期。她表示，围绝经期到更年期的过渡期被认为是神经功能的关键时期，这可能有助于解释为何患痴呆症的女性远多于男性。
Dr Susan Jamieson is an integrative medical doctor who set up a pioneering well-woman clinic in Hong Kong in 1994 and has been supporting women through menopause with bioidentical HRT for years. She says the perimenopause to menopause transition is considered a critical period in its neurological function, and may help to explain why so many more women than men suffer from dementia.
她说，大脑不是静态的。它会“根据不同激素水平发生变化”——特别是雌激素。
The brain is not static, she says. It changes “in response to different amounts of hormones” – in particular, oestrogen.
贾米森解释说，大脑在经历围绝经期和更年期的过渡时会经历一场生物学危机。它对下降的雌激素水平极度敏感，因此需要重新编程并改变其化学行为。
Jamieson explains that the brain undergoes a biological crisis during transition through perimenopause and menopause. It is supersensitive to the falling oestrogen levels, so it needs to reprogramme itself and alter its chemical behaviour.
实际上，雌激素的大幅下降会在大脑中引发类似炎症反应的现象，这会促使其代谢过程发生转变，进而导致包括潮热在内的诸多症状。
In effect, the substantial oestrogen decline triggers something like an inflammatory response in the brain, which prompts a shift in its metabolic processes, which in turn leads to the many symptoms, including those hot flushes.
2002年发表的“女性健康倡议”研究被广泛认为是导致HRT（激素替代疗法）研究和实践倒退的罪魁祸首。该研究的结论被笼统地套用到所有女性身上，而未考虑参与者的年龄——其中许多人绝经已逾十年——或所用疗法的具体类型。
The Women’s Health Initiative study published in 2002 is widely blamed for setting back HRT research and practice. Its findings were applied broadly to all women, rather than accounting for the age of the participants – many of whom were a decade past menopause – or the specific type of therapy used.
结果，许多女性多年错失了一种治疗机会。英国阿尔茨海默症研究协会研究项目经理汤姆·布莱克莫尔博士表示，这种疗法“仍然是控制更年期症状的重要选择，并可能显著改善许多人的生活质量”。
As a result, many women missed out for years on a treatment that “remains an important option for managing menopausal symptoms and may significantly improve quality of life for many people”, according to Dr Tom Blackmore, research programmes manager at Alzheimer’s Research UK.
归根结底，女性的生活质量才是问题的核心：她的感受应当决定女性在更年期过渡期间是否使用激素。布莱克莫尔强调，HRT既非灵丹妙药，也非洪水猛兽，不应将其描述为预防痴呆的“保险盾”，也不应让女性“谈激素色变”。
Ultimately, it is a woman’s quality of life that is the crux of the matter: how she feels is what should determine whether a woman uses hormones during the transition to menopause. HRT is neither a panacea nor a poison, Blackmore stresses, and should not be presented as a guaranteed shield against dementia “or something women should fear”.
相反，它是一种旨在缓解更年期最棘手症状的治疗，有可能帮助女性改善睡眠、保持社交参与、避免抑郁，或通过减轻关节疼痛维持身体活动。这些结果与《柳叶刀》刊发的研究中确定的痴呆预防可改变风险因素高度吻合。
Rather, it is a treatment designed to ease some of menopause’s most disruptive symptoms, potentially helping women sleep better, stay socially engaged, avoid depression, or remain physically active through reduced joint pain. These outcomes align closely with modifiable risk factors for dementia prevention identified in research in the journal The Lancet.
正如斯坦福大学研究的作者之一珍妮弗·布鲁诺所言：“最重要的信息是，女性痴呆风险有许多促成因素，激素疗法只是我们仍在努力理解的更大图景中的一小块拼图。”安西娅·罗文 撰稿
As Jennifer Bruno, one of the authors of the Stanford study, puts it: “The most important message is that dementia risk in women has many contributing factors, and hormone therapy is just one piece of a much larger picture that we’re still working to understand.”