Menopause and women’s health. Menopause changes the structure, connectivity, and energy consumption of a woman’s brain. Did you know that the menopause transition is associated with shrinkage of the brain’s gray matter (where we find nerve cells) and the white matter (where we find the fibers that connect nerve cells)? Moreover, sugar levels decline in areas associated with memory and perception.
So what’s the good news? The brains of women compensate, at least partially, for these declines: Women experience an increase in blood flow. They also make more ATP, a molecule that serves a the primary energy source for cells.
Today, we look at what researchers from Weill Cornell (New York City) and the University of Arizona (USA) discovered about the brain and menopause transition. First, let’s review some basics.
Menopause and memory declines
If you have been through menopause, have you ever had challenges recalling items on a grocery list? Struggled with the name of someone you encounter only occasionally? A 2013 study followed over 2,300 women for four years. Here are the findings:
When premenopausal, the women did well on repeated tests of processing speed, verbal memory, and working memory. As their estrogen dipped during perimenopause, they did not learn as well. After menopause (or with estrogen supplements before their last period), the scores rose.
What is causing these cognitive changes? Could it be evolving levels of blood levels of hormones such as estrogen? A review of published studies including at least 100 women is illustrative. The researchers report no consistent associations between blood levels of estrogen and episodic memory or executive functions in naturally menopausal midlife women or women 65 years of age or older.
Unfortunately, the results are tempered by imprecise estimates of long-term estrogen exposure, a relatively narrow range of psychological testing, and the small number of studies included.
What about hormone replacement therapy and dementia risk?
You may wonder whether estrogen can preserve overall cognitive function for those without dementia. The Women’s Health Initiative Memory Study looked at a subgroup of women who participated in the landmark Women’s Health Initiative study. The study had two arms for postmenopausal women: 1) estrogen plus progesterone versus a placebo, or 2) estrogen alone (for women who had had their uterus removed) versus a placebo.
The scientists then looked at the effects of hormone replacement therapy on dementia and mild cognitive impairment. The study included only women at least 65 years old. Here are the conclusions:
Hormone replacement therapy (HRT) does not protect against dementia or cognitive decline but substantially increases the risk of dementia of any cause and cognitive decline.
But what about hormone replacement just before menopause or immediately after it? Can we generalize the results from older individuals? Unfortunately, this vital question remains unanswered. We have little data to guide us for younger postmenopausal women.
So, Dr. Hunter, you may ask, what is the good news to which you alluded? I began today’s piece by mentioning that the menopause transition is associated with shrinkage of the brain’s gray and white matter.
Estrogen appears to protect the female brain from aging and may reduce the buildup of plaques associated with Alzheimer’s disease. Hormones fluctuate and decline during menopause and perimenopause — the approximately four to ten years leading up to a woman’s final period. During this time, my patients often report hot flashes, night sweats, challenges with sleep, brain fog, memory issues, and more.
Please go here to learn more about menopause and women’s health:
Related posts:
