- Menopause, which marks the end of a woman’s reproductive years, may be accompanied by a number of symptoms, including hot flashes, night sweats and mood changes.
- Not every woman experiences adverse effects during menopause but, for many, symptoms can impact quality of life.
- Now, a study has found that people who experience more menopause symptoms are more likely to have poor cognitive function and mild behavior impairments, both potential markers of dementia, as they age.
- The researchers suggest that estrogen-based hormone therapy may help to mitigate these later effects, and perhaps reduce dementia risk.
Menopause, the end of a woman’s reproductive years, occurs around the age of 52 years and is accompanied by a range of physical and mental changes.
These changes, which start in the years leading up to menopause and may continue for some time after the end of the menstrual periods, can cause a range of symptoms, including:
- hot flashes
- sleep disturbances
- vaginal dryness
- mood swings
- weight gain.
Such symptoms do not affect all of those going through menopause but, for others, severe symptoms can impact quality of life.
A new study, led by researchers at the University of Calgary, Canada, has found that people who experience a greater number of symptoms around menopause may have an increased likelihood of experiencing cognitive and behavioral impairments in their later years.
The study, which is published in PLOS One, suggests that these markers of dementia may be mitigated by estrogen-based hormone therapy used to alleviate menopausal symptoms.
Stefania Forner, PhD, Alzheimer’s Association director of medical and scientific relations, who was not involved in this research, commented for Medical News Today that:
“As this is an observational and not a population-based study, and all data is self-reported, generalizations of these findings require caution. And though there may be a connection between Alzheimer’s/ dementia/ cognitive decline and perimenopause and menopause, there is not yet convincing evidence of a direct cause-and-effect relationship; more studies are needed to further understand this relationship.”
The cross-sectional study used data from the ongoing Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) study.
According to Robin Noble, MD, Chief Medical Advisor for Let’s Talk Menopause, who was likewise not involved in this research, “this is an important study, as it looks at symptom burden, though it is limited by the retrospective approach — using recall of severity of symptoms — which the authors certainly acknowledge.”
The 896 respondents in this study were all at postmenopausal stage, with an average age of 64.2 years at the time of the study, and an average age at menopause onset of 49.4 years. A total of 666 reported menopausal symptoms, 166 of whom had used hormone therapy to alleviate those symptoms.
From their responses, researchers assessed how many menopausal symptoms each person had experienced — their burden of menopausal symptoms.
These symptoms included irregular periods, hot flashes, chills, vaginal dryness, weight gain, slowed metabolism, night sweats, sleep problems, mood symptoms, inattention or forgetfulness, and other unnamed symptoms.
The researchers then assessed the participants’ current cognitive and behavioral state using the ECog II, a measure of everyday functioning that can indicate early neurodegenerative disease, and the MBI-C, which detects changes preceding mild cognitive impairment and dementia.
Those who reported a greater burden of menopausal symptoms were significantly more likely to show cognitive symptoms and mild behavioral impairment, both of which may indicate greater risk of dementia.
Previous studies have linked some menopausal symptoms with cognitive issues, but this is the first study to find an association between overall symptom burden and cognitive and behavioral impairment.
The researchers suggest that there is a dose-dependent effect, with a higher total number of symptoms having a greater effect on cognition and behaviour postmenopause than any single menopause symptom.
Somi Javaid, MD, FACOG, OB/GYN and founder of HerMD, not involved in this research, emphasized that this study did not provide sufficient evidence to draw firm conclusions about the cognitive effects of hormone therapy.
“Hormone therapy’s effects on the brain are nuanced. While it provides behavioral benefits, its impact on cognitive function requires more data,” she told MNT.
About a quarter of those who reported menopausal symptoms used hormone therapy to alleviate these. These included estradiol-based therapy, conjugated estrogens, estrogen-progesterone combinations, and estrogen-progestin combinations, progestin alone, and unnamed hormone therapy types.
The study found that those on hormone therapy had lower mild behavioral impairment scores, but there was no significant relationship between hormone therapy and cognitive scores.
However, mild behavioral impairment has been shown to predict dementia risk, with greater levels of impairment linked to greater dementia risk, so hormone therapy could help lessen the likelihood that a person will develop dementia.
Javaid advised that earlier hormone therapy could be beneficial: “We currently understand that hormone therapy is most effective when started in early menopause, as this is when estrogen’s neuroprotective effects are most impactful.”
Experts agreed that time of intervention, whether in the form of hormone therapy, other medical intervention, or lifestyle modifications, could be key to managing a woman’s risk of dementia.
Noble told MNT: “It has been widely accepted that an early menopause increases the risk for dementia, thus it is quite intuitive to consider treatment with hormones for people who experience menopause earlier than average. What is not known is how hormone therapy impacts the risk for dementia for people transitioning into menopause at a normal age.”
And lead author of the study, Zahinoor Ismail, FRCPC, of the University of Calgary, Canada, and the University of Exeter in the United Kingdom, said in a press interview that early interventions, not only hormone therapy but also “managing vascular risk factors, reducing inflammation from Western diet and environmental toxins, optimizing gut health and gut biome diversity, and supporting social interactions,” could help reduce dementia risk.
“As with nearly every condition in women, more data is needed,“ Javaid further pointed out. “However,“ she said, “if we truly want to move the needle in prevention of disease, rather than chasing it, we must identify when intervention is needed. We begin to see these changes in women in the perimenopausal years. This would support early intervention.”
“Women should be educated about the potential impacts of menopause on their brain health and encouraged to seek care that aligns with their unique needs.”
– Somi Javaid, MD, FACOG
