How menopause affects the brain — and what we still don’t know
Menopause is a key period in a woman’s life. This transition is often accompanied by extensive physical and psychological symptoms – some of which can be debilitating and affect daily life. Menopause has also been linked to cognitive problems — such as memory, attention and language deficits.
To mitigate the effects of menopause – including hot flashesdepressive symptoms and sleep problems — many women turn to hormone replacement therapy (THS). In England, a estimated 15% of women are prescribed HRT for menopausal symptoms. In Europe, this figure is even higher, varying between 18% in Spain to 55% in France.
In short, we found that menopause was associated with poorer quality sleep, an increase in mental health problems, and even changes within the brain itself.
Postmenopausal women were more likely than premenopausal women to report symptoms of anxiety And depression. They were also more likely to seek help from a GP or psychiatrist and be prescribed antidepressants.
Sleep problems were also more common after menopause. Postmenopausal women reported higher rates of insomnia, shorter sleep duration and increased fatigue.
Brain imaging scans also revealed significant reductions in gray matter volume after menopause. Gray matter is an important component of the central nervous system which is composed mainly of brain cells. These reductions were most pronounced in regions critical to learning and memory (namely the hippocampus and entorhinal cortex) and in areas key to emotional regulation and attention (called the anterior cingulate cortex).
In particular, the seahorse And entorhinal cortex are among the first affected by Alzheimer’s disease, the most common form of dementia.
The changes we observed in our study could suggest that menopause-related brain changes could contribute to increased vulnerability to Alzheimer’s disease later in life. This might help explain why there is a higher prevalence of dementia observed in women.
We also investigated whether taking HRT after menopause had an effect on health outcomes. Notably, HRT did not improve the reduction in brain gray matter.
Additionally, we found that women using HRT had higher levels of anxiety and depression than postmenopausal women who had never used HRT. However, further analyzes indicated that these differences were already present. This suggests that pre-existing mental health problems may have influenced the decision to start using HRT rather than these symptoms being caused by the medication itself.
A potential benefit of HRT use has been observed in cognitive performance, particularly with regard to psychomotor speed. Psychomotor slowing is a distinctive characteristic of aging.
Postmenopausal women who had never used HRT had slower reaction times than premenopausal women and postmenopausal women who had used HRT. This indicates that HRT helps slow the decline in psychomotor speed associated with menopause.
HRT and menopause
There’s still a lot we don’t know about HRT – and more evidence about its benefits and risks is still needed.
Some studies report that people taking HRT have a increased risk of dementiawhile others suggest a reduced risk of dementia.
More research is also needed to understand the effects of HRT and how different routes and dosages affect menopausal symptoms. But according to a UK Biobank study of 538 women, the effects does not seem to differ — regardless of factors such as formulation, route of administration and duration of use.
Most importantly, it is difficult to determine whether women are actually receiving an effective dose. One in four women using the highest permitted dose of HRT still had low levels of estradiol (estrogen) – around 200 picomoles per liter. Older women and HRT patch users were more likely to have lower levels.
Optimal plasma levels to relieve menopausal symptoms are between 220 and 550 picomoles per liter. This means that for 25% of the women in the study, HRT would not have provided optimal benefit for menopausal symptoms.
Since most women are postmenopausal, it is important to determine whether HRT is beneficial, including preventing reduction in brain gray matter volume and reducing the risk of dementia. It will also be important to know the best dose and route of administration.
There is evidence suggesting healthy lifestyle habits can alleviate these changes in brain health related to menopause.
Our work and that of other research groups shows that a number of lifestyle habits can improve brain health, cognition and well-being, thereby reducing the risk of cognitive decline associated with aging and dementia. This includes exercising regularly, participating in cognitively stimulating activities (like learning a new language or playing chess), eating a nutritious diet, and balanced dietbenefit from sufficient, good quality sleep and have strong social connections.
Research also shows that regular physical activity can increase the size of the hippocampuswhich could help alleviate some of the menopause-related reductions seen in this region.
Sleep is also critically important because it supports the consolidation of memories and helps clear toxic byproducts from the brain – processes essential for memory, brain health and immune function.
Having a healthy lifestyle may offer an accessible and effective strategy to promote brain health, cognitive reserve, and stress resilience during and after the menopause transition.
This edited article is republished from The conversation under Creative Commons license. Read the original article.
