Does menopause increase our risk of dementia?

Does menopause increase our risk of dementia? There’s little point living longer if we can’t enjoy life to the full. Sadly, the odds don’t stack in our favour. Women have a one in five chance of falling prey to Alzheimer’s after the age of 45, while men of the same age have a one in ten chance.

In The XX Brain, neuroscientist Dr Lisa Mosconi makes the case that “women’s brain health is one of the most under-represented and unspoken concerns” in the medical landscape. “Far more than our breasts and tubes,” she writes, “our brains are under the greatest threat.”

Women over 60 are twice as likely to develop Alzheimer’s when compared to men. A staggering two in three of people with Alzheimer’s are female.

It’s not just dementia that’s afflicting female brains. Women are twice as likely to experience anxiety and depression, four times more likely than men to suffer with migraines and headaches, and also more likely to develop the most common types of brain tumour. Similarly, strokes kill more women than men.

So, why such a discrepancy? Is it simply because women are living longer?

Menopause and dementia

Researchers have long known that Alzheimer’s takes hold in the brain many years before any symptoms begin to emerge. If the disease starts in midlife, Dr Mosconi argues, we cannot say that these skewed statistics are a result of women living longer. Rather, the increased risk of Alzheimer’s is more likely to have something to do with the unique hormonal change that all women experience at this time – the menopause.

During the menopause our ovaries gradually stop producing estrogen. This decline results in a number of neurological symptoms, from anxiety to depression, mood swings, irritability, brain-fog and forgetfulness. The loss of estrogen slows the brain’s ability to metabolise sugars needed for fuel by up to 25%. Many women report feeling slower than they used to. Some find their brains so changed that they have to leave the workplace.

These changes take place because estrogen plays a protective role in our bodies. As levels decline, we lose this protection and the ageing process begins to accelerate. We may notice this in our skin and hair first, but soon joints become achy and bones become increasingly frail.

What the science says

Without estrogen, a similar process is happening in the brain. In fact, the earlier we lose this hormonal protection, the more pronounced the risk of cognitive decline. A study of 6,000 women has shown that an early menopause (before the age of 47) results in a 19% increased relative risk of dementia when compared with women who go through the menopause after the age of 47. This is why GPs are recommended to routinely prescribe hormone replacement therapy (HRT) in what the National Institute for Health and Care Excellence (NICE) call the “cognitive window of opportunity.” The science is clear that, if women want to enjoy the benefits of HRT (protecting some and heart health as well as brain health), they shouldn’t delay. The earlier women begin topping up their estrogen, the greater the protective benefits.

An analysis of over 18 studies has shown that in women aged 50-59, those who took hormones had a 30-44% reduced risk of Alzheimer’s when compared with those who do not take hormones. Food, exercise and getting enough sleep are all really important strategies for looking after our brain health, but these can’t replace hormones once they’re gone. If we don’t integrate hormone health into our strategies for looking after our long-term brain health, we’re missing a vital piece in the puzzle.

What about testosterone?

Far from a male hormone, women produce three times more testosterone than estrogen. We rely on it to keep our brain’s sharp and our bones strong. Despite this, however, it’s notable absent from most HRT during the menopause.

Testosterone receptors can be found in the brain (as well as our muscles, heart, bladder and skin, to name a few) and if our levels of this hormone are low we might notice a reduced ability to concentrate, that we’ve become unusually forgetful, or that we’re battling brain fog. A reduced sex drive or less sensation during sex are also common symptoms of low testosterone.

While estrogen and progesterone remain the essential elements of HRT, testosterone can be prescribed to women with persistent symptoms. For many it is the ‘icing on the cake’, says menopause specialist Dr Louise Newson. “There’s no doubt that people feel better after taking oestrogen and progesterone, but they have testosterone and say ‘Wow, My brain’s alive!’” Read more about testosterone and how to secure a prescription here.

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