‘A PASSPORT TO A BETTER BRAIN’
Experts study link between menopause, Alzheimer’s
Judith Graham, a 52-year-old events planner, visited her doctor in 2017 with symptoms including irritability and forgetfulness.
“I was used to organizing business events all over the world. But then I began to struggle to concentrate, I forgot names, and I had real flashes of anger over minor things.”
Worse were her moods. “Everything felt like a struggle. My doctor prescribed antidepressants, which kept my mood stable. But seven months later, I saw a new GP, who knew about menopause, and she suggested I wasn’t depressed at all, it was menopause. I was given hormone replacement therapy and my brain fog and depression disappeared.”
Experts are now investigating a possible link between menopause and cognitive decline after it was found that two-thirds of Alzheimer’s patients are women.
Lisa Mosconi, an American psychologist from Weill Cornell Medicine’s Brain Initiative, who is studying the link between declining estrogen and dementia, says it isn’t because women live longer.
Mosconi has found menopausal women’s brains show signs of greater dementia risks than male brains of the same age, and that there’s an increase in Alzheimer’s plaques during the transition from perimenopause to menopause.
And it’s all down to estrogen, which is a neuroprotective hormone.
“The brain likes estrogen,” says Tania Adib, a consultant gynecologist at the Lister Hospital. “It needs estrogen to work effectively, to enjoy a fully functioning memory, good concentration and good serotonin production to keep mood levels steady.”
So does menopause increase your risk of dementia?
“To answer that you need to think about what happens after menopause,” says Louise Newson, a menopause specialist. “Your body stops producing hormones, which increases your risk of things like heart disease and type 2 diabetes, but also dementia.”
And some experts question whether a delay in taking, or failure to take, HRT can increase your risk of dementia in later life.
“For women who don’t take HRT, their risk of heart disease and dementia
increases,” says Newson. “Many women are terrified of the cancer risk of HRT, but it’s much safer than most people realize.”
Newson believes more research is needed. “In Victorian times, women died soon after their menopause, so nobody cared much about the health effects,” she says.
“But today, women live until their 80s and work in often high-powered jobs right the way through menopause. We have this great treatment, yet not enough doctors are educated in menopausal health, so women suffer unnecessarily.
“I’m a doctor and a mother of two, and my brain not on HRT is awful — like leaving keys in the fridge awful.
“Some women’s brains are fine during menopause, but some aren’t. Bright, capable women suddenly feel like the rug has been pulled out from under them. I see patients with anxiety, low motivation, low mood, but they don’t link it to menopause.”
She notes that antidepressant prescribing is “huge” in women in their 40s and 50s. “They go to their GP and, because they tick a lot of the depression boxes and the GP hasn’t had much menopausal training, they prescribe antidepressants.
“But these women aren’t clinically depressed, so the root cause isn’t being treated. Research shows 60 per cent of women are misgiven antidepressants for menopausal symptoms.”
“Depression, mood changes and insomnia are very common in the years before, during and after the menopause,” says John Studd, chairman of the British Menopause Society.
“I see five women a day in my clinic with these symptoms. However, GPS usually mistake it for depression and mistreat it. Yet it’s very treatable with the correct hormone therapy. So if your GP isn’t forthcoming, ask to see a doctor with a specialty in menopause or be referred to a menopause clinic.”
Studd says it’s difficult to prove that hormone therapy helps prevent dementia, but says “it makes sense that it does. The earlier you go through menopause, the greater your risk of getting Alzheimer’s. So it’s logical that hormones protect the brain. Changing lifestyle factors can also be very helpful.”
“We don’t know for sure that hormone replacement reduces dementia risk, but anecdotally it appears that way,” says Newson. “We do know, however, that brain metabolism is better when you take hormones, and better blood flow to the brain also decreases risk.
“HRT isn’t everything. But it’s often a passport to a better brain in later life.”