Having multiple menopause symptoms may increase a
person’s risk of cognitive decline, a new study finds.
- 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.”
Burden of
menopausal symptoms linked to cognitive decline risk
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.
Does hormone
therapy help lower the risk of cognitive decline?
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.”
What might
this link mean for dementia risk?
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.”