Are Intense Menopause Symptoms Bad for Your Brain?

Key Takeaways

• A study of Latin American post-menopausal women linked more intense menopause symptoms with a greater likelihood of cognitive decline.
• Women who were more physically and sexually active, and who were more educated, had a lower risk of cognitive impairment.
• Lifestyle choices that benefit heart health can also promote brain health.

For some women, menopause brings both physical and emotional challenges. The hormonal fluctuations that occur during the period of life when menstruation stops can be accompanied by troubles with decision-making, learning and retaining information, and concentrating, research has found.

Now a new study suggests that severe menopause symptoms such as hot flashes and sleep and mood disturbances are linked with a 74 percent increase in the risk of mild cognitive impairment.

"The heightened severity of menopausal symptoms observed among post-menopausal women with mild cognitive impairment aligns with existing literature linking hormonal levels during menopause to cognitive changes," wrote the lead author, Andrés Calle, MD , the research director at Central University of Ecuador in Quito. "Overall, our findings underscore the complex interplay between hormonal, lifestyle, and sociodemographic factors in shaping cognitive health outcomes during the post-menopausal period."

As Estrogen Declines, So May Cognitive Function

Published this month, the findings reflect cognitive assessments of almost 1,300 post-menopausal women in nine Latin American countries. Their average age was 55, and they were about 44 when menopause occurred.

Just over a third used menopausal hormone therapy, and on average participants had 14 years of education and two children.

Women completed questionnaires rating the severity of their post-menopausal symptoms , including hot flashes, cardiac discomfort, sleep disturbances , muscular and joint discomfort, depression, irritability, anxiety , physical and mental exhaustion, sexual problems, bladder issues, and vaginal dryness .

Participants also completed a screening test to assess mild cognitive impairment - a transitional state between normal aging and dementia , particularly Alzheimer's disease . The tool evaluated memory, visuospatial ability, executive function (the ability to handle everyday tasks, make plans, and solve problems), attention, language, and orientation (the ability to describe the time, place, person, and situation).

Overall, about 15 percent had mild cognitive impairment.

The results revealed that women with very intense menopausal symptoms had a 74 percent greater risk of mild cognitive impairment.

Because the menopause transition is characterized by a decrease in estrogen, Dr. Calle and his team suggested that low levels of the sex hormone were linked to this mental decline. They added that estrogen regulates a wide range of neuronal functions in the brain, and compared with women still in their reproductive stage of life, post-menopausal women exhibit lower brain connectivity (how regions of the brain interact with each other).

Physical Activity and Other Factors That May Benefit the Brain

The researchers noted that influences related to better heart function - lower body mass index, sexual activity, and physical activity - were all associated with lower odds of mild cognitive impairment.

"Vascular health has everything to do with brain health," says Stephanie Faubion, MD , the medical director of the Menopause Society and the director of Mayo Clinic's Women's Health Clinic. "People who are in better cardiovascular shape are probably going to have fewer heart issues and probably have less cognitive impairment."

Scientists also found that menopausal hormone therapy was connected to higher cognition scores.

Whether effective treatment of hot flashes with hormone therapy or other approved therapies can improve memory, attention, language, and executive function is unknown, according to the study authors.

"We know that hot flashes and night sweats respond to hormone therapy, but we have no idea if it would help improve brain fog that occurs around the menopause transition," says Dr. Faubion.

She mentions that hormone treatment may be more or less protective depending on when a person receives it.

Findings published last year indicated that women who took hormones in midlife for menopause were less likely to develop dementia than those who hadn't taken estrogen, but dementia risk was not lower for women 65 and older who received hormone therapy.

Another factor tied to lower cognitive risk was a higher level of education. Dr. Calle and his team argued that individuals who had spent more years learning may have built up a cognitive reserve that imparts greater neuronal resilience.

No matter your educational background, Faubion suggests that anyone may pursue activities - like learning a language, reading, or doing puzzles - that stimulate the brain and help prevent cognitive decline.

She points out that the results here may not reflect the experiences of American women. Participants in this study were all from Latin America, and may be more socioeconomically disadvantaged than women in the United States. They also went through menopause at an earlier age, at 44 rather than 52, which is the average menopause age for females in the United States.

Despite these limitations, Valle and his colleagues believe the study lays the groundwork for future exploration into how menopause may influence brain health.

"Further research is warranted to elucidate the underlying mechanisms and inform targeted interventions, aimed at preserving cognitive function in aging women," the authors concluded.

Editorial Sources and Fact-Checking

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Sources

1. Conde DM et al. Menopause and cognitive impairment: A narrative review of current knowledge. World Journal of Psychiatry . August 19, 2021.
2. Calle A et al. Severe Menopausal Symptoms Linked to Cognitive Impairment: An Exploratory Study. Menopause: The Journal of the Menopause Society . August 13, 2024.
3. Nerattini M et al. Systematic Review and Meta-Analysis of the Effects of Menopause Hormone Therapy on Risk of Alzheimer's Disease and Dementia. Frontiers in Aging Neuroscience . October 22, 2023.
4. Menopause basics. Office of Women's Health . January 6, 2023.

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Don Rauf

Author

Don Rauf has been a freelance health writer for over 12 years and his writing has been featured in HealthDay, CBS News, WebMD, U.S. News & World Report, Mental Floss, United Press International (UPI), Health , and MedicineNet. He was previously a reporter for DailyRx.com where he covered stories related to cardiology, diabetes, lung cancer, prostate cancer, erectile dysfunction, menopause, and allergies. He has interviewed doctors and pharmaceutical representatives in the U.S. and abroad.

He is a prolific writer and has written more than 50 books, including Lost America: Vanished Civilizations , Abandoned Towns , and Roadside Attractions . Rauf lives in Seattle, Washington.

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