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The Impacts of Menopause on Cognitive Function | Categories Intellectual Health

by Louisa Bradford↓, Samuel Fuller↓ & Julie Warr Green↓

Problem Statement

An estimated 1.3 million women will enter menopause each year in the US.1 While menopause is commonly viewed as affecting only reproductive health, studies have shown that the reduction of estrogen significantly impacts cognitive functioning as well.2,3 A decline in cognitive functioning may begin as forgetfulness, then progress to cognitive impairment and eventually lead to dementia. Alzheimer’s Disease (AD) is the most common cause of dementia and kills 1 in 3 older adults annually.4 Women make up two-thirds of AD and dementia diagnoses, yet there is no information from either the Centers for Disease Control5 or the Alzheimer’s Association4 that is specific to women and estrogen. This shows that more research needs to be done to examine the connection between estrogen and cognition to determine potential prevention and treatment for dementia in aging women. 

Status of the Literature

Every woman goes through menopause, either through the natural aging process or the surgical removal of the ovaries. The most common symptoms of menopause are hot flashes, changes in mood and appetite, sleeping difficulties, lower libido, decreased concentration, and issues with cognition and memory.6 Some of these symptoms are cloaked in stigma, while hot flashes and reduced sex drive are widely, and stereotypically, discussed in the popular media, drawing attention away from the important neurological symptoms.7 Both brain and ovaries are part of the neuroendocrine system, and estrogen produced by the ovaries is critical for providing energy to the brain.8 Conde et al.9 found that a decline in cognitive performance was a prevailing complaint among menopausal women.

Menopause also has a documented impact on women’s brain functioning, especially in relation to memory. The majority of women report memory decline, especially short-term memory loss, to be a major symptom of menopause.10 Studies have also shown menopause to cause a reduction in processing speed and verbal memory.10 Additionally, in a neuroimaging comparison to age-similar men, menopausal women showed changes in brain structure such as volume reduction in certain areas and hypometabolism of glucose.11

Depression and anxiety are also common symptoms due to the decrease in estrogen. Estrogen loss is correlated with diminished synapse formation in the basal forebrain and hippocampus and reduced cholinergic and serotonergic brain functions, which impacts cognition and mood.3 Depression and anxiety can also affect cognition, as Devere explains,12 indicating there may be more to consider when diagnosing and treating cognitive impairment. Because menopause has so many associated symptoms, it can be difficult to discern whether a patient’s mental health symptoms are a result of menopause or have a different etiology.10 It is crucial that healthcare providers understand the scope of menopausal symptoms and how they might interact with mental health.

Unfortunately, mental health symptoms, issues with working memory and verbal memory, and slower cognition are not the only obstacles facing menopausal women. The impact of reduced estrogen on the brain can put women at a higher risk of developing AD.6 Menopausal women display similar neurological changes as those with AD, including reduced gray matter in the parietal and temporal regions and brain underactivity as indicated by glucose tracers.6

Call to Action

Studies have shown that estrogen influences cognitive function across several regions of the brain, namely those involved with information retrieval and memory, and evidence proves that menopause and AD are linked.12 This is an under researched topic, and one that is critical to the well-being of women. While some literature about cognitive decline in menopause contains controversy over the treatment of dementia, it is still a valid research area2 that further highlights the importance of recognizing the effects of decreased estrogen levels on cognitive decline. It is important for neurologists to take menopause as well as perimenopause into consideration when evaluating memory decline among women. Lastly, because there is the potential for contradiction in study results due to studying women with a variety of genetic factors for dementia, further research needs to take a more individualized approach to examine the effects of hormone replacement therapy among postmenopausal women. This is an issue that, if addressed, can have a life-changing impact on women’s well-being and longevity.

References

  1. Peacock K, Ketvertis K. Menopause. StatPearls. Accessed November 25, 2021. https://www.ncbi.nlm.nih.gov/books/NBK507826/
  2. Pertesi S, Coughlan G, Puthusseryppady V, Morris E, Hornberger M. Menopause, cognition and dementia – A review. Post Reprod Health. 2019 Dec;25(4):200-206. doi:10.1177/2053369119883485
  3. Reuben R, Karkaby L, McNamee C, Phillips NA, Einstein, G. Menopause and cognitive complaints: Are ovarian hormones linked with subjective cognitive decline? Climacteric. 2021 24(4):321-332. doi:10.1080/13697137.2021.1892627
  4. Alzheimer’s Disease facts and figures. Alzheimer’s Association. Accessed November 28, 2021. https://www.alz.org/alzheimers-dementia/facts-figures
  5. What is Alzheimer’s Disease? Alzheimer’s Disease and related dementias. Centers for Disease Control. October 26, 2020. Accessed November 28, 2021. https://www.cdc.gov/aging/aginginfo/alzheimers.htm#Who
  6. Mosconi L, Rahman A, Diaz I, Wu X, Scheyer O, Hristov HW, Vallabhajosula S, Isaacson RS, de Leon MJ, Brinton RD. Increased Alzheimer’s risk during the menopause transition: A 3-year longitudinal brain imaging study. PLoS One. 2018 Dec 12;13(12): e0207885. doi:10.1371/journal.pone.0207885
  7. MacKenzie, M. 1.3 million women enter menopause each year. We have to stop ignoring them. Glamor. October 7, 2020. Accessed November 28, 2021. https://www.glamour.com/story/its-time-to-stop-ignoring-menopausal-women
  8. Mosconi, L. How menopause affects the brain. TEDWomen 2019. 2019. Accessed November 28, 2021. https://www.ted.com/talks/lisa_mosconi_how_menopause_affects_the_brain
  9. Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: A narrative review of current knowledge. World J Psychiatry. 2021 Aug 19;11(8):412-428. doi:10.5498/wjp.v11.i8.412.
  10. Huang W, Jiang S, Geng L, Li C, Tao M. Correlation between menopausal symptoms and everyday cognition in Chinese (peri)menopausal women. Gynecol Endocrinol. 2021 Jul;37(7):655-659. doi:10.1080/09513590.2021.1892629.
  11. Mosconi L, Berti V, Dyke J, Schelbaum E, Jett S, Loughlin L, Jang G, Rahman A, Hristov H, Pahlajani S, Andrews R, Matthews D, Etingin O, Ganzer C, de Leon M, Isaacson R, Brinton RD. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Nature Sci Rep. 2021 Jun;11(10867). doi:10.1038/s41598-021-90084-y.
  12. Devere R. Dementia insights: Cognitive consequences of perimenopause. Practical Neurology. 2019 May:107-109.

Citation

Bradford L, Fuller S, & Green JW. (2022). The Impacts of Menopause on Cognitive Function. Utah Women’s Health Review. doi: 10.26054/0d-8prr-kx1w

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The Impacts of Menopause on Cognitive Function by Louisa Bradford, Samuel Fuller & Julie Warr Green