The mental health repercussions of menopause may be more extensive than commonly understood. (Image credit: ArtistGNDphotography via Getty Images)
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Menopause marks a pivotal stage in a woman’s lifetime. This period is frequently joined by a wide array of bodily and mental signs — some of which may be weakening and impinge on everyday functioning. Menopause has also been related to intellectual difficulties — such as impairments in recall, focus, and communication.
To reduce the consequences of menopause — including sensations of heat, feelings of despondency, and difficulties sleeping — numerous women resort to hormone replacement therapy (HRT). In England, approximately 15% of women are administered HRT for menopausal symptoms. In Europe, this figure is even greater — differing from 18% in Spain to 55% in France.
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In essence, we observed that menopause was linked with diminished sleep quality, heightened mental health concerns, and even shifts happening in the brain itself.
Post-menopausal women were statistically more inclined to describe feelings of worry and sadness compared to pre-menopausal women. They also exhibited a higher likelihood to consult a general practitioner or mental health specialist, and to get prescriptions for antidepressants.
Difficulties with sleeping were additionally more prevalent post-menopause. Post-menopausal women noted increased occurrences of sleeplessness, shortened sleep spans, and enhanced tiredness.
Brain imaging assessments likewise displayed notable decreases in the amount of grey matter after menopause. Grey matter is an essential part of the central nervous system, primarily composed of brain cells. These declines were most obvious in areas vital for learning and memory retention (specifically the hippocampus and entorhinal cortex), along with regions crucial for emotional management and focus (referred to as the anterior cingulate cortex).
Significantly, the hippocampus and entorhinal cortex are among the primary areas impacted in Alzheimer’s disease, the most widespread form of dementia.
The alterations we noticed in our research might point to the possibility that brain modifications linked to menopause could heighten susceptibility to Alzheimer’s disease later in life. This may contribute to explaining why a greater occurrence of dementia is found among women.
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We also explored whether undergoing HRT post-menopause showed any influence on wellbeing. Notably, HRT did not reverse the drop in brain grey matter.
Moreover, we noted that women receiving HRT displayed elevated levels of worry and sadness when contrasted against post-menopausal women who had never received HRT. However, supplementary investigations suggested these distinctions were already present. This implied that pre-existing psychological health challenges may have played a part in the choice to commence HRT instead of the medication triggering these symptoms.
HRT had some benefit on cognitive performance.
A possible advantage of HRT utilization was identified in mental functioning — specifically regarding movement speed. Psychomotor slowing represents a notable characteristic of getting older.
Post-menopausal women who had never been on HRT displayed slower reaction times in comparison to pre-menopausal women and post-menopausal women who had received HRT. This signifies that HRT aids in decelerating declines in movement speed connected to menopause.
HRT and menopause
Our knowledge regarding HRT remains incomplete — and further evidence regarding its pros and cons are yet to be found.
Certain investigations indicate that individuals receiving HRT face a heightened dementia risk, whereas others imply a lessened likelihood of dementia.
Further investigation is also required to comprehend the effects of HRT and how varying routes and dosages impact menopausal signs. Nevertheless, findings from a UK Biobank research project involving 538 women suggest that effects do not vary significantly — irrespective of elements such as its makeup, mode of delivery, and length of usage.
However, it’s crucial to emphasize that verifying whether women are obtaining a potent dosage is challenging. A quarter of women utilizing the highest permitted HRT dosage still exhibited minimal amounts of estradiol (estrogen) — approximately 200 picomoles per liter. Women of advanced age and those utilizing HRT patches demonstrated a greater probability of displaying decreased concentrations.
Ideal plasma amounts for alleviating menopausal signs range from 220 to 550 picomoles per liter. This implies that for 25% of women involved in the study, HRT may not have offered maximum alleviation for menopausal symptoms.
Considering that most women experience menopause, addressing whether HRT is advantageous becomes vital — involving averting reductions in brain grey matter quantity and diminishing the potential for dementia. Determining the optimum dosage and delivery method remains similarly important.
Available data hints that adopting wholesome lifestyle habits might alleviate such menopause-associated brain health transformations.
Our efforts, along with research from other organizations, demonstrate that various lifestyle behaviors can enhance brain health, cognitive processes, and overall well-being, consequently lessening the danger of cognitive diminishment associated with aging and dementia. These encompass regular physical activity, undertaking activities that stimulate the intellect (such as picking up a new language or enjoying chess), consuming a healthy and varied diet, obtaining sufficient quality sleep, and nurturing strong social bonds.
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Research also implies that consistent physical activity can expand the size of the hippocampus, potentially assisting in reducing several menopause-linked declines detected within this region.
Adequate rest is also exceptionally essential since it encourages the strengthening of memories and promotes the elimination of harmful waste byproducts originating from the brain — procedures that are vital for recollection, cognitive wellbeing, and immune performance.
Embracing a healthy lifestyle may present an easily accessible and impactful plan to bolster cognitive health, intellectual reserves, and flexibility when confronted with stress both during and following the menopausal transition.
This edited article is republished from The Conversation under a Creative Commons license. Read the original article.
TOPICSwomen
Barbara Jacquelyn SahakianProfessor of Clinical Neuropsychology, University of Cambridge
Professor Barbara J Sahakian works at the University of Cambridge Department of Psychiatry and Behavioural and Clinical Neuroscience Institute. Sahakian is additionally an Honorary Clinical Psychologist at Addenbrooke’s Hospital and a Fellow of Clare Hall, Cambridge. She is a Fellow of the British Academy and the Academy of Medical Sciences. She was a Member of the International Expert Jury for the 2017 Else Kröner-Fresenius-Stiftung Prize. She is a Past President of the British Association for Psychopharmacology and of the International Neuroethics Society. In 2024 she was awarded a CBE for Services to Research in Human Cognitive Processes.
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