Aug 247 min read

Understanding the Link Between HRT and Dementia

An image of a doctor holding notepad with images of the human body floating above it. — Credits: Park avenue (1)

The menopausal transition, also known as the stage of life where your menstrual cycle stops, can often make you feel like you’re not yourself.

Women in their 40s and 50s can experience symptoms such as extreme mood swings, weight gain, annoying menopause mind fog, crippling insomnia, hot flushes, or even signs of dementia. Even in your 30's, you can experience perimenopause brain fog.

How To Manage These Symptoms: Mindfulness

Many of these symptoms are temporary and suppressible with hormone replacement therapy.

During this transition, your brain needs a lot of time and support to adjust to the major hormonal changes happening in your body, especially for postmenopausal women. (2)

The beauty (and complexity) of biology is that everything is interconnected; the mind and ovaries are both major participants in hormone health and are always chatting with one another!

How Does the Decline of Estrogen Affect Our Brains? Menopause Brain Fog

Around 60% of women in this age range report difficulty concentrating and other issues with comprehension, commonly referred to as "menopause brain fog."

So if you’re between the average age of 40-50 years old and experiencing night sweats and memory issues, you are not alone.

This is supported by the long-term SWAN (Study of Women's Health Across the Nation) trial, which suggests that perimenopausal women may temporarily have trouble learning new information, as well as brain fog with menopause, but it does get better with time as women get past menopause.

Improving Your Sleep Disturbances

Incorporating a consistent bedtime routine and avoiding stimulants like caffeine and nicotine before bed can also help improve sleep quality during this time.

Hormones: How Do They Work in Your Body?

Your body has two complementary systems:

The endocrine system: responsible for secreting hormones that travel through the blood. Composed of glands, that produce and release hormones, and cell receptors that behave as a checkpoint.
The nervous system: behaves as the body’s command center, headquartered in the brain.

A diagram of hormone distribution within cells. — Example process of hormone distribution (3)

The combination of both these systems is referred to as the neuroendocrine system. The brain, specifically an important gland within the brain called the hypothalamus, regulates the endocrine system. It manages other glands and their hormone production. (4)

How Do Reduced Levels Of Estrogen Affect The Brain?

Menopause is directly linked to several neurodegenerative diseases such as dementia. After this period, women's brains display significant differences. This is primarily due to the critical role of estrogen in brain health.

Graphs of testosterone and estrogen levels with age. — Production of testosterone and estrogen with age (6).

Estrogen regulates several processes involved in energy production in the brain (5). It helps neurons produce energy more efficiently and plays a crucial role in cognition and memory loss. High estrogen levels increase the energy available to the brain, while low estrogen levels decrease brain energy.

What Does Low Brain Energy Mean?

As a result, neurons become slower and age faster. During menopause, women’s levels of estrogen decrease, and this has a profound impact on the way the brain works (6). However, the good news is that we can support brain health with simple lifestyle changes.

How Does the Brain Relate to Symptoms of Menopause?

Here are some examples of how decreased levels of estrogen in the brain result in menopausal symptoms:

The hypothalamus regulates body temperature. If the hypothalamus isn’t correctly activated by estrogen, body temperature cannot be correctly regulated by the brain. As a result, women experience hot flashes. (6)
The brain stem is in charge of sleep. When this part does not receive enough estrogen, it can result in trouble sleeping. (6)
The hippocampus stores short-term memory. When this part has decreased levels of estrogen it can result in loss of memory and menopause mental fog. (6)
The amygdala is the emotional center of the brain and estrogen fluctuations also influence other hormones such as serotonin, a brain chemical that promotes feelings of well-being and happiness. The amygdala also receives decreased levels of estrogen. This can contribute to mood swings. (7)

Hormone Fluctuations and Your Mood

The fluctuation of estrogen and another key hormone, progesterone, in your body can cause feelings of anxiety. (8)

For some women, these hormonal dips can be difficult to cope with. The constant mood changes, stress, and anxiety can lead to the onset of depression.

Impact Of Menopause Shown On Brain Energy.

The impact of reduced levels of estrogen can be shown through brain scans before and after menopause. This is a positron emission tomography (PET) scan which looks at brain energy levels.

Images of brain scans before and after menopause.

This is the brain of a 43 old woman before menopause and 8 years later after menopause.

The first brain has very bright and vibrant colors. In the second brain, after menopause, the bright yellow has turned into more purple and orange. This shows there is a 30% drop in brain energy levels after menopause. (6)

How Does Menopause Relate to Dementia? Memory Loss During Menopause

Dementia impacts many people as they age, but is more commonly seen in women than in men (11).

Since age is a major risk factor, this difference was mainly attributed to the fact that women live longer than men. However, another risk factor has been identified by studying dementia associated with Alzheimer's in post-menopausal women: low estrogen levels.

Throughout their lives, men continue to produce testosterone, which can be converted into estrogen, while women’s estrogen levels get lower and lower with age (12).

Menopause and Alzheimer's Disease

As this stage begins, decreased estrogen levels can encourage formation of amyloid plaques between the neurons in the brain. These plaques are a hallmark of Alzheimer’s disease, a form of dementia (6).

While researchers still do not know the exact relationship between menopause and dementia, studies have shown low estrogen levels are a risk factor and that maintaining high estrogen levels can have protective effects (11).

A digital image of amyloid plaques in between several neurons. — Amyloid plaques around neurons (16).

Hormone Therapy and Dementia

HRT and Dementia can benefit one another. One way to lower your chances of developing dementia is through hormone replacement therapy. Providing your body with a continuous supply of estrogen during during this transition has a protective effect, reducing the risks associated with low estrogen levels (15).

The North American Menopause Society’s 2022 statement suggests that the use of HRT in women over the age of 65 can be beneficial for several menopausal symptoms, including reducing risk of dementia.

They recommend individualized, correctly timed treatment, such as hormone therapy, to reduce risks and maximize benefits (14).

How Long Should I Use HRT? : HRT and Dementia

The duration of hormone replacement therapy (HRT) varies for each individual and should be determined based on personalized factors.

It is recommended to consult with a clinician to discuss the best course of action, considering your health history and specific needs.

Initiating HRT at the onset of symptoms and continuing for the shortest duration needed to address symptoms while balancing potential risks is a common approach. Regular evaluations with your healthcare provider can help monitor the effects of HRT and make adjustments as necessary to optimize benefits and minimize risks.

Risks Of Hormone Replacement Therapy

While hormone replacement therapy (HRT) can be beneficial in reducing the risk of dementia associated with low estrogen levels, it is important to consider the potential risks involved. Estrogen replacement and dementia should be discussed with a healthcare provider.

Some studies have linked long-term use of HRT to an increased risk of certain health conditions such as breast cancer, blood clots, cardiovascular disease, and stroke (13).

It is crucial for individuals considering HRT to weigh the benefits against these potential risks and consult healthcare providers, specifically gynecologists, for personalized guidance (17).

Non-Hormonal Methods

Non-hormonal methods of boosting estrogen levels can be a great option for many people looking to reduce their risk of developing dementia. Various lifestyle changes can be essential in alleviating symptoms.

These Include:

Stress reduction techniques such as meditation
Cognitive behavioral therapy
Diet including seeds, nuts, and olive oil
Physical activity
Staying social
Mediterranean diet (18)

By incorporating these non-hormonal methods and staying informed about women's health, women can navigate through menopause with improved cognitive function and overall well-being. It is also important to incorporate foods rich in fatty acids, such as Omega 3 and Omega 6, into the diet to support brain health during menopause.

What Other Factors Besides Menopause Can Cause Dementia?

Besides menopause, there are several other factors that can contribute to the development of dementia.

These include genetics, age-related cognitive decline, lifestyle factors such as smoking and excessive alcohol consumption, chronic conditions like diabetes and hypertension, head injuries, and certain medications.

Maintaining a healthy lifestyle, including regular physical activity such as aerobics, staying mentally and physically active, managing chronic conditions effectively, and seeking regular medical check-ups are all crucial in reducing the risk of dementia.

Exercise Your Brain!

One study found that just three days a week of moderate-intensity exercise, like crossword puzzles, can increase the size of the hippocampus, a part of the brain involved in memory and learning. It is important to address these various factors to promote brain health and overall well-being throughout life.

Drawing of a woman with dark hair helping a woman with white hair who holds her head and seems confused. — Source: Discover (17).

The Importance Of Being Informed About Menopause.

Thousands of women suffer without proper education about menopause. Here are some statistics from The State of Menopause Study conducted with 1,039 women ages 40 to 65 across the United States. (9)

One-third of women never sought information about menopause until they experienced it.
Nearly half the women didn’t know the difference between perimenopause and menopause.
One-fifth of women surveyed weren't assessed menopausal until one year or more after symptoms.
34% had never been formally assessed or diagnosed as menopausal.
73% of women reported that they were not currently treating their menopause.

A study was conducted to see the effect of menopause education on the quality of life of women. Findings showed quality-of-life improved significantly in the group of women informed about menopause while the women with no education significantly regressed. (10) Clearly, women need to be educated about menopause!

Key Takeaways

The loss of estrogen after menopause has been shown in studies to increase the risk of neurodegenerative diseases.
Women have had significant differences in their brains after menopause compared to men.
Estrogen levels in women start decreasing during midlife with menopause.
Estrogen is used for energy production in the brain, when estrogen is high, brain energy is high.
When estrogen doesn’t activate certain parts of the brain properly, it results in changes throughout the body known as “menopause symptoms.”
Low estrogen levels are a risk factor for dementia.
Hormone replacement therapy and lifestyle changes such as the Mediterranean diet, stress reduction, exercise, and sleep, can reduce risks of dementia.
Menopause education can increase the quality of life in women.

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