Menopause and Dementia – How To Tell Symptoms Apart

Weight gain, mood swings, hot flashes, and vaginal dryness – these are the symptoms that most women associate with menopause. Another less talked-about condition that may be brought on by menopause is brain fog, a term commonly used by women going through menopause to describe a sudden cloudiness with memory and focus.

Brain fog may raise alarm bells for dementia or other serious diseases – especially since studies have linked menopause to dementia – but just because you have occasional problems with memory or concentration as your hormones shift through menopause, it doesn’t necessarily mean anything is wrong. 

Why Menopause Is Linked To Dementia

Sixty-five percent of people who currently suffer from dementia are female. Although age is the number one risk factor for dementia, and women have longer average life spans than men, age alone does not completely explain the gap.

Currently, scientists don’t fully understand the reason why women develop dementia at a higher rate than men, but a prevailing theory backed by recent studies is that it may be connected to the hormone oestrogen. Both sexes produce oestrogen, but females have significantly higher amounts of oestrogen as it is the main female sex hormone.

Oestrogen levels drop during menopause, causing a series of reactions within the body. Men, on the other hand, produce testosterone at a steadier rate throughout their entire lives. A certain amount of testosterone circulating through the body is converted to estrogen in the brain through a process called aromatase.

Since males typically don’t have as dramatic a drop in testosterone as females lose estrogen during menopause, women who have been through menopause will have lower levels oesterogen in their brains compared to men of similar age.

This theory correlates with recent research linking early menopause to dementia. A 2022 study examining health data from 154,291 post-menopausal women in the U.K found that women who entered menopause around age 45, which is considered early menopause, were 30% more likely to be diagnosed with the disease before age 65 compared with those who entered menopause at 50 (the average age for American and British women). 

Brain Fog vs. Dementia – Is There a Difference?

Brain fog is a momentary lack of clarity in memory or focus, whilst dementia is a progressive chronic illness. However, even the slightest changes in our cognitive function may arouse panic about Alzheimer’s, which is the most common form of dementia. Don’t freak out if you find your memory getting slightly less sharp as you age. It’s extremely common for women after the age of 40 to experience brain fog, which can be exacerbated by menopause.

If you’ve always had an exceptional memory and never had an issue multitasking or recalling to-do lists, it may be jarring to find yourself going into a room and forgetting what you went in there for – but it could just be normal age-related memory loss.

According to the Alzheimer’s Association, symptoms of normal brain fog include:

• Occasionally needing help remembering how to do things like using new technology
• Sometimes making mistakes when balancing numbers
• Having trouble placing the right word
• Making decisions you normally wouldn’t
• Losing things you use often
• Having specific ways of doing things and becoming irritated when something disrupts your routine
• Feeling exhausted about work, family, and normal social obligations

However, if you find yourself experiencing any of the following 10 warning signs, the Alzheimer’s Association advises consulting with your doctor:

• Finding it extra challenging to solve problems or plan, such as paying bills or following simple steps
• Continuous memory loss that disrupts your daily activities
• Confusion with time or place
• Having trouble with familiar tasks like driving somewhere you go all the time
• Problems with understanding spatial relationships and visual images
• Misplacing things and finding them in places you normally would never put them, such as leaving the TV remote in your car
• Decreased or poor judgment when handling day-to-day tasks like finances or personal hygiene
• Changes in mood and personality, such as flipping on a hair trigger when something is out of your comfort zone
• Increased withdrawal from social activities and work

Can Hormone Replacement Therapy Help?

While further research is needed to explore the connection between hormones and dementia, some recent studies raise the possibility that hormone replacement therapy may help prevent Alzheimers. Hormone replacement therapy (HRT) is a common treatment for symptoms of menopause.

There are two kinds of HRT: estrogen therapy and estrogen progesterone therapy (EPT), also known as combination therapy. Like the name suggests, estrogen therapy only involves taking estrogen. Estrogen may be administered by your healthcare provider in a variety of forms, such as topical creams or gels, oral pills, suppositories, or a vaginal ring.

Combination therapy combines doses of estrogen and progesterone (also known as progestin). Progestins help lower your risk of uterine cancer. In women with intact uteruses whose periods have ceased, estrogen-only therapy has higher rates of uterine cancer. When menstruation ceases and you stop shedding the lining of your uterus, estrogen can incur an overgrowth of cells in your uterus that have the potential of leading to cancer.

A 2023 study published in Frontiers in Aging Neuroscience found that women who took hormones in mid-life to treat symptoms of menopause were less likely to develop dementia than their peers who did not take estrogen. However, this did not hold true for women taking estrogen at ages 65 and up.

Although clinical trials have generally not found that estrogen protects against dementia, the findings from this studies suggest that estrogen replacement earlier in mid-life at the outset of menopause may be able to prevent or delay the Alzheimer’s process.

Moreover, while estrogen-only therapy is typically only used for women who have undergone hysterectomies, the analysis shows that the progestins used in combination therapy may blunt the preventative effect of estrogen (though researchers note that the data were highly variable and further research is needed). 

If you are approaching menopause and concerned about the possibility of dementia, discuss options with your medical provider who will advise you about the best course of action.