Explore the influence of menopause on brain function, including memory, cognition, and cognitive decline. Get the latest insights on the roles of oestrogen, progesterone, and testosterone in brain health and cognitive ageing, as well as lifestyle factors to consider during this significant transition.

Key takeaways

• Menopause significantly impacts brain function, leading to cognitive impairment in 44-62% of women during the transition.
• Oestrogen has neuroprotective effects and helps to modulate various brain activities, with decreases often leading to cognitive decline.
• Other hormones like testosterone and progesterone also play protective roles in brain health and cognition.
• Lifestyle factors, such as sleep quality and sugar intake, have a substantial influence on post-menopausal brain health.
• Further research is required to better understand and optimise treatment recommendations for cognitive issues post-menopause.

As women, we face an increased risk of dementia compared to men, which can't be entirely attributed to our longer lifespan. This disparity is partly due to significant hormonal differences between sexes, with oestrogen playing a crucial role in cognitive processing and neuronal function.

Around 44-62% of women report some cognitive impairment during the menopausal transition, whether it's 'pregnancy brain' or changes during menopause. It's a fascinating area of study for researchers who aim to understand the relationship of sex hormones to menopause and cognitive decline.

Menopause cognitive symptoms

One of the lesser-known impacts of the transition to menopause is cognitive decline. While not every woman experiences cognitive symptoms, for those who do, it can be a worrying and frustrating time.

Common cognitive symptoms include:

• Menopause brain fog
• Memory loss and verbal memory issues
• Mental fatigue
• Difficulty concentrating
• Slower processing speed
• Mood changes

These cognitive symptoms of menopause may be accompanied by other symptoms such as hot flashes, night sweats, sleep disturbances and more.

Oestrogen, menopause and cognition

Oestrogen, one of the primary female sex hormones, is known to have a pivotal role in numerous bodily functions. Over the last few years, research has emphasised its significance in brain health and cognition.

Oestrogen's impact on brain cells is vast. It modulates the making, release, and metabolism of numerous proteins, neurotransmitters, and chemicals within the brain. Oestrogen influences nerve tissues, hormonal centres, and key cytokines such as IL6, 12, and TNFα. Replacing oestrogen in the early postmenopausal period, may help regulate these pro-inflammatory cytokines in some women. It also helps regulate key energy pathways, such as insulin-like growth factor receptors, calcium currents and protects neurons from oxidative stress damage and free radicals.

Oestrogen's decline during menopause affects three crucial brain areas:

• Basal forebrain cholinergic system
• Dopaminergic system
• Mitochondrial bioenergetic system

These systems are suggested to be involved in cognitive ageing. MRI studies have confirmed that oestrogen replacement therapy increases brain activity, particularly in working memory, for postmenopausal women.

The neuroprotective effect of oestrogen

There is a well-founded premise that oestrogen might have a protective effect on the worsening cognition that befalls normal ageing.

Modulation of neuropeptides, neurotransmitters and neurosteroids

Oestrogen influences the synthesis, release, and activity of various neuropeptides, neurotransmitters, and neurosteroids — elements integral to the brain's normal functioning. These compounds facilitate communication between nerve cells, helping to regulate and modulate brain activity. Oestrogen, particularly, has been found to increase the production of serotonin and acetylcholine, neurotransmitters closely associated with mood regulation and memory processes, thereby potentially enhancing cognitive function.

Anti-apoptotic effects

Oestrogen plays a role in preventing apoptosis, also known as programmed cell death. Apoptosis is a crucial process in the body's growth and development. However, excessive apoptosis, particularly in the brain, can lead to neuronal loss and, consequently, cognitive impairment. By inhibiting apoptosis, oestrogen protects the brain's neurons. This can help to maintain their health and longevity, and indirectly contributes to the preservation of cognitive function.

Regulation of key growth factors

Another aspect of oestrogen's neuroprotective effect is its role in modulating growth factors, such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). These factors support neuron growth, differentiation, and survival. Oestrogen's regulation of these factors promotes the health and integrity of neural circuits, thereby helping maintain cognitive abilities.

Reduction of B-amyloid formation

Alzheimer's disease, a leading cause of dementia, is characterised by the presence of B-amyloid plaques in the brain. These plaques, formed by misfolded proteins, interfere with neuronal communication, leading to the progressive cognitive decline seen in Alzheimer's patients.

Research has found that oestrogen can reduce the formation of these harmful plaques. By inhibiting B-amyloid production and promoting its clearance, oestrogen provides a neuroprotective effect that could potentially slow down or prevent the onset of Alzheimer's disease.

Further research is also needed to fully understand oestrogen's complex role in brain health and cognition, and to explore potential therapeutic interventions for cognitive decline during menopause.

The role of progesterone and testosterone in cognition

Progesterone and testosterone, other essential neurosteroids, also impact neuroprotective and anti-inflammatory pathways. Testosterone appears to help protect against oxidative stress, apoptosis, and B-amyloid toxicity. Observational studies suggest testosterone therapy in postmenopausal women may enhance cognitive performance or delay cognitive decline, although more research is needed.

Some research shows that progesterone replacement may support increased verbal fluency and activation in the brain's left prefrontal cortex and hippocampus. However, more research is required to assess its long-term impact on cognitive issues in the postmenopausal era.

Lifestyle factors and the postmenopausal brain

Lifestyle factors play a significant role in post-menopause brain health. For example, poor sleep and insomnia correlate with an increased risk of cognitive decline and dementia. Changes in appetite, body composition, and associated metabolic changes during menopause, including impacts on insulin sensitivity, also contribute to cognitive decline.

Higher blood glucose levels are associated with a greater amyloid burden, brain atrophy, and reduced cortical thickness. Therefore, it is critical to address these lifestyle changes and optimise our health during the menopausal transition.

Lifestyle areas to address may include:

• Nutrition and diet
• Regular exercise
• Weight management
• Sleep optimisation
• Stress management
• Mental health

More research is needed to clarify and optimise treatment recommendations for cognitive issues post-menopause. However, recognising the changes in female hormone levels and their impact on brain health is crucial. Along with considering hormonal replacement therapy, it's important to address lifestyle changes that could benefit metabolic health.

One tool that can assist in managing these metabolic changes is the Vively app, designed to help users improve their glucose control and ultimately support brain health during menopause. Always consult with your healthcare professional for personalised advice.