"I think I have early-onset dementia": This is how menopause changes a woman's brain.

Dossier Ageism: discrimination based on age 1 article

• "I think I have early-onset dementia": This is how menopause changes a woman's brain.

"I'm not well, doctor. I think I have depression or, worse, early-onset dementia," I terrified my family doctor. "I feel deeply sad, I want to cry, I'm in a very bad mood and irritable, and I call my daughters for no reason. At work, I can't concentrate. I'm even starting to have major memory lapses," I confessed through a flood of tears.

After a thorough examination and ordering a blood test and other tests, when we met again to discuss the results, I breathed a sigh of relief. I was diving in full sail. towards menopause, the transition from the fertile stage to the non-fertile stage that all women go through, generally between the ages of 45 and 55.

And although it affects 100% of people with a uterus, not all of us experience it the same way. Some – the lucky ones – don't even realize it, while many others experience it with intensity and some alarm. In fact, more than 80% of women, during menopause – a process that can last between five and 15 years, and which would be before, during and after menopause – may suffer from at least one neurological symptom, and they can become severe, so much so as to stoke the fear of having some form of Alzheimer's, she explains via email Lisa Mosconi.

This neuroscientist began to investigate the relationship between menopause and the brain in 2010 – a pioneer, without a doubt – and directs the Women's Brain Initiative and the Alzheimer's Prevention Program at Weill Cornell Medical Center, Cornell University Medical College, in New York. The good news, Mosconi points out, is that all these cognitive symptoms are generally temporary, because the brain manages to readapt.

"We want answers"

To no one's surprise, because women's health has been systematically undervalued, understudied, and underfunded throughout the history of science and medicine, until less than a decade ago, the whole range of symptoms suffered by middle-aged women were simply ignored or dismissed as the inevitable consequence of the aging process, notes Elisa Llurba of São Paulo.

However, recently, the neurological signs of menopause are attracting scientific interest. On the one hand, and largely because "women of baby boom of the 70s have reached this stage, they are well informed, they want answers and are not content with "that's what it is now, there's nothing to do"", points out Llurba, who is also secretary of the Catalan Society of Health with a Gender and Sex Perspective of the Academy of Medical Sciences of Catalonia, At least more of these women. menopause than of reproductive age. "It's a lot of life and we have to live it as best we can", emphasizes this gynecologist.

And, on the other hand, because, although the majority of women overcome this stage of changes without long-term consequences for brain health, 20% will end up developing dementia in the following decades. In fact, three out of four people with Alzheimer's are women. For a long time, our greater longevity and perhaps genetic factors had been proposed as an explanation for this statistic. But since neuroscientists around the world have begun to research this issue and have conducted studies, there is growing scientific consensus that menopause is also an important risk factor for developing a neurodegenerative disease in later stages of life.

"It's not that menopause causes Alzheimer's," Mosconi clarifies emphatically, but it does "increase vulnerability in some women, such as those at risk due to genetics, metabolic health, or other factors. Therefore, this vital period is a critical window for prevention."

A hormone-dependent brain

Menopause occurs when a woman stops menstruating and the ovaries stop producing the two hormones that regulate female reproduction: estrogen and progesterone. Although we tend to associate this phase only with ovarian function, it also impacts the brain, as recent studies using brain imaging technologies have shown, some conducted by Mosconi and her team. These studies reveal, when compared with the brain images of premenopausal women or men of the same age, a brain with less energy, less connectivity, and changes in structure and function.

In fact, most of the associated symptoms, including the most popular ones, have a brain origin. "The brain and ovaries are deeply connected through the neuroendocrine system, which regulates hormonal cycles. When the ovaries begin to run out of follicles and estrogen production declines, it is the brain that first notices and responds to the change," says Mosconi, author of the book Menopause and the brain (Ed. Kairós).

Anira Escrichs, neuroscientist at Brain and Cognition Center (CBC) from Pompeu Fabra University, adds that "estrogen and progesterone receptors are distributed throughout the brain, with particular density in key regions, such as the hypothalamus, hippocampus, amygdala, and prefrontal cortex."

When the levels of these two hormones decrease, some circuits are altered, from thermoregulation controlled by the hypothalamus to neuronal energy metabolism or the transmission of neurotransmitters.

"Hot flashes, night sweats, insomnia, and memory lapses are the functional manifestation of a brain readjusting to its new hormonal state," says Escrichs, who is leading research with the University of Salzburg to understand the complex interplay between hormonal fluctuations and brain dynamics in women with the most vulnerable brains.

The problem is that often not even women themselves make the connection between what happens to them and this phase transition, and neither do many health professionals. However, as Llurba points out, migraines, anxiety, brain fog, and feelings of sadness are all conditioned or aggravated by a lack of estrogen in the brain.

These symptoms lead some women to reduce their working hours and, in more extreme cases, even to quit their jobs. "They can't cope with the effort, they don't feel professionally valid. The stress they feel from not being able to do everything worsens the symptoms even more; they feel even more tired and end up giving up on many things, such as exercising, going out with friends and socializing, reading, which makes them a target for illnesses.

It is clear that "menopause represents a period of vulnerability, but the brain adapts", and prevention strategies can make a difference in cognitive well-being," Escrichs believes. The most acute cognitive symptoms tend to diminish over time as the brain develops compensatory mechanisms to adapt to the new hormonal levels. Therefore, "cognitive dysfunction is transient thanks to brain plasticity and aging."

More vulnerable to Alzheimer's

Estrogen, for example, at the cellular level pushes neurons to create glucose to generate energy; when levels of this hormone decline, neurons begin to age more rapidly. This is why menopause has been shown to experience a measurable cognitive decline in the ability to learn and retain new information, and in one in ten women, this decline is significant.

Estrogen also modulates synaptic plasticity and promotes the elimination of toxic proteins, such as beta-amyloid and beta-amyloid, which are key in Alzheimer's. For this reason, the fluctuation and eventual decrease in levels of this hormone can trigger processes linked to neurodegeneration. This is precisely what Anna Brugulat, a researcher at the University of Vic and collaborator of the Beta Brain Research Center of the Pasqual Maragall Foundation, is studying.

"Menopause coincides with the preclinical phase of dementia. The brain is already undergoing changes but is not yet showing symptoms. The drop in estrogen could increase the sensitivity of women's brains to dementia," she explains. "It could be a catalyst that causes the disease to start earlier or even worse. In fact, the brain regions affected by menopause coincide with some of the areas affected by Alzheimer's disease, although the relationship between the two is not yet fully understood.

One of the symptoms of menopause most closely linked to an increased risk of Alzheimer's is insomnia. Sleep is the Swiss Army knife of health, because it allows the brain to cleanse itself of toxins and is a key factor in preventing brain disease. "During this period of life, you don't rest well because you have hot flashes or night sweats, or you wake up, and we are seeing that this is a risk factor at this vulnerable age when a woman's brain no longer has the estrogens that protect against the disease and are more exposed to these impacts," Brugulat points out.

THS, under debate

Although further studies are still needed and the evidence so far is inconclusive, research is being conducted into whether hormone replacement therapy (HRT) combining estrogen and progesterone could be protective. For now, Mosconi, who recently launched an ambitious and innovative project called CARE, which seeks to reduce the risk of Alzheimer's through endocrinology, conducted a systematic review in 2023 with data from 51 studies and found that women who started HRT in the first 10 years of life had a higher risk of developing Alzheimer's disease. symptoms of menopause They have a lower risk of developing Alzheimer's later in life compared to women who have not followed HRT.

However, Mosconi emphasizes, the timing of the therapy is crucial. "There is a window of opportunity. HRT can have protective effects against cognitive decline when you start near the beginning of menopause, but it is less effective and can even be harmful when started later." The effect of the therapy also depends greatly on the type of hormones administered, how they are administered, and the biology, ultimately, of each woman.

Therefore, Brugulat insists, "it is key to identify the women most vulnerable to the disease who can benefit from treatments and move toward more personalized medicine to prevent this cognitive decline."

In our hands

Not all women can take HRT. But all women can do so. Adopt preventive strategies that can make a difference in cognitive well-being"The brain has the ability to adjust and recalibrate, although the speed and effectiveness vary from woman to woman," notes Mosconi, who reminds us that we have very powerful tools at our disposal to preserve brain health. For starters: exercise. A sedentary lifestyle is a risk factor for dementia, and women are twice as likely as men to not engage in any physical activity throughout their lives. "You don't have to run marathons, but you do have to walk instead of taking the subway, and go up and down the stairs," Brugulat points out.

Secondly, the diet. The Mediterranean, A diet that prioritizes fruits, vegetables, whole grains, lean proteins, and healthy fats has been shown to be protective, even for women at genetic risk for Alzheimer's. Third, sleep, essential for memory consolidation and hormonal balance. Fourth, minimize chronic stress, which accelerates brain aging: practices like yoga, mindfulness, or spending time in nature can be helpful. And finally, socializing, which is highly beneficial for the brain, especially for women.

"The most empowering thing is being proactive. Brain health isn't just about genes or destiny, but about how we live," Mosconi recalls, adding that menopause isn't a disease, but a transition. With the right support, it can be a turning point toward greater strength, clarity, and long-term brain health.

Dossier Ageism: discrimination based on age 1 article

• "I think I have early-onset dementia": This is how menopause changes a woman's brain.