The most common form of dementia is Alzheimer's Disease (AD), and research indicates that women are at higher risk than men. At age 45, a woman has a 1 in 5 (20%) chance of developing AD over her lifetime, compared to a 1 in 10 (10%) chance for men. Although age is a significant risk factor for women, other contributing factors include lower educational attainment, preeclampsia in pregnancy, early menopause (before age 45), and depression.
The decrease in estrogen following menopause has been well documented, but estrogen’s role in AD is still poorly understood. We know that the brain contains numerous estrogen receptors, and estrogen appears to be crucial for many brain functions. Estrogen can be highly beneficial for brain health, but it's complicated. For example, by neutralizing free radicals, estrogen helps protect neurons from damage, but estrogen also can cause inflammation that exacerbates neurodegenerative diseases. To make matters more complicated, when teasing out the role of estrogen in the brain, various factors need consideration. For instance, poor sleep due to hot flashes in menopause might impact brain health more than low estrogen levels. There is much to learn.
Several clinical trials have investigated the impact of menopause hormone therapy (MHT) on brain health, albeit all of them with limitations. Namely, MHT use was relatively short-term (<7 years) and initiation occurred post-menopause rather than during the menopausal transition. Furthermore, the heterogeneity in hormone combinations used across these studies complicates direct comparisons. For example. one study examined cognition in women taking oral estrogen (Premarin) with those using transdermal estradiol; they concluded that there was no difference in cognition between the MHT regimens. A second study compared dementia risk in women who had taken an estrogen and a progestogen with those who had taken estrogen alone; they found that in women who started taking MHT between age 50-55, neither regimen improved cognition, but in women who didn't start taking MHT until after age 65, there was an increased risk of dementia. In a third study, researchers compared cognition in women who started taking MHT within 6 years of menopause with those who didn't start until 10 years after menopause; they found no difference in cognition or memory between the two groups. Importantly, we lack clinical trials assessing the risk of dementia when MHT is started before menopause.
Based on this limited data, women's health organizations generally agree that starting MHT within ten years of menopause or before age 60 doesn't increase dementia risk. They do not support using MHT specifically for dementia prevention. On the other hand, all major health organizations recommend MHT for preventing dementia in women with premature menopause (under age 45) or primary ovarian insufficiency until the average age of menopause (50-51). Surgical menopause might also warrant estrogen use to reduce dementia risk. In short, although MHT can effectively address other menopause symptoms like hot flashes and genitourinary symptoms, as well as protect bone health, its use solely for dementia prevention is not backed by research.
So what can you do to keep your brain healthy?
1. Eat a Balanced Diet
Numerous studies have shown that a diet rich in antioxidants (e.g., fruits and vegetables), omega-3 fatty acids (e.g., fish), and other nutrients is associated with better cognitive function and a lower risk of neurodegenerative diseases. For example, the Mediterranean diet, which emphasizes these foods, has been linked to reduced cognitive decline and a lower risk of Alzheimer’s disease.
2. Get Regular Physical Exercise
Extensive research supports the benefits of regular physical exercise for brain health. Aerobic exercise, in particular, has been shown to improve cognitive function, enhance neurogenesis, and reduce the risk of dementia. Strength training also has cognitive benefits, particularly in older adults. Finally, HIIT workouts have been shown to stimulate release of vascular endothelial growth factor (which makes your blood vessels more responsive) and prompts release of brain-derived neurotropic factor (BDNF), which aids brain health.
3. Sleep Well
There is robust evidence linking good sleep hygiene to brain health. Quality sleep is essential for memory consolidation, cognitive function, and overall brain health. Chronic sleep deprivation is associated with impaired cognitive performance and an increased risk of neurodegenerative diseases.
4. Manage Stress
Research indicates that chronic stress can negatively impact brain health and cognitive function. Stress management techniques, such as mindfulness and meditation, have been shown to improve cognitive function, reduce symptoms of anxiety and depression, and support overall mental well-being. HIIT workouts also have been shown to reduce cortisol levels
5. Avoid Harmful Substances
Evidence supports the negative impact of excessive alcohol consumption and smoking on brain health. Alcohol abuse is linked to cognitive impairment and increased risk of dementia, and smoking is associated with cognitive decline and neurodegenerative diseases.
6. See Your Doctor Regularly
Managing chronic health conditions such as hypertension, diabetes, and high cholesterol is crucial for brain health. Research shows that controlling these conditions reduces the risk of cognitive decline and neurodegenerative diseases.
7. Maintain A Healthy Weight
Keeping a healthy weight is associated with better cognitive function and reduced risk of neurodegenerative diseases.
8. Be A Lifelong Learner
Engaging in creative activities and lifelong learning has been linked to improved cognitive function and a lower risk of cognitive decline. Creative pursuits stimulate various brain areas and support cognitive resilience.
9. Don't Forget Your Mental Health
Research Support: Addressing mental health issues such as depression and anxiety is important for overall brain health. Research shows that untreated mental health conditions can negatively impact cognitive function and increase risk of neurodegenerative diseases like AD.
Many menopausal women experience brain fog, particularly during the early years of menopause. I can't tell you how many menopausal women tell me in a panic that they feel like they are going crazy or developing dementia when what they actually are experiencing is brain fog. Brain fog is not dementia. Here are a few differences:
Brain Fog | Dementia |
Typically temporary and related to hormonal changes. | Chronic and progressive, leading to a gradual decline in cognitive function. |
Symptoms includes difficulty remembering recent events or information, trouble focusing on tasks or maintaining attention, and feeling foggy or having trouble organizing thoughts. | Symptoms include significant and progressive loss of memory, including long-term memories, difficulty with complex tasks, language, reasoning, and problem-solving, and changes in behavior, mood, and personality, including confusion and disorientation. |
Caused by hormonal fluctuations & related factors like sleep & mood. | Caused by pathological changes in the brain. |
Typically temporary and often improves as hormone levels stabilize after menopause. | Chronic and progressive. |
MHT help alleviate cognitive symptoms in some women. Improving sleep and managing stress also may help. Omega-3 fatty acids (DHA) may help some women. | Some medications can help manage symptoms or slow the progression. Cognitive & behavioral therapies can support quality of life. |
In summary, estrogen's role in brain health is complex - offering both protective and potentially harmful effects. Women face a higher lifetime risk of dementia compared to men, but current research on MHT and its impact on dementia risk remains inconclusive. The evidence available at this time suggests that MHT should not be used specifically for dementia prevention, though it may be beneficial for managing other menopausal symptoms and addressing premature menopause.
Great information