Turns out that more than a woman’s ability to reproduce is affected when she goes through menopause. Two out of three people affected by Alzheimer’s disease are women and scientists are now investigating a possible link between menopause and dementia.

Lisa Mosconi, director of the Women’s Brain Initiative at Weill Cornell Medical College, is studying the link between declining estrogen levels in menopause and cognitive problems.

Women in perimenopause—the transitional time before menstrual periods stop completely—or early menopause might notice declines in cognitive performance, brain fog, confusion, or memory problems, she says.

“Some women end up missing appointments or not being able to keep on top of things, “she says. “It can be very concerning.”

Estrogen stimulates energy production, supports the immune system, and has anti-inflammatory properties. So when it goes away, there’s a cost.

“It keeps your brain young and juicy and active,” Mosconi says. “As you lose estrogen your brain can suffer. It’s like losing a strong layer of protection.”

She’s looked at hundreds of brain scans of men and women age 40 to 60. Men and younger women don’t seem to show declines. Men, she says, don’t show much neuron loss or build-up of the plaques between neurons that are linked to the disease.

Younger women seem OK, too: “For women who are not experiencing symptoms of menopause or perimenopause, their brains look as good as men’s,” she says.

But as women approach menopause, problems start to appear.

“For many of those in perimenopause, who are having hot flashes and can feel menopause approaching, we notice a decline in energy levels inside the brain and the beginning of Alzheimer’s plaques,” Mosconi says. 

A brain drain

Mosconi has found that brain energy decreases up to 40% on average during peri- and early menopause, and women in this group have more Alzheimer’s plaques than men of similar age or younger women. 

These changes are not found in everybody, and they are not found to the same degree in everybody. Still, “It’s something that needs addressing,” she says. 

It’s important to note that menopause doesn’t cause Alzheimer’s. But if you have a genetic predisposition to Alzheimer’s, during menopause your brain can become less resilient and less able to slow the development of Alzheimer’s plaques. 

“It’s a time in a woman’s life when she is taking care of everybody and she needs to take care of herself.”
Lisa Mosconi
Director, Women’s Brain Initiative, Weill Cornell Medical College

Perimenopause can last four to eight years. And for most women, it starts in the late 30s to early 50s—a time when they likely face a lot of demands.

“It’s a time in a woman’s life when she is taking care of everybody, and she needs to take care of herself,” Mosconi says. “She might make a doctor’s appointment, and then school is closed for a snow day, or her mom falls and needs help.”

For many women cognition goes back to normal after menopause, but for others it never gets better, and for some it gets worse.

What you can do

Mosconi developed the Women’s Brain Initiative at Cornell to study Alzheimer’s disease in women.

“We need to boost research in this field,” she says. “We can’t provide good recommendations without the data to back it up. We want evidence-based recommendations, not some internet blog telling you to take supplements.” 

With a clear link between estrogen levels and brain health, it makes sense to look at estrogen replacement therapy as an option for fighting cognitive decline.

“We want evidence-backed recommendations, not some internet blog telling you to take supplements.”
Lisa Mosconi
Director, Women’s Brain Initiative, Weill Cornell Medical College

Studies of estrogen replacement were famously interrupted in the early 2000s when researchers discovered that the therapy increased the risk of heart disease and cancer.

“Millions of women stopped cold turkey,” Mosconi says.

But new studies are finding that starting estrogen replacement therapy closer to menopause might help fight cognitive declines. 

“In the meantime, we’re left with the question, ‘What else do I do?’” Mosconi says. “Estrogen replacement therapy is not for everybody. The benefits are not clear.”

A cluster of lifestyle changes can help reduce your risk of these cognitive declines. And these changes can also help alleviate the other symptoms of menopause, and can lower your risk of heart disease

They include:

Choose a Mediterranean diet

“Especially for women, it looks like the Mediterranean diet is really helpful,” says Mosconi, who is also the author of Brain Food: The Surprising Science of Eating for Cognitive Power. “This diet has lots of fiber, and fiber helps regulate estrogen levels.” 

Go heavy on the vegetables, fruit, whole grains, and legumes, choose moderate amounts of fish and olive oil, minimize meat and dairy, and steer clear of processed foods. 

Eating this way can help lower your risk for heart disease, diabetes, hot flashes, cancer, and dementia.

Move around

“There are plenty of studies showing that exercise is good for the brain,” Mosconi says. You don’t have to hit the gym (not that there’s anything wrong with that). Just keeping active during the day is associated with a much lower risk of Alzheimer’s disease later in life.

Use your brain

Stimulating your brain to grow stronger and more creative builds extra reserve that can help prevent Alzheimer’s disease. 

Mosconi points out that for many years, women didn’t have the same opportunities for education and intellectual stimulation that men did. They had less access to higher education and professional opportunities. 

But it’s not too late to engage your brain. And you don’t need to download an app. Mosconi says it’s better to develop a skill, study a new language, learn to play an instrument, or memorize something by heart.

“Anything that requires presence and concentration is good for your brain,” she says.  

Reduce stress

“There’s alarming evidence that very high stress levels impact the brain,” Mosconi says. They affect cognitive performance in both men and women. In women, they also can make the brain shrink faster. “Women’s brains seem to suffer from stress more noticeably than men’s of the same age,” Mosconi says. 

Mosconi says meditation works. “There’s strong validity to the argument that it helps the brain relax, increases the blood flow to the brain, and reduces cortisol levels. It definitely has an effect,” she says. 

If meditation isn’t for you, you can exercise to tame your stress levels.

Quit smoking

Smoking is toxic to the ovaries. Smokers reach menopause two years earlier than nonsmokers, on average. 

“Cigarettes have to go,” Mosconi says.

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