“Could menopause be causing me to lose my memory?” I recall the question distinctly, despite being asked of me almost five years ago. It was posed by a female patient in her mid-forties. She had three teenagers at home, an aging parent with health problems and a full-time job. She was worried when she couldn’t remember what her boss had told her about projects, about the various appointments for her mother and even what she had meant to pick up at the grocery store. She was having irregular periods and daily hot flashes and she was afraid she was developing dementia. I tried to reassure as best I could, telling her I thought her memory problems were related to her multiple sources of stress. At that time, there wasn’t a lot of research about cognitive changes during menopause and the transition years around it.
It was wonderful to finally have an answer for her question. An article from the April 21, 2020 issue of the Journal of the American Medical Association looked at several studies about cognitive function in the menopause transition. In comparison to women before menopause and after menopause, there seemed to be a temporary decrease in the ability to process information quickly, and also in immediate and later (delayed) recall of information. Thus, it was hard to learn new things but there was no decrease in ability to function. However, even with those difficulties, cognitive performance was still in a normal range for the women in the studies.
Does menopause impact mental health?
What about mental health concerns outside of worries about dementia? Does menopause increase a woman’s risk for depression? If it does, how can a woman avoid or decrease that risk?
We do know that the ovarian hormones—estrogen and progesterone—affect various parts of the brain. They do so by direct effects on certain brain tissues and in their effects on brain cell messengers, called neurotransmitters. Those effects are seen at the time of puberty, in pregnancy, after delivery, and at menopause. Estrogen has high levels in puberty and during pregnancy, and lower levels after pregnancy and in menopause. Mood changes and depression can be seen when those peak levels decrease and may contribute to post-partum depression or depression in menopause. Certain areas of the brain seem to be more sensitive to estrogen’s effects, especially the area associated with motivation, emotion, learning and memory.
Interestingly, the other ovarian hormone, progesterone, may positively influence overall nerve cell survival and is being used experimentally assist individuals with traumatic brain injury. It seems to work in many areas of the brain and high levels have even been seen to have a sedative effect. Some women are more sensitive to its effects than others, which may account for mood changes before periods. Mood changes may decrease with menopause, but could be made worse.
Much of the effects on women’s brains are caused by changes in levels of the nerve cell messengers—the neurotransmitters. A woman’s mental health is also dependent on which neurotransmitter is most affected by the changing hormone levels and in what part of the brain the transmitter is working. Her genetic make-up and the sensitivity of her brain cells to her own neurotransmitters makes a difference, too.
Hormonal effects during menopause
With as many effects of the ovarian hormones on women’s brains, especially in the areas which control emotion, then it is not surprising that women have a 1.5-3 times higher risk of depression than men. One of the highest risk factors for depression in menopause is a history of depression earlier in a woman’s life. So, a woman with a history of depression at a younger age may want to tell her physician about this so they can both watch for signs of depression and treat it early. Treatment can decrease her risk for Alzheimer’s dementia, which can be increased in people with depression, especially if it is severe.
As a woman loses ovarian function, especially hormone production, there are quite a few changes seen. Menopause affects eating and sleep patterns, metabolism, sex drive, behavior, mood and even the immune response. Does this mean she should start using hormone replacement? The data gathered from years of study of the effects of hormone replacement seems to say that for most women, the risks outweigh the benefits. What we do know is that the natural positive effects of exercise and a healthy diet seem to decrease the risk for both cognitive changes and depressed mood. Maintaining social activities and doing cognitive exercises also help. If you have medical problems like diabetes, high blood pressure or high cholesterol, keeping those conditions under control helps too. Be sure to discuss your own situation with your physician. Your primary care physician can help you survive and even thrive during your menopausal transition.
Our exceptional physicians at the Des Moines University Clinic are here to help you thrive before, during, and after menopause. For more information, or to make an appointment, visit the DMU Clinic website or call 515-271-1710.