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New Study Shows Premature Menopause Linked to Dementia, Experts Explain Why

The preliminary study is raising a lot of questions.

menopause, dementia risk, woman with gray hair
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A preliminary study has found that women who go through menopause before the age of 40 have a 35% higher risk of developing dementia at some point in life.

The study, which is not yet published, is being presented at the American Heart Association’s annual conference this week. For the study, researchers analyzed health data for 153,291 women with an average age of 60 who participated in the UK Biobank, a large biomedical database in the United Kingdom.

Researchers looked at women who were diagnosed with dementia and factored in when the women started menopause, before adjusting for things like their age at their last exam, race, educational level, cigarette and alcohol use, body mass index, cardiovascular disease, diabetes, income, and physical activity level.

Not only did they find that women who started menopause before 40—which is known as premature menopause—were 35% more likely to be diagnosed with dementia, they also found that women who started menopause before 45 were 1.3 times more likely to be diagnosed with dementia before they were 65, a condition known as early-onset dementia.

But women who started menopause at age 52 or older had similar rates of dementia to the general population.

This raises a lot of questions about the link between menopause and dementia. Here’s what you need to know.

First, what is premature menopause?

Menopause is the time in your life when you naturally stop having periods, according to the American College of Obstetricians and Gynecologists (ACOG). Your ovaries also stop making estrogen, a hormone that helps control your menstrual cycle.

Menopause that happens before age 40 is called premature menopause, per the U.S. Department of Health and Human Services’ Office on Women’s Health (OWH). When menopause happens between ages 40 and 45, it’s called early menopause. About 5% of women naturally go through early menopause. (The typical age of menopause is 52, the OWH says.)

There’s a long list of reasons why someone might go through premature or early menopause, according to the OWH:

  • A family history of early menopause
  • Smoking, which can cause menopause to happen up to two years before women who are nonsmokers
  • Chemotherapy or pelvic radiation treatments for cancer
  • Surgery to remove the ovaries
  • A hysterectomy
  • Certain health conditions, including autoimmune diseases, chronic fatigue syndrome, and HIV and AIDS

    Why might early menopause be linked to dementia?

    The researchers didn’t explore the link between the two in the study—they just found the association. However, they said in a press release issued by the American Heart Association that lower estrogen levels that come with menopause may be a factor.

    “We know that the lack of estrogen over the long term enhances oxidative stress, which may increase brain aging and lead to cognitive impairment,” study co-author Wenting Hao, M.D., a Ph.D., candidate at Shandong University in Jinan, China, said. (Oxidative stress, in case you’re not familiar with it, happens when unstable atoms build up in your body that can damage cells.)

    Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and author of Hot Flash Hell, also says the drop in estrogen may play a role. “We certainly know that there are vascular changes when someone stops making estrogen,” she says. “There might actually be decreased oxygen that goes to the brain that could raise your risk of developing dementia.” But, she adds, “it may not just be about decreased estrogen. Plenty of people have low estrogen and don’t develop dementia.”

    Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, says that the findings are “not surprising.”

    “We have known for years that women who undergo menopause early and don't take estrogen replacement therapy have a significantly higher risk of heart disease and dementia,” she says, citing a Mayo Clinic study. “Why is there this link? We know from some experimental data that women who take estrogen fairly soon—within six years of menopause—have less thickening of their carotid blood vessels compared to women who do not take estrogen,” Dr. Minkin says. “And blood flow to the brain is good.”

    Scott Kaiser, M.D., board-certified geriatrician and Director of Geriatric Cognitive Health for the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, Calif., also points out that women do develop Alzheimer’s disease at a greater rate than men. “There’s a lot of work to try to understand these sex-based differences, and this study offers some important clues and raises some critical questions,” he says.

    Doug Scharre, M.D., a neurologist and Director of the Center for Cognitive and Memory Disorders at The Ohio State University Wexner Medical Center, notes that “there have been studies that suggest estrogen may play a role in cognition and Alzheimer’s disease.” One older study, in particular, he cites found that women who used estrogen supplementation during menopause were at a reduced risk of developing Alzheimer’s disease compared to those who didn’t take the hormone.

    But Amit Sachdev, M.D., medical director in the department of neurology and ophthalmology at Michigan State University, says that more research is needed before people should jump to conclusions. “I would take this trend with a grain of salt,” he said. “It’s a big leap to go from [menopause] to brain degeneration.”

    “The reality is, nobody knows,” says Christine Greves, M.D., an ob/gyn at the Winnie Palmer Hospital for Women and Babies in Orlando. “This doesn’t prove causation—just that there’s a link. There needs to be more research done.”

    How to lower your risk of dementia

    Dementia is a complicated condition and there are many factors that go into why someone may develop it, Dr. Sachdev says. That’s why he recommends that people focus on their health as a whole to lower their risk. “A healthy body leads to a healthy brain,” he says. “Better overall health is best.”

    “It’s important for all of us to think about how we engage in that way to improves our brain health but especially for people with increased risk, which might include women who go through early menopause,” Dr. Kaiser says.

    The U.S. Department of Health and Human Services (HHS) specifically recommends that people do the following to lower their risk of dementia:

    • Control high blood pressure
    • Manage blood sugar
    • Maintain a healthy weight
    • Eat a healthy diet with a mix of fruits and vegetables, whole grains, lean meats, seafood, unsaturated fat, and low-fat or nonfat dairy products, while minimizing other fats and sugars.
    • Aim to get at least 150 minutes of moderate-intensity physical activity each week
    • Stay mentally active by reading, playing board games, crafting, or taking up a new hobby
    • Stay connected with family and friends
    • Get recommended health screenings
    • Try to get seven to eight hours of sleep each night
    • Limit how much alcohol you have to no more than two drinks a day for men and one for women
    • Avoid tobacco use

      But, if you're going through menopause, Dr. Streicher recommends talking to your doctor about estrogen supplementation, which can lower your risk of experiencing a slew of side effects, including hot flashes and, perhaps, dementia. “The idea that women should just ‘tough it out’ and potentially deal with serious health consequences is so unfair,” she says.

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