Your Brain After Menopause

4 min

Over the past several years, new studies have looked more deeply into what happens in the brain before, during, and after menopause, and the answer to your question is certainly Yes. In what ways the brain changes, and to what effect, are still being studied.

Research has provided good evidence to support what women have long reported: menopause can have an effect on memory (see Can Menopause Mess Up Your Memory?). That’s not all, however. Newer and ongoing studies are looking at several ways in which the hormonal changes of menopause (which start years earlier, during perimenopause) affect the central nervous system. This is not an exhaustive list, but here are some of the findings:

• Women are known to be more susceptible to osteoporosis after menopause, and there is a brain connection in that process. A hormone called osteocalcin is involved in bone density and rebuilding, but research has found that it also has an effect on memory, visual-spatial learning, and even mood. In one long-term study of more than 3,600 older adults, those who had lower bone density at the beginning of the study had twice the chance of a dementia diagnosis a decade later. That doesn’t mean that increasing your bone density will decrease your risk of dementia—it may, but the evidence is not yet there. Of course, stronger bones are better than weak ones for many reasons. Having a structurally sound skeleton prevents fractures and increase quality of life as we age, so it’s a good idea to prevent bone loss, using strategies known to work, including adequate intake of calcium and other micronutrients, weight-bearing exercise, avoiding smoking, and limiting alcohol.
• The decline in estrogen that starts during perimenopause is associated with an increase in chronic inflammation, auto-immune disorders, obesity, metabolic changes, and Alzheimer’s disease. These associations are complex and may be affected by previous pregnancies and age at menopause. There is plenty of evidence that reducing inflammation reduces your risk of several conditions, including heart disease and certain cancers as well as Alzheimer’s disease, so with or without a menopause connection it’s prudent to follow an anti-inflammatory diet.
• A woman’s risk of stroke increases substantially after menopause for reasons that are not well understood. One study found that (in rats, at least) the loss of estrogen following menopause was associated with an increase in the release of inflammasomes. These proteins are active throughout life, but an excess of them after menopause is associated with a greater risk of ischemic stroke and neurogenerative diseases. On the other hand, estrogen replacement therapy also carries a risk of stroke, so the risks and benefits need to be weighed carefully. While the connection between estrogen and stroke risk is still unclear, the effects of stroke on the brain are well known, and the healthy habits to reduce your risk of stroke are well worth adopting.
• Women are less likely than men to develop Parkinson’s disease, but post-menopausal women are at greater risk than younger ones. That suggests a hormonal connection to the condition, with estrogen providing a protective effect. Some studies, however, have found an increased risk of Parkinson’s disease in women who took hormone replacement therapy. I hope that more research will clarify the complex relationship between menopause and Parkinson’s.

Women’s health—including brain health—has not been studied well enough to draw solid conclusions about how menopause affects the brain. I feel confident in saying that it does, and that future studies will better define the relationship. In the meantime I continue to recommend everyday habits that promote overall good health: a nutritious diet,  exercise, good sleep habits, and stress management.

Andrew Weil, M.D.

Sources
Marc Schatz, Sharnikha Saravanan, Nathan D. d’Adesky, Helen Bramlett, Miguel A. Perez-Pinzon, Ami P. Raval, “Osteocalcin, ovarian senescence, and brain health,” Frontiers in Neuroendocrinology, Volume 59, 2020, 100861, ISSN 0091-3022, doi/10.1016/j.yfrne.2020.100861. sciencedirect/science/article/pii/S0091302220300522

Xiao T, Ghatan S, Mooldijk SS, Trajanoska K, Oei L, Gomez MM, Ikram MK, Rivadeneira F, Ikram MA. “Association of Bone Mineral Density and Dementia: The Rotterdam Study.” Neurology. 2023 May 16;100(20):e2125-e2133. doi: 10.1212/WNL.0000000000207220. Epub 2023 Mar 22. PMID: 36948596; PMCID: PMC10186235. pubmed.ncbi.nlm.nih/36948596/

McCarthy M, Raval AP. “The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease.” J Neuroinflammation. 2020 Oct 23;17(1):317. doi: 10.1186/s12974-020-01998-9. PMID: 33097048; PMCID: PMC7585188. pubmed.ncbi.nlm.nih/33097048/

Raval AP, Martinez CC, Mejias NH, de Rivero Vaccari JP. “Sexual dimorphism in inflammasome-containing extracellular vesicles and the regulation of innate immunity in the brain of reproductive senescent females.” Neurochem Int. 2019 Jul;127:29-37. doi: 10.1016/j.neuint.2018.11.018. Epub 2018 Nov 27. PMID: 30500463. pubmed.ncbi.nlm.nih/30500463/

Welten SJGC, Onland-Moret NC, Boer JMA, Verschuren WMM, van der Schouw YT. “Age at Menopause and Risk of Ischemic and Hemorrhagic Stroke.” Stroke. 2021 Aug;52(8):2583-2591. doi: 10.1161/STROKEAHA.120.030558. Epub 2021 Jun 3. PMID: 34078111; PMCID: PMC8312566. pubmed.ncbi.nlm.nih/34078111/

Unda SR, Marciano S, Milner TA, Marongiu R. “State-of-the-art review of the clinical research on menopause and hormone replacement therapy association with Parkinson’s disease: What meta-analysis studies cannot tell us.” Front Aging Neurosci. 2022 Oct 20;14:971007. doi: 10.3389/fnagi.2022.971007. PMID: 36337706; PMCID: PMC9631815.

Barth C, de Lange AG. “Towards an understanding of women’s brain aging: the immunology of pregnancy and menopause.” Front Neuroendocrinol. 2020 Jul;58:100850. doi: 10.1016/j.yfrne.2020.100850. Epub 2020 Jun 3. PMID: 32504632. pubmed.ncbi.nlm.nih/32504632/