Menopause in Mind: Do Hormones Explain Your Midlife Memory Problems?

Co-authored by Anna Blanken and Darby Saxbe, Ph.D.

Around two-thirds of women report undesirable changes in memory during midlife that can be both frustrating and embarrassing. Common experiences may include more frequently misplacing keys or important items, forgetting names, difficulty finding the correct words to say, or walking into a room only to forget one’s purpose. Uh oh—does any of that sound familiar or significant for an adult entering their 50s? In fact, upon noticing these changes, many women fear they have begun to develop dementia. Luckily, research on the cognitive changes associated with menopause, and other changes in female hormone levels, has picked up in recent years. The more we know about the expected effects of hormonal transition periods, the more we can normalize some of these anxiety-producing experiences for women, while also keeping an eye out for more sinister signs of neurodegenerative disease.

A recent study published in the scientific journal, Neurology, investigated how the age at which menopause starts may affect an individual’s cognitive changes. At least 13 previous studies have reported that women who enter menopause later tend to have better cognitive function. Attempting to better understand this link, researchers from University College London examined how two aspects of cognition, verbal memory, and processing speed, changed for women during midlife (e.g., during menopause). They measured these thinking skills four times over a period of 26 years (ages 43-69), while also examining multiple forms of menopause (e.g., surgical vs. natural) and contributions from other life factors that may play account for or alter hormone changes or cognition (e.g., hormone replacement therapy, socioeconomic status, smoking status, education). Their results supported the previous findings that later age of menopause was associated with higher verbal memory score, even after adjusting for the effects of BMI, education, childhood cognitive ability, and use of hormone replacement therapy. Similarly, for women with surgically-induced menopause, later age of surgery was associated with better verbal memory score, however, for these women, other life factors like education seemed to explain the difference.

Source: Kalhh/Pixabay

What could explain this difference? Well, more studies have shown that there are receptors in the brain, called estrogen receptor β, that are activated by estrogen. These receptors are also responsible for modulating brain-derived neurotrophic factor, which is a protein that is found concentrated in the part of the brain, the hippocampus, that is important for forming memories! This brain structure is also implicated in Alzheimer’s disease, by the way. This in no way suggests that all women going through hormonal changes are going to develop Alzheimer’s, but rather validates that the experience of brain fog is due to hormone changes that involve the same memory systems that are affected in Alzheimer’s disease! No wonder the symptoms are so easy to confuse for dementia. A major difference between the memory issues seen during menopause and those associated with Alzheimer’s disease is that the lapses in memory function caused by transitioning levels of hormones are not as consistent (e.g., they happen sometimes, not always), they do not exceed what is expected for age (this can be harder to determine without neuropsychological testing), and they should not become progressively worse over time.

Of course, much more research is needed in this area to understand how the transition in hormone levels during midlife affects women. There is plenty of opportunity for improving women’s health care. For example, despite being abandoned as a treatment option for dementia due to numerous adverse effects during clinical trials, estrogen replacement therapy may still be a viable treatment option to combat brain fog during particular times in a woman’s life, such as early on in the menopause transition. Similarly, other protective mechanisms need to be considered to find ways to keep women’s brains healthy as estrogen levels decrease.

Source: Anna Blanken Used with Permission

Co-author Anna Blanken is a graduate student in the USC Psychology Department's Clinical Science program.