Preventing Dementia at Menopause

Three weeks ago my stepfather passed away from complications related Alzheimer’s disease. Over the course of his illness, it was heartbreaking to watch this bright and charismatic man gradually become confused, withdrawn, and eventually unable to recognize my mother, his wife of 30 years.

Most of you likely have a similar story to share. And if you don’t have one yet, unfortunately the odds are that someday you will. 

Currently, there are an estimated 46.8 million people in the world living with dementia. This number is expected to almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050.  One new case of dementia is diagnosed every 3.2 seconds.


Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.

Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.

Dementia vs Alzheimer’s Disease

Dementia isn’t technically a disease. It’s a group of symptoms that affect mental tasks like memory and reasoning. Dementia can be caused by a variety of conditions, the most common of which is Alzheimer’s disease. As dementia progresses, it can have a devastating impact on the ability to function independently. It’s a major cause of disability for older people, and places an emotional and financial burden on families and caregivers.

Currently, there are no drugs that effectively stop or prevent the course of dementia.


Women are at Increased Risk

More women than men get dementia, in part because women tend to live longer than men and the chances of developing dementia increase with age. The other reason is related to genetic factors that are expressed uniquely in women, specifically mutations at the APO-E gene.  Women who carry the APOE-E4 gene, which increases the risk for Alzheimer’s, are more likely to develop the disease than men who have the same gene. The reasons for this difference are not yet fully understood. 

What I do know for sure is that many of my patients experience memory loss and brain fog around mid-life and concerns about a future decline into dementia are important to consider when evaluating treatment options for menopause.


Hormone Therapy Can be of Benefit

In addition to an organic whole foods diet, appropriate clinical nutrients, physical fitness and cognitive exercises, hormone replacement therapy can help ensure our cognitive abilities stay strong as we age.

A number of studies have shown that estrogen therapy at the time of menopause can preserve brain structure and reduce the risk of dementia in women. A recent study published in the Neurobiology of Aging confirms these earlier findings and provides more support for the proper use of hormone therapy at mid-life.

Specifically, MRI scans of the brains of women in this study showed that those who had taken estrogen throughout menopause had a larger hippocampus. The hippocampus is one of the most important structures in the brain for memory and sense of place and the part of the brain that is affected early in the progression of Alzheimer’s disease.


Timing is Important

It is important to note that the benefits of hormone replacement therapy were shown to be greatest for women who started at the time of menopause and then remained on hormones past menopause. Women who discontinued therapy after menopause lost the benefits gained during the time of treatment.


Consider bHRT

There are many reasons to consider the use of bio-identical hormones at menopause to manage symptoms, prevent osteoporosis and cardiovascular disease. Now we have more evidence that women who use estrogen at the time of menopause, and who remain on estrogen therapy, may also have a reduced risk of dementia.

Decisions about the appropriate treatments for menopause are best made on an individualized case basis. Let’s discuss whether hormone therapy is the right choice for you.

It's definitely worth thinking about.