Dementia, Alzheimer’s Disease (AD) and the role of Hormones during (Peri)menopause

Dementia, Alzheimer’s Disease (AD) and Menopause

Alzheimer’s disease (AD) is characterised by the build-up of amyloid protein plaques in the brain, and it is the most common cause of dementia in the elderly. It results in loss of memory, significantly disturbs the individual’s daily life, and reduces their quality of life.

Worldwide there are 55 million people who are diagnosed with AD or dementia. The lifetime risk of AD is greater in women. Almost two third of people with AD are females.

The link between hormones and AD

Although initially this was thought to be due to the fact that women tend to live longer than men but now there is good evidence to show hormones, especially oestrogen, play a significant role in the sex difference in incidence of AD.

Although all three female hormones, oestrogen, progesterone, and testosterone play a role in brain function of females but there are many more oestrogen receptors in the brain and so oestrogen is crucial for its optimal function. Oestrogen increases energy production in the brain by metabolising glucose and it is also important for the neuroplasticity of brain which is important in the process of learning.

Testosterone has a similar function in brain function of males but the drop in its levels is much more gradual and hence the effect less acutely noticed.

(Peri)menopause and fluctuating hormones

Around the time of (peri)menopause there is a rapid fluctuation and eventual fall in the main female hormones. This results in symptoms like brain fog, poor memory, concentration, and focus.

Progesterone also plays an important role in brain function as it stimulates repair of brain cells (oligodendrocytes) and their protective sheath (myelin).

The case for Hormone Replacement Therapy (HRT) and how it can prevent AD

In May 2021 , results of 10-year retrospective analysis was published. In this research over 370, 000 women over the age of 45 with or without use of hormone therapy were analysed.

Patients with diagnosis of neurodegenerative disease (NDD) were identified. This included Alzheimer’s disease (AD), Parkinson’s disease (PD), dementia, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). Average follow up time was 5.1 years.

The paper concluded that hormone therapy was associated with reduced risk of all NDD, including AD and dementia, with greater duration of therapy and natural steroid formulations associated with greater efficacy.

AD is a chronic disease and individuals are more likely to develop it if they have a family history.  The pathological changes associated with AD starts years before manifestation of its symptoms and so it is important to start “risk reduction” measures to prevent or delay its development as early as possible. There is a hypothesis about “critical timing” for efficacy of hormone therapy to impact estrogenic action in brain.

Starting to replace hormones early and continuing to replace hormones for longer seem to have a greater impact on NDD prevention.

It’s also important to note that although the average age of menopause in the UK is 51 but 1 in 100 women enter menopause under the age of 40. This increases risk of developing all chronic diseases including AD. It is vital to consider all measures to reduce their risk of developing chronic diseases including AD even in the absence of menopausal symptoms.

Other factors that can reduce the chances of AD and Dementia

Other important factors which is just as important as optimising hormone levels, is lifestyle modification. Reducing cardiovascular risk factors by quitting smoking, reducing consumption of alcoholic beverages, reducing excess weight, and keeping cholesterol and blood pressure normal are all beneficial.

Lifestyle modification needs to be tailor made to the needs of individuals and made sustainable as our health at midlife is very important in how healthy we age.

1) Exercise

Increasing physical activity at perimenopause has been shown to reduce risk of developing dementia later in life.

Exercise also improves cardiovascular health.  A combination or aerobics exercise like brisk walking, tai chi, dancing, cycling for 30 minutes 5 times a week as well as muscle strengthening is recommended.

2) Nutrition

Basically, go for “heart healthy” diet.

Fats and fibre- Omega 3 + 6- DHA (RDA 2g) in fish and sea food as well as ALA in vegetables

Antioxidants- brain is metabolically very active and needs glucose for energy. Through the metabolism of sugar free radicals are produced. We know that free radicals result in faster ageing process in cells. Antioxidants clear up free radicals and are necessary to prevent rapid ageing process. Best antioxidants are vitamins A, C and E.

3) Sleep

Both the length and the quality of sleep are important in maintaining an optimal brain function. This is because in deep sleep when our body is completely still, our brain repairs and replenishes itself. With age, AD plaques naturally form, but during this deep phase of sleep, brain can clear the plaques and therefore reduce the risk of developing AD.

With the drop in female hormones at (peri)menopause, the sleep hormone (melatonin) level drops and stress hormone (cortisol) level rises. This results in early morning waking which can have a knock-on effect on brain function and energy levels and mood.

HRT has a beneficial effect on brain function via a combination of its effects. Replacing oestrogen and progesterone which work on brain stem (the sleep centre of the brain) improves sleep. Replacing hormones also results in better control of symptoms like night sweats which can disturb sleep. HRT results in better mood and motivation resulting in increased activities which can stimulate brain cell function.

4) Stress

Meditate before bedtime, try yoga, drink some herbal tea in the evening and stop looking at screen at least an hour before bedtime. Learn a new skill, join a book club, learn a new language or musical instrument if it interests you.

If you’re concerned about dementia or AD and would like to find out how OMC’s personalised treatment plans can help you, get in touch via our Contact page or Book a consultation with an experienced menopause doctor.