Menopause and Alzheimer’s: What Do We Know About the Hormone Connection?
Around 65% of people currently living with dementia are women.
Age is the biggest risk factor for dementia and, because women generally live longer than men, this accounts for some of the difference. However, researchers don’t believe longevity tells the whole story.
Increasingly, scientists are investigating whether hormones, and particularly the significant fall in oestrogen that occurs around menopause, could be another piece of the puzzle.
For generations, menopause was largely discussed in terms of periods stopping, hot flushes and a difficult few years to get through. Today, we are learning much more about the influence hormones can have throughout a woman’s body, including on our bones, cardiovascular system, metabolism and brain.
So, what do we currently know about menopause and Alzheimer’s, and what could emerging research tell us about women’s long-term brain health?
About Me
Before we continue, I wanted to introduce myself. I’m Lorraine Bellis, the proud owner of Herbs of Grace.
Women’s health is something we care deeply about, not just because of the work we do, but because of our own experiences as women. We know how easy it is to put our health further down the list, accept symptoms as “normal” and simply get on with things.
At Herbs of Grace, we want women to feel informed and confident talking about their health through every stage of life, and we offer a range of natural herbal supplements for women.
Why Are Women More Affected by Dementia?
According to the Alzheimer’s Society, women make up an estimated 65% of people currently living with dementia. Women’s longer life expectancy is certainly a factor, but it doesn’t appear to explain the difference completely.
One area researchers are investigating is oestrogen and brain health.
Oestrogen isn’t simply a reproductive hormone. Oestrogen receptors are found throughout the body, including in the brain, and research has shown that oestrogen is involved in processes associated with memory, cognition and brain function.
Before menopause, the ovaries produce significant amounts of oestrogen. During perimenopause, hormone levels begin to fluctuate before eventually falling substantially.
Interestingly, men continue to produce testosterone throughout their lives, some of which can be converted into oestrogen within brain cells. This means that after menopause, women can have lower levels of oestrogen in the brain than men of the same age.
That doesn’t mean that low oestrogen causes Alzheimer’s disease. Alzheimer’s is a complex condition influenced by ageing, genetics, cardiovascular and metabolic health, lifestyle and many other factors.
However, it has led researchers to ask an important question: could menopause represent a particularly important period for women’s future brain health?
Why Is Research Into Menopause and Brain Health Still Developing?
Given that menopause is a natural stage of life for women, it might seem surprising that there are still so many unanswered questions about its potential long-term effects.
Part of the explanation lies in the history of medical research.
For decades, women were under-represented and sometimes deliberately excluded from clinical research. Concerns around pregnancy, the potential effects of experimental medicines on unborn babies and even the perceived complications caused by fluctuating female hormones contributed to this.
In 1977, the US Food and Drug Administration recommended excluding women of childbearing potential from early-stage drug trials.
It wasn’t until the 1990s that this began to change significantly. The US National Institutes of Health established its Office of Research on Women’s Health in 1990, while legislation introduced in 1993 required women to be included in NIH-funded clinical research unless there was a valid reason for their exclusion.
The result is a gap in our understanding of women’s health that researchers are still working to fill today. For too long, findings from research conducted predominantly in men were often assumed to apply equally to women.
Menopause research faced another significant complication: HRT.
HRT, Menopause and the Study That Changed Everything
The Women’s Health Initiative (WHI), launched in the US in 1991, was an enormous research programme involving more than 160,000 postmenopausal women.
Part of the research investigated hormone therapy and whether it might protect women against chronic conditions such as cardiovascular disease.
Then, in 2002, results from one part of the hormone trial caused widespread concern. The study reported increased risks associated with a particular combined hormone treatment, including breast cancer and cardiovascular problems.
The resulting headlines transformed attitudes towards HRT almost overnight. Many women stopped taking it and prescribing rates fell dramatically.
Over the following two decades, however, researchers have developed a much more nuanced understanding of the findings. One important consideration was the age of the women studied.
Women taking part in the WHI hormone trials ranged from 50 to 79. Many were considerably older than the average age at which women naturally experience menopause, and some began hormone therapy many years after menopause.
Subsequent research has therefore explored factors including a woman’s age, how close she is to menopause when treatment begins, the hormones being used and how those hormones are administered.
This doesn’t mean the original research was “wrong”. Rather, scientific understanding has continued to develop as researchers have asked more specific questions and gathered further evidence.
One of those questions concerns the brain.
What Does Research Tell Us About Menopause and Alzheimer’s?
A study published in JAMA Neurology in 2023 examined 292 cognitively healthy adults, including 193 women.
Researchers looked at two proteins strongly associated with Alzheimer’s disease: beta-amyloid and tau. They found that women had higher levels of tau than men in several areas of the brain, particularly when beta-amyloid was already elevated.
An earlier age at menopause was also associated with greater tau accumulation in women who already had higher beta-amyloid levels.
Researchers additionally examined hormone therapy. Women who began hormone therapy more than five years after menopause had higher tau levels than women who started it closer to menopause.
It’s important to be clear about what this research does and doesn’t tell us. The study was observational. It doesn’t prove that menopause causes Alzheimer’s, nor does it prove that taking HRT prevents it.
However, the findings contribute to a growing body of research investigating whether when menopause occurs, and potentially when hormone therapy is started, could be relevant to women’s long-term brain health.
If something has been going on long enough that you've quietly built a way of living around it, that's usually the sign it's worth raising again, not evidence that it's fine. For me, that meant planning around toilets and accepting flooding as part of my life. For someone else, it could mean arranging life around pain, avoiding certain activities or simply getting used to feeling unwell.
Sometimes the adaptations we make tell us more about the impact of a symptom than the symptom itself.
Menopause, Memory and Brain Fog
Long-term brain health isn’t the only reason researchers are interested in the relationship between hormones and cognition. For many women, changes to memory and concentration are noticeable during perimenopause and menopause.
Researchers at Newson Health have been investigating cognition, including memory, concentration and the ability to think clearly, during this stage of life. In data involving more than 10,000 women attending Newson Health, 97% reported problems with memory or concentration.
It’s an experience that will probably sound familiar to many women: walking into a room and forgetting why you went there, losing a word halfway through a sentence or finding yourself reading the same paragraph repeatedly because the information simply isn’t going in.
For many women, menopause brain fog can be very real.
Other Newson Health data involving 978 women found that 93% reported memory problems and 91% reported difficulty concentrating. After three months of HRT, 57% reported improvements in concentration and 49% reported improvements in memory.
Again, these figures need to be considered carefully. They represent self-reported improvements in menopausal symptoms. They don’t demonstrate that HRT prevents Alzheimer’s disease.
What they do add to is the evidence that changing hormone levels can affect cognition during menopause.
Could Genetics Influence Women’s Alzheimer’s Risk?
Genetics could be another part of the picture.
Newson Health researchers are investigating whether the effects of HRT on cognition differ depending on a woman’s APOE genotype.
APOE is a gene involved in transporting fats and cholesterol around the body and brain. There are several versions of the gene, including APOE4, which is the strongest common genetic risk factor for late-onset Alzheimer’s disease.
Having APOE4 does not mean that someone will develop Alzheimer’s. Equally, people who don’t have APOE4 can still develop the condition.
Researchers hope that understanding how genetics interact with women’s hormones could eventually help explain why some women may be more vulnerable than others.
It also demonstrates just how interconnected women’s health can be. Hormones, the brain, cardiovascular health, metabolism, inflammation, sleep, diet, exercise and even the gut microbiome don’t exist independently of one another.
Does HRT Prevent Alzheimer’s?
Based on current evidence, we cannot say that HRT prevents Alzheimer’s disease. This distinction is important.
Researchers are investigating whether the timing, type and duration of hormone therapy could influence long-term brain health, but the evidence is still developing.
Some observational studies have found lower rates of dementia among certain groups of women taking hormone therapy, particularly when it was started around the time of menopause.
Other research, particularly involving women beginning hormone therapy at an older age, has produced different findings.
This isn’t an argument that every woman should take HRT. Instead, it highlights the importance of women being able to have informed conversations about menopause, their symptoms, individual medical history and the options available to them.
If you are considering HRT, speak to an appropriately qualified healthcare professional who can provide advice based on your individual circumstances.
How Can Women Support Brain Health as They Age?
Statistics about women and Alzheimer’s can understandably sound worrying, but they don’t mean our future health is already determined.
Hormones are only one part of an extremely complex picture, and research has identified a number of factors associated with dementia risk that individuals may be able to influence.
Cardiovascular health is particularly important because many of the habits associated with a healthy heart are also associated with better brain health.
Supporting healthy ageing means looking at our wellbeing as a whole. Staying physically active through a combination of strength and aerobic exercise, eating a varied, predominantly whole-food diet with plenty of plants, maintaining healthy blood pressure and cholesterol, avoiding smoking and moderating alcohol can all play a part. Good-quality sleep matters too, as do strong friendships and social connections, continuing to learn and challenge the brain, managing conditions such as diabetes with appropriate medical care, and having hearing loss checked and treated where necessary.
None of these provides a guarantee against Alzheimer’s disease. Together, however, they form part of the bigger picture of supporting our health and wellbeing as we age.
Is It Time to Think Differently About Menopause?
Perhaps one of the biggest lessons emerging from menopause research is that we need to think about this stage of life differently.
Previous generations of women were told remarkably little about menopause. It was often something women were simply expected to put up with, with conversations typically limited to hot flushes and periods stopping. Today, research is demonstrating that hormones aren’t simply about reproduction. Their influence reaches our bones, cardiovascular system, metabolism and brain.
Because women’s health was historically under-researched, scientists are still trying to answer important questions about what hormonal changes during menopause could mean for women’s health 20 or 30 years later. The fact that women account for around two-thirds of people living with dementia makes women’s brain health an important area for continued research.
Rather than allowing these statistics to frighten us, they can encourage us to ask better questions.
What happens to the female brain during perimenopause? What role does oestrogen play? Why are some women more vulnerable than others? How do genetics such as APOE4 fit into the picture? Does the timing of hormone therapy matter?
And, perhaps most importantly, what can women do now to support their health and wellbeing as they age?
Researchers don’t yet have all the answers. But after decades in which women’s hormonal health received far too little research attention, scientists are finally investigating many of these questions specifically in women.
Greater knowledge gives us the opportunity to understand our bodies better, ask more informed questions and make considered choices about our health.
Supporting Women’s Health Naturally with Herbs of Grace
At Herbs of Grace, we believe women deserve to feel informed, empowered and supported through every stage of life.
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This article is for general information only and isn’t intended to diagnose, treat or prevent Alzheimer’s disease or any other medical condition. If you are concerned about changes in your memory or cognition, or would like advice about menopause or HRT, speak to an appropriately qualified healthcare professional.