60% of middle-aged women report difficulty concentrating and experiencing cognitive issues. While a cognitive decline is expected with age, studies indicate that a contributing factor could be menopause, which is characterized by a decline in reproductive hormones such as estrogen and progesterone. Estrogen, primarily known for its function in menstruation and reproductive well-being, also serves as a neuroprotective hormone responsible for maintaining cognitive health. The brain’s vitality is dependent on estrogen — a steady flow of the hormone to estrogen receptors in the brain is essential for memory, concentration, and stable mood. Lack thereof can increase the risk of cognitive disorders such as Alzheimer’s and other forms of dementia.
During the perimenopausal stage, the few years leading up to menopause, ovaries gradually begin producing less estrogen and may cause brain fog, hot flashes, and mood swings. While these symptoms are common during this phase, women often don’t link the loss of mental clarity to menopause. Even general physicians, sometimes unaware of the effects of menopause, establish depression as a likely cause of the symptoms and prescribe antidepressants. Antidepressants won’t treat the root cause of menopause, but hormone replacement therapy has been shown to be effective.
It’s not yet conclusive as to whether HRT will prevent Alzheimer’s; however, anecdotal data suggests it can make a positive difference and may lower the risk of the illness. Dr. Louise Newsom, a general physician, and menopausal expert, advocates for HRT due to experiencing symptom relief from it herself, “I’m a doctor and a mother of three and my brain not on HRT is awful. Leaving keys in the fridge awful. I would forget to take my children’s games kit to school, or struggle to remember the name of a drug I had prescribed for years…”
The time at which HRT is taken from the onset of menopause is critical for achieving maximal benefits. In two recent studies, women who started taking estrogen after 65 were more likely to have trouble with thinking and memory. Women who started between 50 and 54 were not. The general consensus is that taking HRT within 10 years of onset is best — it ensures hormonal levels are adequate enough to protect brain function and prevent severe neurodegeneration later on.
The following are different forms of estrogen therapy:
- Estrogen pill – the most common treatment, and generally taken once a day without food. Your doctor will recommend the dosage and provide further instructions.
- Estrogen patch – patch is worn on the skin of your abdomen and is replaced every few days. Patches can have different dosages and hormone combinations.
- Topical Estrogen – this includes creams, gels, and sprays. This treat is absorbed by the skin and into the bloodstream.
- Vaginal estrogen – comes in a cream, vaginal ring, or vaginal estrogen tablet. It is used for vaginal dryness, itchiness, or pain during intercourse. Creams are used daily and the ring is replaced every three months.
There are risks of HRT to be aware of, including but not limited to: heart disease, stroke, blood clots, and breast cancer. Risks increase with age. Women with a history of breast cancer, ovarian cancer, endometrial cancer, blood clot in the legs or lungs, liver disease, or stroke generally are advised alternative treatments.
To see if HRT is right for you, discuss with your physician your individual symptoms and health risks.
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