Women, Hormones and Cognition
There are many factors which affect cognitive status throughout the lifespan, with stress, poor sleep and depression being some of the best documented factors. There is a lot of talk, speculation and research going on presently about the role of women’s hormones and their effect on cognitive health in various life transitions, but few well-founded conclusions.
One often-asked question is whether cognitive changes noticed during peri-menopause and post menopause are hormonally related, presumably, with the decrease of estrogen production. So what does estrogen have to do with it? Estrogen plays a role in more bodily functions than just reproduction. In fact, estrogen has many important functions in the brain. Estrogen is a master regulator that functions through a network of estrogen receptors that controls and regulates energy metabolism in the brain. Estrogen ensures there is enough energy for optimal brain function and when estrogen levels drop in the brain, it changes how the brain uses glucose (the primary brain fuel) and that can also change neurotransmitter functioning. (1) For example, headaches are a common result of a drop in estrogen. This occurs immediately before menstruation for many women, but will also occur as a result of variation and decreases of estrogen in peri-menopause. It has been demonstrated that estrogen directly affects blood vessels through nitric oxide release; but it is not clear whether it is through this mechanism, or dysregulation of glucose metabolism (which can also cause headaches) or some other mechanism which results in the headache! So what we do know is that estrogen has both direct and indirect effects on brain systems and we do not clearly understand all the intricacies and interplay.
Although perimenopause is primarily viewed as a reproductive transition the neurological symptoms are indicative of alteration or disruption in many estrogen-regulated systems such as thermoregulation, sleep, circadian rhythms and mood regulation, which in turn affect various areas of cognitive function. The estrogen receptor network becomes uncoupled from the bio-energetic system during the peri-menopausal transition and as a result, neurological dysfunction can develop.
As a more direct effect, research has shown that estrogens elevate levels of neurotransmitters such as serotonin and acetylcholine and promote growth and formation of neurons and synapses. One animal study showed that estrogen reduced anxiety and depression directly due to its effects on serotonin and HPA axis function.
For women, research results suggest that verbal fluency mechanisms are the most vulnerable and most affected during the menopausal transition.(2) This comes as no surprise to many midlife women.
While this topic is currently being researched and studied, as yet there appear to be no firm conclusions as to how permanent reductions in various hormones post menopause impact cognition. Several large cross-sectional studies suggest that the peri-menopausal period of hormonal variation and the subsequent disruption to the neurological systems has the greatest impact, and that when hormones stabilize post menopause there is an adjustment to the “new normal”. (3)
What we do know, is that cognitive changes occur naturally as a result of the aging process for both men and women alike. Without focusing on hormones or gender, we can continue to emphasize nutritional interventions for preserving cognition such as a Mediterranean Diet including plenty of fish, vegetables and fruits, optimizing our fatty acid profiles, and utilizing additional specific supplements for supporting cognitive function. In my opinion, to use an old phrase with no offense intended, “What’s sauce for the Goose is sauce for the Gander” meaning, practitioners can address the needs of older adults concerned about age-related cognitive decline wholistically according to the individual. One of the kindest and most practical things a practitioner can do is to remind patients that aging is a natural process that everyone will experience differently and that some forgetfulness is “the new normal”.
By Lisa Murray RDN, LD
- Brinton R, Yao J, Yin F, Mack W, Cadenas E. Perimenopause as a neurological transition state. Nat Rev Endocrinol. 2015 Jul;11(7):393-405. doi: 10.1038/nrendo.2015.82. Epub 2015 May 26.
- Berent-Spillson A1, Persad CC, Love T, Sowers M, Randolph JF, Zubieta JK, Smith YR. Hormonal environment affects cognition independent of age during the menopause transition. J Clin Endocrinol Metab. 2012 Sep;97(9):E1686-94. doi: 10.1210/jc.2012-1365. Epub 2012 Jun 22.
- Gail A. Greendale, MD,corresponding author Carol A. Derby, Ph.D, and Pauline M. Maki, Ph.D Perimenopause and Cognition Obstet Gynecol Clin North Am. 2011 Sep; 38(3): 519–535.doi: 10.1016/j.ogc.2011.05.007