Journal / Preventive Care

Is it Menopause or Dementia?

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated October 14, 2021

Some types of memory loss aren’t related to dementia at all. They can stem from menopause and are very treatable conditions. Scientists have long suspected that estrogen and progesterone play a role in Alzheimer’s, and new studies on dementia and what occurs during a woman’s reproductive years support that idea.

Feel Like You Are Losing Your Mind?

If you are like most women experiencing peri- and menopause, you might notice a decline in your cognitive performance with brain fog, confusion, or memory problems. You are likely wondering if the memory loss may be due to early dementia or Alzheimer’s disease.

Memory loss – whether it’s difficulty remembering a person’s name or searching for your glasses that are on the top of your head – is a normal part of aging. It may not come as any surprise, but researchers have confirmed that the “brain fog” that often seems to roll in with menopause is real. As the hormone estrogen levels start to wain, so do the protective functions it provides in brain function.1 As estrogen levels decline, many women find themselves becoming increasingly forgetful or feeling “foggy.”1-4 That might look like missing appointments or just feeling a step behind in the conversation. It can be very concerning.

The hormone estrogen plays many roles in the body including stimulating energy production, supporting the immune system, and even has anti-inflammatory properties. So when it is not balanced, the whole body – including the mind – can suffer.1-2 This correlation between hormones and brain function has made many ask if low hormone levels are the cause of Alzheimer’s disease.

To be clear, Alzheimer’s disease is a specific type of degenerative brain disease and a form of dementia. Dementia is not one specific disease but rather an overall term that describes a group of symptoms. Alzheimer’s is the most common form of dementia. 

Living in the Sandwich Generation

Most of us in peri- and menopause are living in the middle of a generational sandwich – aka the sandwich generation – raising our kids and taking care of our parents. In our 40s through our 60s, middle-aged women often support both parents and children. This support can be financial, physical, and/or emotional. While we are lucky to have them in our lives, it is a stressful time. Many women, can’t remember a time when their lives were more stressful. In the midst of it all, peri- and menopause hits with all of its outrageous symptoms.

Alzheimer’s Disease researchers stress, “It’s a time in a woman’s life when she is taking care of everybody and she needs to take care of herself.”3,4

Many women try to ignore perimenopause, but it can last four-eight years.5 For most women, it starts in the late 30s to early 50s—a time when they likely face a lot of demands. Menopause can last another 10-15 years. So, it is worth sorting out ways to help yourself by normalizing your hormone levels.

For many women, cognition goes back to normal after menopause, but for others, it never gets better, and for some, it gets worse. As we look at our parents, sometimes it’s hard not to assume that whatever they are battling is what we will deal with down the road too. With all of the scary information in the media about Alzheimer’s, it’s hard to ignore that maybe we’ve been forgetting things lately — keys, names, appointments can leave you worrying, “Are these signs of dementia?”

Most Common Causes of Memory Lapses

If all of this sounds familiar, you’re not alone. It is true that the number of people with dementia is increasing, but that is partially due to the fact that more people are living longer leading to neurodegenerative diseases like Alzheimer’s.1 But there are many other reasons for memory problems, which is good news.

Unlike a neurodegenerative disease, if your cognitive symptoms are due to decreased hormone levels they don’t have to get worse – in fact, they can get better. Treatment is available that can do something about it – hormone replacement therapy (HRT).

First, we must identify the possible reason for a faltering memory, ranging from mood disorders, sleep deprivation, to the medications you take. Most often memory lapses are due to one of the following:

I. Hormonal Changes with Peri- and Menopause

Low hormones can cause brain fog, anxiety, and memory lapses. Research is clear,  memory loss is common in perimenopause and menopause.

II. Stress, Anxiety, and Depression

These three states of mind will definitely affect how your brain functions – especially its ability to recall the little things like – “where are my sunglasses?” Being distracted is an honest reason to forget where you put those glasses. Your brain can be ‘not in the mood to process or take in new information.1 That’s fair.

As we age, many of us are not getting out and interacting with friends and family as much as we used to. Likely, we aren’t exercising enough and not taking proper care of ourselves leading to anxiety and depression that will worsen memory issues.

III. Insomnia

Poor sleep and memory problems are often linked regardless of your age. Your ability to pay attention when sleep deprived is a fight you just won’t win; you will likely be sluggish and less able to retrieve information quickly.

Sleep also plays an important role in your ability to store memories. We know that dreams are a part of our mental processing and experts think that memories are sorted and filed away when you sleep. If you don’t get enough deep sleep you won’t be able to properly file those memories away.  Sleep disturbances are very, very common in perimenopause and menopause, but can be improved with HRT.

Scientists have studied the relationship between memory and sleep for over 100 years. We know that the ability to keep key memories – and also to discard unimportant, excessive information – takes place during sleep.2

IV. Medication

There are many medications that can impact your memory, but we will discuss just two types. The most common are medications that you might be taking daily – like the antihistamine found in Benadryl, Tylenol PM, and Advil PM (all have Diphenhydramine). These medications can directly alter the brain’s ability to retain information, and if you are taking them daily, they may also be impacting your ability to think clearly the next day.1 

When you treat anxiety or insomnia with benzodiazepines (such as Ativan, Valium, and Xanax) you can also be impacting your ability to remember. To add to the complexity, if you start taking these medications in your 40s and 50s, and continue taking them as you age, your body’s response to what was once a ‘normal’ dose may change. Normal levels can become too much and cause increasing memory problems.1 Even if there were no memory problems when you started taking the medication, recall can get increasingly worse with age.1

If you are noticing changes in your mental processing, talk to your doctor about the medications you are taking. It could be a simple fix of changing the dosage.

V. Alcohol

Many drinks in order to forget – and it comes as no surprise that it can affect your cognitive function. As we age our ability to metabolize alcohol may become increasingly problematic. As women age natural metabolic changes, and drops in hormones can exaggerate the effects of alcohol. Even as little as one drink a day can be enough to cause memory problems, and if you drink more those lapses may become even more pronounced.1 

VI. Medical problems

While it is a less common cause, memory loss may be caused by medical conditions like brain injuries, stroke, and vitamin deficiencies. So, it’s also important to consider these causes with your doctor.

Hormones and Mental Declines

Hormones, particularly estrogen, have lots of jobs, but one that is intriguing is the role they play in keeping the brain young and active.3 When researchers look at a variety of variables that might impact a woman’s hormone levels throughout her life, we see a common pattern. Here’s what we know, women are less likely to develop dementia later in life if they:7

  1. Begin to menstruate earlier (go through puberty sooner), 

  2. Go through menopause later. Menopause at age 45 or younger can increase the risk of dementia by 28%.

  3. Have more than one child. The risk of dementia for women who had three or more children was 12% lower than the risk for women who had one child.6  

  4. Maintain youthful levels of the hormones estrogen and progesterone, which can influence the risk of Alzheimer’s and other forms of dementia.5,6

  5. Take Hormone replacement therapy (HRT), which may offer a way to protect women’s brains if it is given at the right time/early enough.5-8

Multiple research studies indicate that identifying the role of decreased hormones during menopause could help explain why women make up nearly two-thirds of people in the U.S. with Alzheimer’s. It isn’t just that women are living longer, there is a biological underpinning. Scientists are investigating a possible link between menopause and dementia. Is there a link between cognitive problems and declining estrogen levels?

When researchers compared brain scans of men and women aged 40 – 60 it was clear that men and younger women don’t show the same level of mental declines as older women. Men didn’t show the same level of neuron loss or build-up of the  plaques between neurons that are linked to Alzheimer’s disease.3

The younger women who were not experiencing symptoms of menopause or perimenopause had brains that looked similar to the men’s brain scans. As women approach menopause, their hormone levels drop (estrogen, progesterone, and testosterone), and problems start to appear.4 For women in perimenopause, who are experiencing hot flashes and other menopause symptoms, scientists noticed a decline in energy levels inside the brain and the beginning of Alzheimer’s plaques.3,4

When we talk about brain energy we are talking about the activity levels and observe a  decrease of up to 40% on average during peri- and early menopause! Women in the older age group have more Alzheimer’s plaques than men of similar age or younger women.3,4 These changes will not be found in everybody, but the results point out an important role for estrogen and suggest that the role it plays in Alzheimer’s needs to be addressed.

To be clear, menopause does not cause Alzheimer’s, but with decreasing estrogen levels during menopause, your brain can become less resilient and less able to slow the development of Alzheimer’s plaques.3,4 We need evidence-based recommendations, about hormonal replacements that can prevent the disease.

HRT and Alzheimer’s

With a link between estrogen and progesterone levels and brain health, it makes sense to look at hormone replacement therapy (HRT) as an option for fighting cognitive decline. The notorious Women’s Health Initiative (WHI) mistakenly failed to report estrogen as brain-protective, and reported relationships between hormones increased the risk of heart disease and cancer. Not only are the WHI studies debunked, but new studies  have shown that starting estrogen replacement therapy closer to menopause might help fight cognitive declines.3,4

Recent research findings suggest that the levels of estrogen and progesterone — which rise at puberty and during pregnancy, then fall at menopause — affect the risk of developing Alzheimer’s and other forms of dementia. If levels are low, the risk of Alzheimer’s goes up. Studies show that higher levels of these hormones, through more pregnancies or more reproductive years, can reduce a woman’s risk of developing dementia.

We don’t know for certain if it’s the actual level of the hormones or the rapid changes in their levels that seem to lead to worsening Alzheimer’s risks. One possibility is that it’s not female sex hormones on their own, but rapid changes in their levels that are a problem.7,8 When women experience these dramatic hormonal transitions, like in perimenopause or menopause, possibly in the long run it can give rise to Alzheimer’s disease.7-10

One way for women to minimize the dramatic hormonal changes that occur at menopause is to use HRT. That approach fell out of favor with the WHI. More recent studies suggest that hormone therapy can be really helpful if women get it early enough.6 The effects of hormone therapy depend on the timing of use.  When women started taking estrogen after age 65 they were more likely to have trouble with memory. But women who started taking estrogen earlier did not have memory issues. Estrogen may benefit the mental function of younger women because it reduces hot flashes and so many other menopause symptoms.6

“The more hot flashes a woman has, the worse her memory performance. And when we intervene to address those hot flashes (with HRT), her memory performance bounces back.”6

Findings like these are renewing the idea that it may be possible to use HRT at peri- and menopause to prevent Alzheimer’s and other forms of dementia later on.6

Other Ways to Help Prevent Mental Declines.

In addition to hormonal supplementation, there are lifestyle changes that can help reduce your risk of these cognitive declines. And these changes can also help alleviate the other symptoms of menopause and can lower your risk of heart disease.

  1. Diet: Ensure you eat a nutritious diet that has lots of fiber, vegetables, fruit, whole grains, and legumes. Include moderate amounts of fish and olive oil, with meat and dairy, and reduce processed foods. Not only will eating this way potentially help with brain health, but it can help lower your risk for heart disease, diabetes, cancer, and many of the symptoms of menopause.

  2. Exercise: We have heard it for years,  exercise is good for the brain. While it doesn’t have to be a crazy exercise class, being active throughout the day has been associated with a much lower risk of Alzheimer’s disease later in life.3,4

  3. Think. Think. Think: Stimulate your brain in new ways, try a new language, memorize a poem, or join friends for a new game? Rummy anyone? Whatever it takes to get you concentrating and engaged in thinking will help to grow your brain to be stronger and more creative. This kind of brain engagement can help build extra reserves that can help prevent Alzheimer’s.3

  4. Reduce Stress: High stress levels can adversely impact the brain, and women’s brains seem to suffer from stress more noticeably than men of the same age.3,4 Meditation and calming exercises can be an effective way to get your brain to relax, increase the blood flow to the brain, and reduce cortisol (your stress hormone) levels.3,4

  5. Quit smoking: Smoking is obviously very bad for your health, but it is toxic to the ovaries which produce estrogen and progesterone.3 Women who are smokers typically reach menopause two years earlier than nonsmokers (before 50).

Age beautifully. Goodbye getting old.

Explore Treatments

Other Ways

  1. Sleep. Get at least 7 solid hours of sleep per night.

  2. Stay socially engaged. It is sometimes tough, but it is important.

  3. Take educational classes. There are so many ways to take classes now – phone apps, online courses etc., why not?

  4. Seek help for depression. Depression is directly correlated to the onset of Alzheimer’s. It should always be taken very seriously.

Appropriate Age-Related Changes vs. Inappropriate

You can expect some typical “age-related behaviors” according to the Alzheimer’s Association. Don’t be too concerned if you notice a slight change in memory, including:7

  • Making occasional mistakes when balancing your bank account

  • Occasionally needing help remembering how to do things like record a TV show

  • Having trouble sometimes finding the right word

  • Misplacing things but being able to retrace your steps to find them

  • Making a poor decision on occasion

  • Sometimes feeling tired of work, family, and social obligations

  • Having specific ways of doing things and getting irritated when the routine is disrupted

How do you know when your memory changes are not part of normal aging? The Alzheimer’s Association advises visiting your doctor if you experience any of these 10 warning signs:

  1. Memory loss that disrupts your daily life

  2. Challenges in your ability to plan or solve problems, like following a recipe or paying bills

  3. Difficulties completing familiar tasks like driving to a familiar location

  4. Confusion with time or place

  5. Trouble understanding visual images and spatial relationships

  6. New problems with words when speaking or writing, like calling things by the wrong name

  7. Misplacing things and finding them in unusual places

  8. Decreased or poor judgment, for example, when dealing with money or personal hygiene

  9. Withdrawal from work and social activities

  10. Changes in mood and personality, and becoming easily upset when out of your comfort zone

Summary: 

While memory lapses may feel scary, most have a treatable cause. Most memory problems unrelated to dementia are temporary and can be treated by normalizing your hormone levels, stopping or changing the dosage of medications, getting better sleep, and/or improving your diet.

If you notice memory problems, don’t automatically assume the worst. Instead, start collecting information about the lapses you’re having. Ask others around you if they’ve noticed changes and make sure you understand what Alzheimer’s is. The people who are close to you are often the first to see differences in your behavior or to notice patterns. You should see your doctor immediately if you experience memory problems that are putting your safety at risk, like leaving things on the stove, or unsafe driving.

Take your concerns to your doctor and ask about Alzheimer’s risks. Be certain to bring a complete medication list and mention any other symptoms you may be experiencing.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References:

  1. https://www.health.harvard.edu/mind-and-mood/is-it-dementia-or-something-else

  2. https://www.sleepfoundation.org/how-sleep-works/memory-and-sleep

  3. https://www.considerable.com/health/dementia/menopause-alzheimers-dementia/

  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198681/

  5. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal

  6. https://www.npr.org/sections/health-shots/2018/07/23/630688342/might-sex-hormones-help-protect-women-from-alzheimer-s-after-all-maybe

  7. https://www.alz.org/aaic/overview.asp

  8. https://www.npr.org/sections/health-shots/2016/03/30/472161906/possible-heart-benefits-of-taking-estrogen-get-another-look

  9. https://www.dailymail.co.uk/health/article-5529805/Hormone-replacement-therapy-boost-brain-stop-memory-loss.html

  10. https://www.texaschildrens.org/blog/2015/10/memory-changes-it-menopause-or-alzheimer%E2%80%99s