Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy

Abstract

During the menopausal transition, which begins four to six years before cessation of menses, middle-aged women experience a progressive change in ovarian activity and a physiologic deterioration of hypothalamic-pituitary-ovarian axis function associated with fluctuating hormone levels. During this transition, women can suffer symptoms related to menopause (such as hot flushes, sleep disturbance, mood changes, memory complaints and vaginal dryness). Neurological symptoms such as sleep disturbance, “brain fog” and mood changes are a major complaint of women transitioning menopause, with a significant impact on their quality of life, productivity and physical health. In this paper, we consider the associations between menopausal stage and/or hormone levels and sleep problems, mood and reduced cognitive performance. The role of estrogen and menopause hormone therapy (MHT) in cognitive function, sleep and mood are also discussed.

Psychological Climacteric Symptoms and Attitudes toward Menopause among Emirati Women

“…The MENQOL scale contains 29 items, which explore the experience of different menopausal symptoms as endorsed or not endorsed as well as the degree of being bothered by symptoms on a scale that ranges from 0 (not at all bothered) to 6 (extremely bothered). Symptoms assessed by the MENQOL are distinguished into four domains: vasomotor (items 1-3), psychosocial (items 4-10), physical (items [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], and sexual (items 27-29) [9,42]. The questionnaire was translated into Arabic by a professional translator.…”

“…Forgetfulness and reductions in attention, processing speed, and verbal fluency (indicated by difficulty finding words) are common cognitive problems endorsed by menopausal women and women in the menopause transition [11,12]. Declines in memory represent the second most frequent menopausal symptom after vasomotor symptoms and joint stiffness, and the severity of these symptoms can be quite alarming [1,12].…”

“…Declines in memory represent the second most frequent menopausal symptom after vasomotor symptoms and joint stiffness, and the severity of these symptoms can be quite alarming [1,12]. Estrogen deficiency alters brain structure and function, resulting in symptoms of cognitive aging and susceptibility to Alzheimer's disease in genetically vulnerable individuals [11]. In particular, estrogen, a neurosteroid with multiple neuroprotective effects, interacts with brain cells through its widely distributed estrogen receptors (ERs) β and α to regulate key processes relevant to executive functioning and memory: signal transduction and neurotransmission (e.g., of acetylcholine, serotonin, noradrenaline, and glutamate) in the prefrontal cortex, synaptic plasticity, production of neurotrophic factors such as nerve growth factor, neurite growth, dentate gyrus neurogenesis, DNA repair, mitochondrial production of adenosine triphosphate, and production of internal antioxidants [11,[13][14][15].…”

“…Menopause-related estrogen decline may trigger mood dysregulation by impeding the production of major neuroprotective factors (e.g., brain-derived neurotrophic factor) and, by altering neurotransmission, it interferes with the synthesis of catecholamines such as noradrenaline and upregulates 5-hydroxytryptamine (serotonin) (5-HT2A) receptor [1,11]. The latter contributes to hot flashes by modulating the set point temperature [1].…”

“…Mood changes that affect menopausal women are associated with numerous factors other than hormonal declines such as genitourinary symptoms (e.g., vaginal dryness/dyspareunia), less education, nonwhite ethnicities, history of smoking, history of anxiety and postpartum depression, nulliparity, obesity, stressful life events, poor social support and partner death, low self-esteem, unemployment, encountering multiple stressors, and poor coping style [11,16,18,20].…”