Cognitive Decline in Early and Premature Menopause

Abstract

Early and premature menopause, or premature ovarian insufficiency (POI), affects 1% of women under the age of 40 years. This paper reviews the main aspects of early and premature menopause and their impact on cognitive decline. Based on the literature, cognitive complaints are more common near menopause: a phase marked by a decrease in hormone levels, especially estrogen. A premature reduction in estrogen puts women at a higher risk for cardiovascular disease, parkinsonism, depression, osteoporosis, hypertension, weight gain, midlife diabetes, as well as cognitive disorders and dementia, such as Alzheimer’s disease (AD). Experimental and epidemiological studies suggest that female sex hormones have long-lasting neuroprotective and anti-aging properties. Estrogens seem to prevent cognitive disorders arising from a cholinergic deficit in women and female animals in middle age premature menopause that affects the central nervous system (CNS) directly and indirectly, both transiently and in the long term, leads to cognitive impairment or even dementia, mainly due to the decrease in estrogen levels and comorbidity with cardiovascular risk factors, autoimmune diseases, and aging. Menopausal hormone therapy from menopause to the age of 60 years may provide a “window of opportunity” to reduce the risk of mild cognitive impairment (MCI) and AD in later life. Women with earlier menopause should be taken care of by various specialists such as gynecologists, endocrinologists, neurologists, and psychiatrists in order to maintain their mental health at the highest possible level.

Association between dietary inflammatory index and cognitive impairment among American elderly: a cross-sectional study

“…As the women enrolled in this study were over 60 years old, the majority of them were experiencing the menopausal period. Many researches have indicated a connection between estrogen and impairments in cognitive abilities ( Schwarz et al, 2023 ; Sochocka et al, 2023 ). Primarily, the mechanism for this cognitive impairment is believed to stem from the direct impact of diminished estrogen concentrations on neural cells.…”

The Heterogeneity of Post-Menopausal Disease Risk: Could the Basis for Why Only Subsets of Females Are Affected Be Due to a Reversible Epigenetic Modification System Associated with Puberty, Menstrual Cycles, Pregnancy and Lactation, and, Ultimately, Menopause?

“…However, the studies by Seo et al [19] and Yang et al [20] were performed with Asian populations while that of de Bakker et al [21] was with a Canadian population that was likely mainly Caucasian, so there could potentially be racial/ethnic differences in this regard. Early menopause, defined as menopause onset < 40 years of age, has been reported to increase the risk of developing dementia and cognitive decline (reviewed in [22][23][24]).…”

A systematic review of community pharmacy interventions to improve peri- and post-menopausal health

“…12 The incidence of cardiovascular disease, rheumatoid arthritis, Alzheimer's disease and ovarian cancer has also been shown to be associated with menopause. 13,14 Community settings such as community pharmacies are ideally placed to provide support and advice for peri-and post-menopausal women. Community pharmacies are highly accessible 15 and beyond dispensing medicines, pharmacy teams are involved in health screening, medication management and providing lifestyle advice, amongst a range of other services.…”

“… 12 The incidence of cardiovascular disease, rheumatoid arthritis, Alzheimer’s disease and ovarian cancer has also been shown to be associated with menopause. 13 , 14 …”