Menopause and Dementia - What You Need to Know | Stella
Long-term health
12 mins

Menopause and dementia – what you need to know

byDr. Nick Morse

Menopause can leave you feeling confused, unfocussed, and forgetful. It is easy to see why many people wonder if they could be showing early signs of dementia at this time.

While dementia is common in older people, it is relatively unusual for it to develop at the time of menopause, which usually happens in your late 40s and early 50s. Read on to find out about the early signs of dementia, if hormone therapy (HT) helps, and when you should see your healthcare provider.

What is dementia?

Almost seven million people over 65 are estimated to be living with dementia in the US.

Dementia is an umbrella term for a number of different diseases that can cause similar symptoms, such as:

  • memory problems
  • slowed thought processes
  • problems coping with normal daily activities

The symptoms vary dramatically in severity. While some will experience only mild inconvenience, others will require round-the-clock care.

The underlying diseases include Alzheimer’s disease, vascular dementia, and Lewy Body dementia.

What are the early signs of dementia?

Early signs of dementia can be extremely varied, and are often quite subtle. Some people will only realize the true extent of their early symptoms when looking back many years later.

Possible symptoms include:

  • Memory problems and forgetfulness – either recent events or things that happened long ago
  • Thinking more slowly than usual
  • Trouble with language – for example, struggling to find the right word or to understand what is being said to you
  • Difficulty making decisions or judgments
  • Struggling with organization or planning
  • Changes to your mood – including feeling low, anxious, irritable, or angry
  • Personality changes
  • Struggling with your usual activities, such as moving from one task to another, physical coordination and manual tasks

As you can see, many of these symptoms are often experienced in menopause too. This is why your healthcare provider should properly assess any signs that you are worried about – there may be something else going on.

You may hear some unfamiliar terms used when discussing these and other symptoms. Here are a few:

  • Cognitive symptoms these affect the way you think and reason. They include problems with remembering, speaking, understanding, concentrating, and problem-solving
  • Cognitive impairment – any problem with the way you think and reason. This is a catch-all term that includes both minor issues with those areas mentioned above, as well as more severe problems
  • Brain fog – this refers to problems with concentration, focus, memory, and clarity

Can menopause be confused with dementia?

Absolutely! In menopause, it is common to struggle with memory, concentration, brain fog, and mood changes. These can be made worse by the physical symptoms that also go along with menopause. Sleep deprivation, hot flashes, and aches and pains can all contribute.

It is sometimes easy to link your symptoms to menopause when this might not be the case. Other conditions, including thyroid problems and depression, can also cause symptoms that look like dementia.

If your symptoms are disruptive or persist, speak to your healthcare provider. They will be able to help you find the root cause and identify any suitable treatments.

Does menopause cause dementia?

In a word, no. Every woman goes through menopause if they live long enough. If menopause caused dementia, all women would eventually have the disease and this is not the case. Only 3% of adults aged 70 to 74 had dementia in 2019, and only 33% of adults aged 90 and older had dementia.

However, the decrease in estrogen during menopause may affect the biology of the brain in ways that contribute to the development of dementia. The following are two possible explanations of how this may happen – neither are scientifically proven.

  1. Estrogen helps several hormones to work properly within the brain. These include serotonin, acetylcholine, and dopamine. As these hormones are involved in memory and mood regulation, lower estrogen levels could affect these pathways and contribute to the development of dementia. 
  1. Estrogen is thought to help prevent the build-up of harmful proteins that can lead to some types of dementia. In Alzheimer’s disease, proteins known as amyloid-β and tau build up within the brain where they cause damage to the cells. A decrease in estrogen after menopause removes this protective effect, so this may be why these proteins can build up more quickly after menopause.

Can hormone therapy (HT) help reduce the risk of dementia?

We are still learning about the way that hormones like estrogen and progesterone affect brain health. This is a complex topic and your risk of dementia depends on multiple factors including lifestyle, genetics, and luck. If HT plays any role, it is probably a minor one compared to other factors.  

Studies on HT and dementia have so far shown mixed results. One 2023 study showed that taking HT was associated with a decrease in the risk of dementia symptoms in people who carry a specific gene – APOE4 – responsible for an increased risk of dementia. However, an association does not prove that HT is the cause of this result. The evidence is still not strong enough to recommend HT solely to protect against or treat dementia.

However, HT is a proven and effective treatment for many menopause symptoms, and many people find that it helps with menopausal forgetfulness and brain fog. Like all medications, HT comes with certain risks and side effects, and is not suitable for everyone. 

Read more about the risks and benefits of HT.

Does HT cause dementia?

We are still learning about the impact of HT on dementia risk. Experts currently advise that taking HT does not increase your risk of dementia.

This became a topic of debate when a 2023 research paper suggested that certain types of HT increased dementia risk. However, others raised doubts about the study’s conclusions, saying that its participants were more likely to have dementia, and more likely to be diagnosed early due to their health behaviors.

Expert opinion is unchanged. We do not currently have any convincing evidence to link HT to dementia, but research is ongoing and will be evaluated as more information comes to light.

Read more about the benefits and risks of HT.

Does early menopause increase your risk of dementia?

Most people go through menopause in their late 40s or early 50s, with 51 being the average age of menopause in the US.

However, some experience early menopause before age 45 or premature menopause before age 40. 

Premature menopause can be associated with an increased risk of developing dementia. However, we still do not know to what extent HT prevents this. Some studies seem to suggest a protective effect in this age group, but further research is needed to confirm this. 

HT is strongly recommended for those who have gone through premature or early menopause, regardless of whether or not it reduces the risk of dementia. This is because HT is proven to help maintain your bone density and reduce the risk of heart disease.

What can you do to prevent dementia?

A generally healthy lifestyle can help to keep your brain healthy. It is estimated that up to 40% of dementia cases could be prevented or delayed by lifestyle changes.

Some great ways to boost your brain health:

  • Stop smoking. Smokers are more likely to get dementia, so stopping can cut your risk
  • Get some exercise. This is another big win, with a potential reduction in risk of 40%
  • Stay mentally active. Education, challenging work, and other types of mental stimulation (for example, puzzles and language learning) all count
  • Maintain a healthy blood pressure. Speak to your healthcare provider to get your blood pressure checked, watch your weight and salt intake, and take blood pressure medicines if prescribed to you
  • Check your hearing. Poor hearing is thought to lead to cognitive harm because the brain becomes under-stimulated. Wear a hearing aid if it is recommended – it may help reduce your risk of dementia 
  • Maintain a healthy BMI between 18.5 and 25. Obesity is linked with dementia in later life
  • Drink in moderation. A review of studies looking at alcohol consumption and dementia found that heavy drinking was associated with an increased risk

When should you see your healthcare provider?

It is important to see your healthcare provider if you have any concerns about your memory, physical coordination, or any other brain function.

There are lots of possible causes for these symptoms and your healthcare provider will be able to help you understand if there is a significant medical problem and give you an accurate diagnosis if there is.

Likewise, many of the other conditions that can mimic dementia – including menopause – have safe and effective treatments. HT might be a useful option for you, especially if you have other symptoms of menopause.

How will your healthcare provider assess you for dementia?

They may ask you to take a quick memory test, which can be done in a few minutes. They may also ask to speak to your closest friends or family for more information, as those close to you may have noticed things worth highlighting. More detailed and lengthy testing may follow when simple tests or interviews raise concerns.

It may help to keep a list of your symptoms to take to your appointment. Specific examples are often useful – for example, if you forget to turn the oven off, or struggle to find your way home from the shop.

Blood tests are often done to check for other conditions that can cause memory problems, including thyroid issues and low vitamin B12.

Final word

While menopause doesn’t directly cause dementia, there is a lot of overlap between the kinds of symptoms you may experience in both.

Speak to your healthcare provider for an assessment and advice on how to manage your symptoms. And don’t forget that healthy lifestyle changes can dramatically cut your risk of dementia in later life!

Find out more about menopause on our blog or in our symptoms library.