Going Through Menopause Before Age 45 Might Raise the Risk of Dementia Later On

A new study expands on what we know about the link between the two.

wilted rose and fading brain inside overlapping circles

People who enter menopause early—before the age of 45—may be at a higher risk for developing dementia later in life, according to new research. The findings highlight the importance of assessing individuals' personal risk of dementia, especially those who experience menopause, and monitoring brain health as they age.

The preliminary research, presented at a conference for the American Heart Association (AHA) earlier this month, shows that women in the study who experienced very early or premature menopause (menopause before the age of 40), had a 35% higher risk of developing any kind of dementia later in life than women who entered menopause at the standard age, around 50 years old. Women who entered menopause at age 45 or earlier were 1.3 times more likely to develop dementia before age 65, known as early-onset dementia.

"Being aware of this increased risk can help women practice strategies to prevent dementia and to work with their physicians to closely monitor their cognitive status as they age," Wenting Hao, MD, study author and PhD candidate, said in a press release.

Here's what to know about the link between early menopause and dementia—and what other risk factors are linked to cognitive decline.

The Impact of Early Menopause on Dementia Risk

Alzheimer's disease—a specific type of dementia, and the most common cause of it—disproportionately affects women. Two-thirds of Americans diagnosed with the disease are women, according to the Alzheimer's Association. The new research provides clues as to why the disease affects certain populations differently—specifically linked to early menopause and the hormonal changes that go along with it.

For the study, researchers at Shandong University in Jinan, China, analyzed health data from UK Biobank, a large biomedical database. The data came from more than 150,000 women, who were on average 60 years old between 2006 and 2010. Researchers looked at dementia diagnoses among women who entered menopause early and among women who entered menopause at the average age of 50 to 51 years old.

Compared to women who entered menopause around 50 years old, those who started menopause before age 40 were 35% more likely to get diagnosed with any type of dementia—including Alzheimer's disease, vascular dementia, or dementia of other causes. Meanwhile, women who experienced menopause before age 45 were 1.3 times more likely to be diagnosed with dementia before the age of 65 (early-onset dementia). The results held true even after they were adjusted for other factors, including race, cigarette and alcohol use, body mass index, and underlying diseases.

The researchers did not determine a cause for the potential link between early menopause and increased risk of dementia, but they noted that estrogen levels may be the culprit. "We know that the lack of estrogen over the long term enhances oxidative stress, which may increase brain aging and lead to cognitive impairment," Dr. Hao said in the press release.

"Hormone receptors, specifically for estrogen, are present in the brain," Alyssa Dweck, MD, a practicing gynecologist in Westchester County, New York, and chief medical officer of Bonafide, told Health.com. "It seems reasonable that sudden or gradual decline in estrogen levels, due to menopause and regardless of age, might influence cognition," Dr. Dweck, who was not involved in the research, added.

The research has its limitations—primarily that it was self-reported and limited to mainly white women in the UK, and therefore couldn't necessarily be generalized to a more diverse population, study authors said. "It also did not analyze women who underwent early menopause due to surgical intervention for a variety of reasons and whether this was also associated with [early] onset dementia," Gabriel Zada, MD, professor of neurological surgery and director of the USC Brain Tumor Center, who was not involved in the study, told Health.com.

Regardless, the new research is still aligned with previous findings. "This study adds to our knowledge about the potential link between reproduction history and brain health," Heather Snyder, PhD, vice president of medical and scientific relations at the Alzheimer's Association, told Health.com. She cited a another study presented at the 2018 Alzheimer's Association International Conference, which also found that people who experienced early menopause at 45 or earlier had a heightened risk of dementia. "The physical and hormonal changes that occur during menopause—as well as other hormonal changes throughout life—are considerable," Snyder said. "And it's important to understand what impact, if any, these changes may have on the brain."

Other Known Risk Factors for Dementia

There's currently no known effective ways to treat or prevent Alzheimer's disease or related dementias—but there are ways to help reduce your overall risk of developing the diseases.

Knowing the risk factors you can't change are a good start: Age—which is the greatest known risk factor for Alzheimer's disease and related dementias—and genetic disposition are two things that can greatly affect a person's likelihood of developing the cognitive issues, according to the National Institute on Aging (NIA). Race and gender also influence a person's risk of disease—regarding dementia, African Americans, American Indians, and Alaska Natives have the highest rates, as do women.

Past those uncontrollable risk factors, certain lifestyle practices can increase your general health overall—and possibly offer some protection against disease. "Recommended practices to help prevent dementia include focusing on overall well-being," Dr. Zada said. The NIA offers up suggestions including: controlling high blood pressure and managing blood sugar, staying mentally and physically active, preventing head injuries, and lessening (or stopping) alcohol and tobacco use.

Though it's not currently considered a risk factor or predictor for future dementia diagnoses, study authors said the new research shows health care professionals should at least be aware of the effect early menopause may have on dementia risk—and that women who experience early menopause should potentially be monitored for cognitive decline.

"Further research is needed to assess the added value of including the timing of menopause as a predictor in existing dementia models," Dr. Hao said in the press release. "This may provide clinicians with a more accurate way to assess a woman's risk for dementia."

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