The risk of developing diseases like stroke and cognitive impairment increases with age. This risk is higher in women because of the reductions of estrogen during menopause. Estrogen protects blood vessels. The reduction in estrogen following menopause raises the risk of cerebrovascular dysfunction. Cerebrovascular dysfunction means impaired blood flow in the brain. A new study reported that women who begin menopause at an early age (<45) may have a higher risk of developing cerebrovascular dysfunction.
This study is the first to highlight potential root causes of why early menopause increases the risk of cerebrovascular dysfunction. One way to measure cerebrovascular health is to expose someone to low-levels of carbon dioxide and then measure cerebral reactivity. Cerebral reactivity is the ability of the blood vessels to widen and provide blood flow that matches the increase in demand. In this study, cerebral reactivity was lower than in women that experienced early-onset menopause.
Furthermore, there appeared to be no differences in brain volume, but there were differences in brain structure. The study team took MRI images of the brain and quantified white matter hyperintensities (WMH). WMH are lesions linked to cognitive impairment and Alzheimer’s disease. In women with early-onset menopause, there were more WMH lesions. This is another indicator that women with early-onset menopause may be at greater risk of Alzheimer’s disease and cognitive impairment.
In an article published by UW-Madison, the lead author of the study, Erin Moir, stated, “Increasing our understanding of how aging affects blood flow in the brain is critical to improving brain health in older adults… For women, it’s very important to understand the changes to cerebrovascular function and brain health that come with menopause. ”
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One key point made by the authors is that women who experience menopause late could have a “legacy effect of estrogen”. After menopause, estrogen gradually declines; it is not an abrupt change. A previous study indicated that menopausal hormone therapy, or estrogen supplementation after menopause, can sustain cerebrovascular reactivity even three years after stopping the therapy. This is termed the “legacy effect of estrogen”. So, women that undergo menopause later may maintain cerebrovascular reactivity due to this effect of estrogen. Future studies need to assess whether menopausal hormone therapy could reduce changes in cerebrovascular function in women that undergo menopause early.
In conclusion, this study is the first to identify that early menopause is associated with reductions in cerebrovascular health. These findings may assist clinicians in identifying women at risk of cerebrovascular disease and vascular-related cognitive disorders, allowing for the implementation of preventative strategies that aim to promote cerebrovascular health in women.
Moir, M. E., Corkery, A. T., Senese, K. A., Miller, K. B., Pearson, A. G., Loggie, N. A., Howery, A. J., Gaynor-Metzinger, S. H. A., Cody, K. A., Eisenmenger, L. B., Johnson, S. C., & Barnes, J. N. (2023). Age at natural menopause impacts cerebrovascular reactivity and brain structure. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 324(2), R207–R215. https://doi.org/10.1152/ajpregu.00228.2022
- White, L. UW–Madison study breaks new ground on how menopause affects brain health. (March 22, 2023). University of Wisconsin-Madison School of Education. Retrieved March 27, 2023, from https://education.wisc.edu/news/uw-madison-study-breaks-new-ground-on-how-menopause-affects-brain-health/
- Barnes, J. N., Harvey, R. E., Eisenmann, N. A., Miller, K. B., Johnson, M. C., Kruse, S. M., Lahr, B. D., Joyner, M. J., & Miller, V. M. (2019). Cerebrovascular reactivity after cessation of menopausal hormone treatment. Climacteric: The Journal of the International Menopause Society, 22(2), 182–189. https://doi.org/10.1080/13697137.2018.1538340