|
Memory Loss, Estrogen,
Menopause & Alzheimer's Disease
Gayatri Devi, M.D.
Menopause
symptoms due to estrogen
deficits, include memory
problems, trouble finding words,
inability to pay attention, mood
swings and irritability, in
addition to the more well known
symptoms. These symptoms are
often overlooked or left
untreated but should be
addressed. Treatment will not
only result in symptom remission
but may also, in my opinion,
have preventive value. Some
common questions I have
encountered in my practice about
estrogen and memory loss include
the following:
Q: Do I have Alzheimer's
disease?
A: This unspoken fear is often
the reason why women suffer in
silence when they experience
cognitive symptoms during
menopause. Scared about what
they may discover, many women
opt not to seek treatment.
However, menopause related
memory and cognitive
disturbances are being
increasingly described in
scientific literature and are
generally responsive to
treatment. They can and should
be addressed and treated.
Return
To Top
Q: Does estrogen have an impact
on functions of the mind?
A: Yes. Estrogen influences
language skills, mood,
attention, and a number of other
functions in addition to memory.
Return
To Top
Q: How does estrogen affect the
mind?
A: Estrogen docking sites are
present in several regions of
the brain, including those
involved in memory (such as the
hippocampus). When activated by
estrogen, these sites, in turn,
activate processes that are
beneficial to the brain. In
addition, estrogen may, in
effect, raise levels of certain
brain chemicals
(neurotransmitters). These
include the neurotransmitters
acetylcholine (implicated in
memory), serotonin (implicated
in mood), noradrenaline
(implicated in mood and other
autonomic functions), and
dopamine (implicated in motor
coordination). Thus, estrogen
facilitates networking between
nerve cells, promoting their
ability to "talk to" one
another.
Return
To Top
Q: Does this mean that my recent
irritability, apathy, 'foggy'
state of mind, trouble finding
words, constantly losing my
keys, inability to function at
my job, etc. may be related to
estrogen deficit?
A: Given estrogen's myriad role
in brain processes, it should
come as no surprise that it can
influence many of the mind's
functions. However, a
careful history and a thorough
examination are needed to sort
through symptoms and rule out
other conditions. You
should plan to spend about an
hour with your physician to
discuss the issues related to
menopause, symptoms and
treatment options.
Return
To Top
Q: What do the recent Women's
Health Initiative data mean to
the average menopausal women?
A: This large, multi-center
study found that replacement
with an equine estrogen and
progestogen combination caused a
higher incidence of dementia,
breast cancer, heart disease and
blood clotting than in those
women on a placebo ("sugar
pill"). In interpreting the
results, there are important
caveats that need to be
remembered:
1) Women
were started on hormone
replacement in their sixties and
some experts feel that starting
treatment earlier may have
resulted in more benefits.
2) The data
was derived from using equine
estrogen derived from pregnant
mares. Whether the use of a
soy-based, biologically
identical estrogen would have
changed the results is unclear.
3) The
decision to discontinue the
study was not without
dissenters. Significantly,
researchers conducting a similar
trial called WISDOM in the
United Kingdom, reviewed the
data from the WHI trial and
unanimously voted to
continue on with their trial,
given the lack of statistical
significance of difference in
risks in the WHI trial. This
decision was reversed in several
weeks following the
recommendations of an outside
panel.
Return
To Top
Q: I am on hormone replacement
and my symptoms persist. What
next?
A: If your symptoms do not
resolve with hormone
replacement, you may need to
discuss the dosage and type of
hormone replacement you are on
with your doctor. Sometimes,
changing to another preparation
is helpful. If problems still
persist, you might want to seek
further help from a physician
who specializes in this area.
Return
To Top
Q: What are other treatment
options for my problems?
Estrogen related cognitive
deficits may be differentiated
from those associated with other
conditions through a careful
history, examination and
testing. During this time in a
woman's life, many problems
coexist, including treatable
causes (e.g.: depression,
hypothyroidism).
Neuropsychological testing is
useful in this regard to help
delineate the nature of the
problem. Testing will also
establish a cognitive baseline
for future comparison. Treatment
options will depend on the
cause(s) of the memory loss.
Return
To Top
Q: Ideally, what areas should be
covered in neurocognitive
testing?
A: As estrogen affects various
cognitive functions,
comprehensive testing should
assess all aspects of language
(reading, naming, understanding,
word fluency), memory (both
short and long term memory,
visual and verbal memory), and
other cognitive functions
(problem solving skills,
visuospatial skills, etc).
Simple screening tools, such as
the mini mental status
examination, will most often
remain normal in peri- and
post-menopausal cognitive loss.
A good neurocognitive battery of
tests should establish a
cognitive baseline for future
comparison and allow monitoring
of treatment response.
Return
To Top
Q: Will my depression get better
if I go on estrogen?
A: If the mood changes are
related to estrogen deficiency,
they usually will respond to
hormone or estrogen treatment.
If the mood changes persist, you
need to discuss this with your
physician.
Return
To Top
Q: I have heard that estrogen
prevents Alzheimer's disease. Is
this true?
A: Several naturalistic studies
suggested that estrogen may
reduce risk for Alzheimer's by
up to 50% although other studies
did not find this benefit.
However, the definitive Women's
Health Initiative Memory Study
(WHIMS), which followed several
thousand woman for several years
found that treatment with
horse-derived estrogen was
associated with an increase
in the risk for developing
Alzheimer's. However, there is
controversy surrounding this
study.
Return
To Top
Q: My friend's mother has
Alzheimer's disease. Will
estrogen or hormone replacement
help in this case?
A: Data in this area is
conflicting. An multi-center
trial found that conjugated
equine estrogens was not helpful
in treating Alzheimer's. A
smaller study, using an
estradiol patch found a
beneficial effect. In my
opinion, further work still
needs to be done in this area.
Return
To Top
Q: Is there a beneficial effect
from consuming naturally
occurring estrogens found in
substances like soy milk: the
so-called phytoestrogens?
A: There is not enough data on
the use of these naturally
occurring substances for
treatment of cognitive symptoms
of menopause.
Return
To Top
Q: Why do I need hormone
replacement? Isn't it the
natural order of life that women
go into menopause?
A: The average age of menopause
is 52.3 years and has not
changed much over the years.
However, a century ago, life
expectancy was much less for a
woman than it is today. Today,
the average woman will spend
from a fourth to up to half of
her life without the protective
and beneficial effects of
estrogen.
Return
To Top
Q: What is the difference
between hormone replacement and
estrogen replacement therapy
(HRT vs. ERT)?
A: Hormone replacement therapy
is a combination of estrogen and
progestogen and is generally
given to women who have not
undergone hysterectomies.
Return
To Top
Q: What is the difference
between a patch and an oral
preparation?
A: Skin patches are often used
when oral estrogen is not
tolerated. Skin absorption
bypasses the liver circulation
and is more easily titrated.
Return
To Top
Q: If my blood hormone levels
are normal on testing, but my
periods are becoming irregular,
am I going through menopause?
A: Hormone levels fluctuate
monthly during the menstrual
cycle and during the course of a
woman's reproductive life. The
current guidelines for a
diagnosis of peri-menopause and
menopause are based on a woman's
history and examination. Blood
hormone levels may be normal
during peri-menopause and early
in menopause.
Return
To Top
Q: Is hormone replacement a
possible treatment for me?
A: This is a question that every
peri-menopausal and menopausal
woman needs to discuss with her
physician. Pros and cons of
estrogen use in an individual
woman vary.
Return
To Top
Women need to be well informed
about all options available to
them as they undergo menopause.
These and many other questions
are answered in the book
Estrogen, Memory and Menopause.
Please note that due to the
volume of mail, I am unable to
answer individual questions. You
may find answers to some
questions on our
discussion board.
Return
To Top
|
Please note that all
material contained
herein is provided
for informational
purposes only and
should not be
considered as
medical advice or
instruction. Consult
your health care
professional for
advice relating to a
medical problem or
condition. Please
also read the
disclaimer section.
|
|