Menopause and Alzheimer's Disease

Alzheimer's disease is most common in people over age 65. We also know that Alzheimer's disease is more common in women than men.¹

Researchers already know that the hormone changes that happen during menopause cause biological changes in the brain. They are now beginning to understand how these hormone changes may make the brain more vulnerable to the damage that causes Alzheimer’s disease, especially in people who experience early menopause.^1,2

Women and Alzheimer's disease

About 6 out of 10 people with Alzheimer's disease are women. Around 6 million people over 65 in the United States have Alzheimer's disease. Of these, 4 million are women. Many factors likely lead to the increased risk of Alzheimer's disease in women.³

Differences in life experience may play a role in women's risk. For example, research shows that women who do not engage in paid work during adulthood have faster memory loss.⁴

Plus, hormones influence women's brains differently than men's brains. Genetics also plays a role in Alzheimer's risk.⁵

These are just a few factors that may contribute to the higher rate of Alzheimer's among women. Scientists are working to determine what other factors increase women's risk.⁴

Menopause and Alzheimer's risk

Research suggests that the menopausal transition is a key window for women's brains. The menopausal transition is a period of time when women's hormone levels begin to change. These changes usually happen between the ages of 45 and 55. Eventually, women's menstrual cycles stop, and estrogen and progesterone levels decrease.^5,6

The average age for women to have their last menstrual period is 51. Early menopause is when a woman's menstrual cycle stops earlier than expected. This can happen naturally or from surgery or medicine that block hormone production.^5,6

The decreased hormone levels during menopause cause changes in the brain that are linked to Alzheimer's. As estrogen levels drop, the metabolic activity of brain cells decreases. This can lead to cell damage. Menopausal women also have a faster build-up of amyloid in the brain.^2,5

Estrogen regulates multiple brain functions. It plays an essential role in an area of the brain called the hippocampus. This is one of the parts of the brain first affected by Alzheimer's disease.^5,7

A 2022 study showed that women who enter menopause before age 40 are 35 percent more likely to develop dementia than women who enter menopause around age 50.⁸

Hormone replacement therapy and Alzheimer's risk

Studies show menopausal hormone replacement therapy may help protect against late-onset Alzheimer's disease. Women with a genetic risk seem to benefit the most. Furthermore, starting hormone replacement therapy closer to the start of menopause seems to have the most benefit.^2,5

Studies have provided conflicting results about the benefits of hormone replacement therapy. Potential risks of hormone therapy include blood clots, heart attack, stroke, and breast cancer. Starting hormone therapy more than 5 years after the start of menopause or in women with diabetes may be harmful.⁵

More research is needed to fully understand the role that hormone therapy after menopause plays in Alzheimer's disease.^5,9

How can women reduce their risk of Alzheimer's?

There is not yet a cure for Alzheimer's disease. But efforts to keep your body and brain healthy can reduce your risk.7,10

Here are steps you can take to support brain health:^1,7,10

1. Exercise regularly. Try walking, yoga, or group exercise classes.
2. Treat high blood pressure and diabetes. High blood pressure and diabetes can affect normal blood flow to the brain.
3. Keep learning. Learn to play a new instrument, do crossword puzzles, or take a class.
4. Eat healthy foods. Doctors recommend the Mediterranean diet, which includes fruits, vegetables, whole grains, fish, lean meat, and olive oil.
5. Stay connected with other people. Social isolation increases the risk of Alzheimer's disease.
6. Treat hearing loss. Hearing aids can help you continue to enjoy an active social life.
7. Use memory support tools. Lists, reminders, and alarms can help you stay on track.
8. Avoid tobacco and excessive alcohol use.

Damage to brain cells starts years before symptoms develop. The menopausal transition is a good time to take steps to protect your brain health. Talk with your doctor if you are concerned about your risk of Alzheimer's disease.⁵