Menopause can leave you feeling confused, brain-fogged and forgetful. It’s easy to understand 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 (usually in your 40s and 50s). Read on to find out about the early signs of dementia, if HRT helps, and when you should see a doctor.
Find what you need quickly
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What is dementia?
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What are the early signs of dementia?
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Can menopause be confused with dementia?
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Does menopause cause dementia?
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Would HRT help?
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Does HRT cause dementia?
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Does early menopause increase your risk of dementia?
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What can I do to prevent dementia?
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When should I see a doctor?
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How will my doctor assess me for dementia?
What is dementia?
Dementia is an umbrella term for a number of different symptoms related to the brain. These commonly include:
- Memory problems
- Slowed thought processes
- Problems coping with normal daily activities
These vary dramatically in severity. While some will experience only mild inconvenience, others will require round-the-clock care.
The underlying cause can be one of a number of different medical conditions. Common examples include Alzheimer’s disease, vascular dementia and Lewy body dementia.
Almost a million people are estimated to be living with the condition in the UK alone, and one in 14 people over 65 are affected.
What are the early signs of dementia?
Early signs of dementia can be extremely varied, and are often quite subtle. Some people will only realise the true extent of their early symptoms when looking back many years later.
Possible symptoms include:
- Memory problems – either recent events or things that happened long ago
- Forgetfulness
- 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 judgements
- Struggling with organisation or planning
- Changes to your mood – including feeling low, anxious, snappy or angry
- Personality changes
- Struggling with your usual activities (including coordination and manual tasks)
As you can see, many of these symptoms are often experienced in menopause too. This is why any early signs of dementia in women should be properly assessed by your doctor – there may be something else going on.
Read more about how to talk to your doctor about menopause.
You may hear a number of 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 reasoning
- Cognitive impairment – any problem with the way you think and reason. This is a catch-all term which includes both minor issues with those areas mentioned above, as well as more severe problems like dementia
- Brain fog – a non-technical term which covers 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 compounded by the physical symptoms that also go along with menopause. Sleep deprivation, hot flushes and aches and pains can all contribute.
It is sometimes easy to put your symptoms down to menopause when this might not be the case. Other conditions, including thyroid problems and depression, can also mimic dementia.
If your symptoms are disruptive or persist, speak to your doctor. They will be able to help you find the root cause and identify any suitable treatments.
Does menopause cause dementia?
Not directly. However, the hormonal changes of menopause are thought to make dementia more likely for reasons that are not yet fully understood.
We know that oestrogen levels decrease dramatically at menopause. This is likely to be significant as oestrogen has many different effects on the brain and nervous system, some of which are related to memory.
Oestrogen helps a number of other hormones to work optimally within the brain. These include serotonin, acetylcholine and dopamine. As these hormones are involved in memory and mood regulation among others, a sudden decrease in oestrogen can have a significant impact on the way your brain works.
Finally, oestrogen is thought to help prevent the build-up of the harmful proteins that can cause 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 oestrogen after menopause removes this protective effect. This is why higher levels of dementia can be seen in women after menopause.
Would HRT help?
We are still learning about the way in which hormones like oestrogen affect brain health. This is a complex topic and your risk of dementia depends on multiple factors including lifestyle, genetics and luck.
Studies on HRT and dementia have so far shown mixed results. One 2023 study seemed to show promising findings for women who carry a specific gene (APOE4) responsible for an increased risk of dementia. However, the evidence is still not strong enough to recommend HRT solely to protect against or treat dementia, especially in the context of the risks that come with some forms of HRT.
However, HRT is a proven and effective treatment for many menopause symptoms, and many women find that it helps with menopausal forgetfulness and brain fog. Like all medications, HRT comes with certain risks and side effects, and is not suitable for everyone.
Read more about the risks and benefits of HRT.
Does HRT cause dementia?
There’s no need to panic. Here’s the truth behind the latest research on HRT and dementia.
A paper published in June 2023 (Pourhadi, 2023) seemed to suggest that some forms of HRT increase your chance of dementia. The findings suggested that using a combination of oestrogen and progesterone could increase your risk by up to 74% depending on how long you’d been using HRT. Those who had used HRT for 12 years or more had the highest figures.
However, experts have cast doubt on these findings.
In an editorial in the British Medical Journal, concerns were raised about the accuracy of this study’s findings for a number of reasons.
- It is possible that the women included in the study were already at higher risk of having dementia than the general population. This is because women with cognitive issues – some of which will later turn out to have dementia – often seek out HRT if they think their symptoms are linked to menopause. In fact, in the early years of this study, doctors even specifically recommended HRT as a treatment for those women who were already experiencing cognitive decline, which could in many cases have been an early sign of dementia.
- There is also the possibility that the women included in the study did not have more dementia than the general population, but were simply diagnosed earlier. They were seeing doctors regularly due to being on HRT so any dementia may have been diagnosed earlier simply because they were more likely to be screened or to mention their memory problems.
It goes without saying that this is much more complex than it seems at first glance! More research is needed before we can truly understand the implications of this paper.
Recommendations for HRT use remain unchanged for the time being.”
If you would like to learn more about this paper and the problems with it, the British Menopause Society recommends this interview with a menopause specialist.
Does early menopause increase your risk of dementia?
Most women go through menopause in or after their late 40s, with 51 being the average age of menopause in the UK.
However, a number of women experience early or premature menopause. This means going through the menopause before age 45 (in the case of early menopause) or 40 (for premature menopause).
Premature menopause can be associated with an increased risk of developing dementia. However, we still do not know to what extent HRT prevents this. Some studies seem to suggest a protective effect in this age group, although further research is needed to confirm this.
HRT is not currently recommended to prevent dementia, although is generally recommended for those who have gone through premature or early menopause, regardless of whether or not you are worried about your memory. This is because HRT is proven to help maintain your bone density and reduce the risk of heart disease.
What can I 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. This one change can cut your risk of dementia by an enormous 50-80%!
- 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. You can check your blood pressure at most doctors’ surgeries and some pharmacies. Speak to your doctor if it is raised
- Check your hearing. Poor hearing is thought to lead to cognitive impairment because the brain becomes under-stimulated
- Maintain a BMI in the healthy range. Obesity is linked with dementia in later life
- Drink in moderation. Regularly consuming over 14 units per week is associated with dementia
When should I see a doctor?
It is important to see a doctor if you have any concerns about your memory or cognitive function (the overall way your brain works).
There are lots of possible causes for these symptoms and they will be able to help you get an accurate diagnosis.
Your doctor will also be able to help you find the best treatment for you. There are medications which can be used to slow dementia in some circumstances.
Likewise, many of the other conditions which can mimic dementia – including menopause! – have safe and effective treatments. HRT might be a useful option for you, especially if you have other symptoms of menopause.
Start your free online menopause assessment to see if HRT is right for you
How will my doctor assess me for dementia?
Your doctor may ask you to take a quick and simple memory test, which can be done in a few minutes during your appointment. 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.
It may help you 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 as a matter of routine. This will usually include tests 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 doctor for a thorough assessment and advice on how to manage your symptoms. And don’t forget that a few healthy changes can dramatically cut your risk of dementia in later life!
Find out more about menopause on our blog or in our symptoms library.
Hormones and dementia, Alzheimers.org
NICE, Guidance on dementia
British Menopause Society, Management of the Menopause, sixth edition
Livingston, G. et al. Dementia prevention, intervention and care: 2020 report of the Lancet commission. Lancet. 396(10248): 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Rocca, W.A., Grossardt, B.R.m Shuster, L.T. Oophorectomy, estrogen, and dementia: a 2014 update. Molecular and Cellular Endocrinology. 389 (1-2) p7-12. https://doi.org/10.1016/j.mce.2014.01.020
Saleh, R.N.M., Hornberger, M., Ritchie, C.W. et al. Hormone replacement therapy is associated with improved cognition and larger brain volumes in at-risk APOE4 women: results from the European Prevention of Alzheimer’s Disease (EPAD) cohort. Alz Res Therapy 15, 10 (2023). https://doi.org/10.1186/s13195-022-01121-5
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