A preliminary study has found that women who go through menopause before the age of 40 have a 35% higher risk of developing dementia later in life.
The study analysed health data from 153,291 women with an average age of 60. Researchers examined dementia diagnoses in women and factored in the age at which they started menopause, adjusting for variables such as age at their last medical exam, race, education level, smoking and alcohol use, body mass index, cardiovascular disease, diabetes, income, and physical activity levels.
Findings showed that women who experienced menopause before 40—known as premature menopause—were 35% more likely to be diagnosed with dementia. Women who entered menopause before 45 had a 1.3 times higher risk of developing dementia before 65, a condition known as early-onset dementia.
However, women who reached menopause at 52 or older had dementia rates similar to the general population.
These findings raise important questions about the link between menopause and dementia. Here’s what you need to know
First, what is premature menopause?
Menopause marks the time in life when periods naturally stop, and the ovaries cease producing oestrogen, a hormone that regulates the menstrual cycle.
When menopause occurs before the age of 40, it is known as premature menopause. If it happens between ages 40 and 45, it is referred to as early menopause. Around 5% of women experience early menopause naturally. (The average age of menopause is 51, according to Better Health Channel.)
There are several factors that may contribute to premature or early menopause, including:
- A family history of early menopause
- Smoking, which can trigger menopause up to two years earlier than in non-smokers
- Chemotherapy or pelvic radiation treatments for cancer
- Surgery to remove the ovaries
- A hysterectomy
- Certain health conditions, such as autoimmune diseases, chronic fatigue syndrome and HIV/AIDS
While menopause is a natural part of ageing, entering it too soon may have long-term effects on overall health.
Why might early menopause be linked to dementia?
The study did not investigate the exact reason behind the connection between early menopause and dementia—only that a link exists. However, researchers suggest that the decline in oestrogen levels that comes with menopause may play a role.
“We know that the lack of oestrogen over the long term enhances oxidative stress, which may increase brain ageing and lead to cognitive impairment,” says study co-author Dr Wenting Hao. (Oxidative stress occurs when unstable atoms build up in the body, potentially damaging cells.)
Clinical professor of obstetrics and gynaecology Dr Lauren Streicher, agrees that dropping oestrogen levels could be a factor. “We certainly know that there are vascular changes when someone stops making oestrogen,” she says. “There might actually be decreased oxygen flow to the brain, increasing the risk of developing dementia.” However, she adds, “it may not just be about decreased oestrogen—many people have low oestrogen and don’t develop dementia.”
Clinical professor of obstetrics, gynaecology, and reproductive sciences Dr Mary Jane Minkin says these findings aren’t surprising. “We have known for years that women who go through early menopause and don’t take oestrogen replacement therapy have a significantly higher risk of heart disease and dementia,” she says, citing a Mayo Clinic study. Research also suggests that starting oestrogen therapy within six years of menopause may help protect against carotid artery thickening, improving blood flow to the brain.
Dr Scott Kaiser also highlights that women develop Alzheimer’s disease at higher rates than men. “There’s a lot of work trying to understand these sex-based differences, and this study offers important clues and raises critical questions,” he says.
Neurologist Dr Doug Scharre points out that oestrogen has been linked to brain function in past studies. One study even found that women who took oestrogen during menopause had a lower risk of developing Alzheimer’s than those who didn’t.
However, Dr Amit Sachdev urges caution before drawing conclusions. “It’s a big leap to go from menopause to brain degeneration,” he says.
Dr Christine Greves agrees, stating, “This doesn’t prove causation—just that there’s a link. More research is needed.”
How to lower your risk of dementia
Dementia is a complex condition, influenced by many factors, says Dr Sachdev. That’s why focusing on overall health is the best approach to reducing risk. “A healthy body leads to a healthy brain,” he says.
Dr Kaiser agrees, noting that women who go through early menopause should be especially mindful of brain health.
According to Better Health Channel, some of the best ways to lower the risk of dementia include:
- Managing blood pressure
- Keeping blood sugar in check
- Maintaining a healthy weight
- Following a nutritious diet rich in fruits, vegetables, whole grains, lean meats, seafood, and healthy fats, while minimising processed foods and sugars
- Getting at least 30 minutes of moderate-intensity exercise per day
- Staying mentally active through reading, board games, or learning new skills
- Keeping socially connected with family and friends
- Getting regular health screenings
- Limiting alcohol consumption to no more than two standard drinks per day
- Not smoking
If you’re going through early or premature menopause, Dr Streicher recommends discussing oestrogen supplementation with your doctor. Not only can it reduce hot flashes and other menopause symptoms, but it may also help protect brain health.
“The idea that women should just ‘tough it out’ and potentially face serious health consequences is so unfair,” she says.
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