Menopause is a normal part of the ageing process for individuals who have periods. It can have a significant effect on brain health and mental wellbeing. It normally occurs between the ages of 45-55. However, premature menopause affects 1 in 100 menstruating individuals, and may occur due to genetic and environmental factors, including early menarche and heavy alcohol consumption throughout life. Decades of research support a role for oestrogen, a female hormone, as playing an important role in brain health as well as female reproduction. This hormone can function to produce energy (ATP) within multiple brain regions involved in cognitive function. It is widely understood that oestrogen levels significantly decline when entering menopause. Menopause has been identified as having the potential, therefore, to negatively impact on the brain through impairing memory and cognition . Postmenopausal individuals are at a significantly higher risk, as a result, for developing Alzheimer’s disease. Conversely, an association has been observed between more optimal oestrogen levels and improved cognitive function and memory following the menopause.

Role of Oestrogen and Homocysteine with relation to Increased Risk of Cognitive Decline Postmenopausally

A key consideration for menopause and brain health is that the risk of developing Alzheimer’s disease increases. One hypothesis is that changes in levels of oestrogen and subsequent impact on the brain’s bioenergetic system may decrease metabolic activity and increase deposit of a key marker of Alzheimer’s disease, beta-amyloid.  Recent research has also indicated that levels of homocysteine, a marker involved in neurological diseases such as Alzheimer’s disease, rise in response to a fall in oestrogen levels during the menopause.

B Vitamins, Omega-3 and Zinc

Research has indicated that increasing levels of folate and B12, as well as omega-3, may help to reduce levels of homocysteine. This can be done through increasing consumption of green leafy vegetables (folate), chicken and fish (B12) and oily fish (omega-3), as well as through supplementation of these nutrients (particularly B12 and omega-3 if vegetarian or vegan). Furthermore, recent research has highlighted the key role of zinc in significantly reducing concentrations of homocysteine. This may be due to its synergistic relationship with folate and B12.

Manganese

An area of emerging research is manganese levels and menopause. A recent study  indicated that alterations in blood levels of manganese occur before and during menopause. Manganese is a micronutrient required for insulin secretion and blood glucose balance, as well as modulating the body’s endogenous antioxidant systems and thereby reducing oxidative stress, as well as the homeostasis of neurotransmitters such as dopamine, glutamate, and GABA. Further research is required to explore the full mechanisms through which manganese is involved in the menopause, and how altered levels may impact on female brain health.

Mediterranean Diet

Following the Mediterranean diet, which involves consuming extra-virgin olive oil, vegetables, fruits, legumes, pulses, nuts and oily fish, may be particularly supportive during menopause. The European Menopause and Andropause Society has also recently proposed the Mediterranean diet as an appropriate dietary pattern post-menopause, as it may help to reduce cognitive decline, cardiovascular and metabolic diseases, which are both risk factors for Alzheimer’s disease. An additional food of note, which can be incorporated into a Mediterranean diet, is flaxseed, which has been specifically shown to support individuals during and post menopause. This is possibly due to flaxseed’s omega-3 content (ALA), as well as lignan content, which may help to modulate oestrogen levels.

Medical Treatments

Notably, many individuals opt during this stage of life to take hormone replacement therapies (HRT). A recent study published in the British Medical Journal has demonstrated that some types of HRT may increase risk of developing Alzheimer’s disease when used long term. Individuals should consult their doctor before beginning HRT, particularly raising any concerns if they have a family history of Alzheimer’s disease, or exhibiting symptoms of cognitive decline.