Menopause
Menopause linked to loss of grey matter in the brain, study finds
Menopause is linked to grey matter loss in key brain regions, along with increased anxiety, depression and sleep problems, new research suggests.
The study also found that hormone replacement therapy (HRT) does not appear to mitigate these effects, though it can slow the decline in reaction times.
Grey matter is brain tissue that contains nerve cell bodies and helps process information, control movement and manage memory and emotions.
Dr Christelle Langley from the University of Cambridge department of psychiatry said: “Most women will go through menopause, and it can be a life-changing event, whether they take HRT or not.
“A healthy lifestyle – exercising, keeping active and eating a healthy diet, for example – is particularly important during this period to help mitigate some of its effects.
“We all need to be more sensitive to not only the physical, but also the mental health of women during menopause, however, and recognise when they are struggling.
“There should be no embarrassment in letting others know what you’re going through and asking for help.”
Researchers analysed data from UK Biobank of almost 125,000 women, who were classified into three categories: pre-menopause, post-menopause who have never used HRT, or post-menopause who have used HRT.
Participants answered questionnaires about their experience of the transition, self-reported mental health, sleep patterns and overall health.
Some took part in tests of cognition, including tests of memory and reaction times. Around 11,000 participants also underwent MRI scans, allowing the researchers to examine brain structure.
Post-menopausal women were more likely than those pre-menopause to have sought help from their GP or a psychiatrist for anxiety, nerves or depression, and to score more highly on questionnaires for symptoms of depression.
They were also more likely to have been prescribed antidepressants.
Although women in the HRT group had greater anxiety and depression compared with the non-HRT group, further analysis showed these differences were already present before the transition began.
The researchers suggest that in some cases, a woman’s GP may have prescribed HRT in anticipation of symptoms worsening.
Women post-menopause were more likely to report insomnia, get less sleep, and feel tired.
Those on HRT reported feeling the most tired of all three groups, even though there was no difference in sleep duration between these women and those not on the medication.
In both groups of women post-menopause, the researchers found significant reductions in grey matter volume.
These differences occurred particularly in the hippocampus, which is responsible for forming and storing memories; the entorhinal cortex, a gateway for passing information between the hippocampus and the rest of the brain; and the anterior cingulate cortex, which helps manage emotions, make decisions and focus attention.
Post-menopausal women who were not on HRT had slower reaction times than those yet to start the transition or who were on HRT.
However, there were no significant differences between the three groups when it came to memory tasks.
Dr Katharina Zühlsdorff from the department of psychology at the University of Cambridge said: “As we age, our reaction times tend to get slower – it’s just a part of the natural ageing process and it happens to both women and men.
“You can imagine being asked a question at a quiz – while you might still arrive at the correct answer as your younger self, younger people would no doubt get there much faster.
“Menopause seems to accelerate this process, but HRT appears to put the brakes on, slowing the ageing process slightly.”
Professor Barbara Sahakian, the study’s senior author from the department of psychiatry, added: “The brain regions where we saw these differences are ones that tend to be affected by Alzheimer’s disease.
“Menopause could make these women vulnerable further down the line.
“While not the whole story, it may help explain why we see almost twice as many cases of dementia in women than in men.”
A new study will investigate why women’s hearts may be affected differently by type 2 diabetes before and after menopause.
The researchers are among a cohort of leading mid-career scientists to receive a total of almost €6m, about £5.2m, through a partnership between the British Heart Foundation, the Dutch Heart Foundation, the German Centre for Cardiovascular Research and the Lefoulon-Delalande Foundation to support international research collaborations over four years.
The menopause project will be led by Dr Lisa Heather, from the University of Oxford, Dr Miranda Nabben, from Maastricht University and Dr Annie Turkieh, from the Pasteur Institute.
Professor Metin Avkiran is director of international partnerships and special programmes at the British Heart Foundation.
Avkiran said: “We’re delighted to be supporting these ambitious research programmes alongside our European partners, and to welcome CNIC and CIBER-CV to this pioneering partnership,” said
“By joining together, we can make the money donated by BHF’s generous supporters go further to drive more lifesaving research.
“By placing mid-career researchers at the heart of this scheme, we’re backing emerging leaders in cardiovascular science.
“These partnerships are designed to last well beyond the lifetime of the awards and help address the biggest unmet needs in cardiovascular research.”
Before menopause, women are largely protected from diabetic cardiomyopathy, a type of heart muscle damage linked to diabetes, yet after menopause they become more vulnerable than men and more susceptible to heart failure.
Researchers do not yet fully understand why this happens, but believe changing hormone levels after menopause may disrupt cell signals sent out by fat tissue.
This may lead to diabetic cardiomyopathy and trigger damage to the heart.
The study will examine how the hearts and fat tissue of women with type 2 diabetes differ before and after menopause, using animal models, human cells, computer modelling and patient data.
The team says this could lead to a blood test for earlier diagnosis and better treatments for women living with type 2 diabetes.
Cognitive behavioural therapy (CBT) may offer short-term relief for menopause insomnia and night-time hot flushes, a pilot study suggests.
CBT is a structured, short-term talking treatment that helps people change thoughts and behaviours that can worsen sleep problems.
Researchers found the intervention was linked to meaningful short-term improvements in insomnia severity, hot flush interference, sleep self-efficacy, or confidence around sleep, and depressive symptoms.
The Menopause Society said insomnia affects an estimated 20 to 60 per cent of perimenopausal and postmenopausal women in the US.
Ongoing research is focusing on effective treatments because insomnia can have serious physical and psychological effects.
Dr Monica Christmas, associate medical director for The Menopause Society, said: “Nocturnal hot flushes (night sweats) and sleep disruption can have a significant effect on the quality of life with many women claiming extreme impairment due to symptoms that often start in early perimenopause and last 10 or more years.”
“Sleep disturbances can persist even in those using pharmacological therapy to manage hot flushes.
“The study’s findings highlight the utility of cognitive-behavioural therapy as a standalone treatment for insomnia and hot flushes, offering women an alternative or adjunct to pharmacological treatments.”
Insomnia is defined as disturbed sleep associated with distress or impaired daily functioning and is one of the most common complaints in perimenopause and postmenopause.
It can reduce quality of life and is linked to higher healthcare use and costs, disability, depression and cardiovascular disease.
Hot flushes occur in 60 to 80 per cent of women during the menopause transition and can persist for four to five years on average.
Night-time hot flushes are linked to sleep disruption, and women may respond by napping or spending longer in bed, which can help keep insomnia going.
Previous studies have shown that cognitive behavioural therapy is an effective treatment for insomnia and may also help women cope with hot flushes and other menopause symptoms.
However, few trials have looked at both insomnia and hot flushes together.
Insomnia during and after the menopause transition is complex and can have many causes, including ageing, hormone fluctuation, hot flushes, other sleep disorders, psychiatric and medical conditions and psychosocial stressors.
Because women with acute and sustained insomnia can experience greater negative health effects, effective treatment is important.
The pilot study concluded that CBT was feasible and may be a promising approach for menopause-related insomnia and nocturnal hot flushes, although the benefits appeared to lessen after three months.
Women aged 50 to 80 with menopause symptoms were more likely to report sleep problems than those without in a US national poll.
In a cross-sectional analysis of 1,202 US women, investigators found that 56.4 per cent reported sleep problems overall.
Among women with menopause-related symptoms, 75 per cent reported sleep problems, compared with 49.8 per cent of those without such symptoms.
The findings add to existing evidence that sleep disturbances are common during the menopause transition and may be closely tied to active symptom burden.
The Menopause Society has noted that women with vasomotor symptoms during the menopause transition are more likely to report disrupted sleep, and its 2022 hormone therapy position statement says hormone therapy improves sleep in women with bothersome night sweats and hot flushes that disrupt sleep.
Sleep problems in midlife and older women are clinically important because they may affect quality of life, daytime function, cardiometabolic health and long-term wellbeing.
Reviews of sleep disorders during menopause have identified several possible contributors, including vasomotor symptoms, ovarian hormone changes, restless legs syndrome, periodic limb movement disorder and obstructive sleep apnoea.
The findings underscore the importance of asking about sleep when evaluating menopause symptoms and, conversely, considering menopause-related symptom burden when women in midlife and older adulthood present with insomnia, fragmented sleep or poor sleep quality.
“Integrating screening and evidence-based interventions for sleep disturbances into menopause management may improve overall health, quality of life, and long-term outcomes,” Joseph R. White, MD, MS, and colleagues wrote in the study abstract.
White and colleagues analysed survey data from Wave 10 of the National Poll on Healthy Aging, a nationally representative household survey of US adults aged 50 years and older conducted from 21 January to 7 February 2022 to assess timely issues related to health, health care and health policy.
Respondents in the current analysis were stratified and weighted to reflect the US Census. Investigators used chi-square testing to evaluate associations between sleep problems and menopause symptoms.
Among the 1,202 respondents, 65 women were premenopausal with no symptoms, accounting for 7.3 per cent of the weighted sample.
Thirty-seven women were perimenopausal with some symptoms, accounting for 3 per cent, 40 were menopausal within the past year with regular symptoms, accounting for 3.3 per cent, and 35 were menopausal within the past year without regular symptoms, also accounting for 3.3 per cent.
Most respondents were postmenopausal.
A total of 243 women were postmenopausal with symptoms, accounting for 20.8 per cent of the weighted sample, and 765 were postmenopausal without symptoms, accounting for 61.2 per cent.
Overall, 677 respondents reported sleep problems. Women with any menopause-related symptoms were significantly more likely to report sleep problems than women without menopause-related symptoms.
The current findings suggest that sleep assessment may be an important component of that individualised approach.
In primary care, screening may include questions about sleep duration, sleep latency, nighttime awakenings, early-morning awakening, daytime impairment, snoring or witnessed apnoeas, restless legs symptoms, mood symptoms, medication use, alcohol use, and the timing and severity of hot flushes or night sweats.
Investigators did not identify which specific menopause symptoms were most strongly associated with sleep problems.
However, earlier research has shown that greater vasomotor symptom severity is associated with more sleep disturbance, greater sleep-related impairment, worse sleep quality, and greater impairment in daytime activities and work productivity.
Limitations of the analysis include the fact that it was cross-sectional, that sleep problems and menopause symptoms were self-reported, and that it does not specify whether respondents had diagnosed sleep disorders or whether other contributors, such as depression, anxiety, chronic pain, cardiometabolic disease, or medication use, were assessed.
Still, the large, nationally representative sample provides clinically relevant insight into the overlap between menopause-related symptoms and sleep complaints among US women aged 50 to 80 years.
The authors said the findings support routine sleep screening as part of menopause evaluation and follow-up, particularly among women reporting active symptoms.
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