Unveiling the Role of Estrogen in Women's Cognitive Health
A peer-reviewed study using PET imaging to reveal how estrogen receptor density evolves in menopausal brains—highlighting menopause as a neurological transition.
A key aspect of menopause is the decline in estrogen production, which not only causes the end of menstruation but also leads to neuropsychiatric effects such as 'brain fog', depression, and anxiety. A newly published brain imaging study in Scientific Reports showed that the menopause transition was associated with a progressively higher density of estrogen receptors (ER) in brain cells. Additionally, the study pioneered the use of PET imaging, highlighting its potential as a valuable tool for studying the brain effects of menopause and estrogen therapy.
In the study, lead author Lisa Mosconi, PhD, and her colleagues scanned the brains of 54 healthy women aged 40-65 using PET with a tracer that binds to ERs. Comparisons of scans from women at different menopausal stages revealed progressively higher ER density in several estrogen-regulated brain networks in the postmenopausal and perimenopausal groups compared with premenopausal controls. The researchers found that high ER density in some of these regions was associated not only with menopause status but also with reported cognitive and mood symptoms related to menopause.
Recently, Mosconi, an associate professor of neuroscience in neurology and radiology, and director of the Women’s Brain Initiative at Weill Cornell Medicine, sat down with NeurologyLive® in an interview to discuss how sex hormones like estrogen influence neurological conditions. She also talked about the implications from the study and the ability to measure hormones directly in the brain for women's health. Moreover, Mosconi, who also serves the director of the Alzheimer's Prevention Program at Weill Cornell Medicine and NewYork-Presbyterian, commented on how hormone therapy, particularly estradiol, may impact brain health during menopause.
What to read next
Hormones regulate so many of the systems in your body. At times, it seems unclear exactly what each of them accomplishes, or why certain levels of particular hormones are floating around. This conversation comes up, especially around perimenopause, and even post-menopause, when specific hormone therapies can be utilized as treatments for bothersome menopause-related symptoms like hot flashes, low energy, and low libido. Estrogen is the most common hormone used in hormone replacement therapy, also known as menopausal replacement therapy, but what about testosterone? Yes, we’re talking about that hormone, the one that’s typically known as the “male” hormone. That’s right — testosterone is found in women’s bodies (at one-tenth of the amount in men’s bodies, but still) and any people born as female. Ovaries make testosterone and technically produce it at even higher levels than estrogen. And during menopause, when the ovaries slow down in their functioning, estrogen levels lower, as do testosterone levels in the body. Just like estrogen, testosterone can be safely used as a hormone replacement therapy during menopause. Still, not many people know that, because it’s not well-studied or officially FDA-approved for women. Keep on reading for everything you didn’t know about testosterone in women, testosterone replacement therapy, and how to know if it could be the right treatment for you.
Every year, about 1.3 million American women enter menopause—the stage of life when
your estrogen levels diminish and your periods stop completely. It’s a natural part
of aging and nothing to fear.
That said, the symptoms of menopause—including hot flushes, low sex drive, trouble
sleeping, weight gain, UTIs and vaginal dryness, brain fog, heart palpitations, muscle
and joint aches, and mood changes—can be miserable and debilitating. You also lose the
health benefits of estrogen itself, like heart and brain protection, says Avrum Z.
Bluming, MD, a hematologist and medical oncologist who has spent decades investigating
the benefits of estrogen. Women can avoid many of these problems with one treatment:
hormone replacement therapy, or HRT. Alternatively called MHT, for menopausal hormone
therapy, HRT refers to the combination of estrogen and progesterone given to women who
still have their uterus; estrogen alone is given to women who have had a hysterectomy.
Unfortunately, HRT remains controversial, due mostly to the results of the decades-old
Women’s Health Initiative, the largest study done on the health of postmenopausal women
in the United States. In 2002, findings from the WHI were released suggesting that women
on HRT had greater risks of heart disease, stroke, dementia, and, scariest of all, breast
cancer; as a result, millions of women of menopausal age either quit or avoided it at all
costs. Subsequent studies have walked back these claims, but many women remain gun-shy
about taking estrogen. The fallout has been enormous: Among menopausal women in the
United States, just under 5 percent are currently on HRT, and it’s been estimated that
between 2002 and 2012, over 90,000 American women died prematurely, mainly from heart
disease, as a result of avoiding HRT.
An illuminating NeurologyLive interview where Dr. Mosconi explains how menopause affects brain function and the importance of targeting midlife for Alzheimer’s prevention.