Surgical Menopause Linked to Steeper Cognitive Decline

surgerical-menopauseA study presented at the American Academy of Neurology’s 65th annual meeting studied the effects of early surgical menopause on cognitive function. Results show that early surgical menopause leads to a steeper cognitive decline than natural menopause.

The study analyzed 1884 women. Of the women studied, one third had undergone surgical menopause. Surgical menopause is classified as the removal of a woman’s ovaries before she has reached menopause.

The average age of the subjects was 78 years, and their cognitive function was tested annually. Episodic, semantic, and working memory were evaluated, along with visuospatial ability and perceptual speed. Researchers also collected data on each subject’s use and extent of hormone replacement therapy.

The authors wrote that analysis of the results showed that, “women who were younger at the time of surgical menopause have a more rapid rate (steeper slope) of cognitive decline than women who were older at the time of surgery or than women undergoing natural menopause.” Early surgical menopause affected semantic and episodic memory the most.

Hormone replacement therapy (HRT) was found to slow the decrease in cognitive decline if initiated within the “window of opportunity”, or within 5 years after oophorectomy, and maintained for 10 years.

These results raise questions about the possible benefits of HRT and if it should be prescribed to those who undergo early surgical menopause. HRT has been found to be neutral or harmful to women who begin treatment in their 60s. This study suggests that if started within the window of opportunity, HRT can slow cognitive decline. However, HRT poses other health risks, including an increased risk of breast cancer. Therefore, all risks and benefits of HRT should be taken into account before it is prescribed.

What causes the decline in cognitive function?

Removing the ovaries causes a steep decline in the release of estrogens. Estrogens play multiple roles in cognitive function. “Estrogen affects brain function in several ways; for instance, enhancing synaptic plasticity, which is essential for learning and memory. It also increases formation of neurons in the hippocampus — which is critical for memory formation — and protects against cell death.
Estrogen also helps to dilate blood vessels to increase blood flow to your brain,” writes Kay Uzoma of LiveStrong. Clearly, estrogens have a major role in your brain’s function and activity, so a sudden absence of these hormones can cause cognitive problems.

A decrease in estrogen is also caused by natural menopause. Early surgical menopause, however, is shown to have a stronger affect on cognitive function than natural menopause.  It is believed that when these abrupt changes happen earlier, they have worse effects on a woman’s body.

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