Is Estrogen Good for Your Brain?
It is no secret that bioidentical hormone replacement is a hotly debated subject. For this reason when a woman approaches menopause, I think she should take some time to think about it, and if possible talk with a doctor who also takes a thoughtful approach whether or not it’s a good idea for her.
One of the factors to think about is whether estrogen could have a protective effect on the brain. Women after all have a greater burden of Alzheimer’s than men do. At the age of 65, women have a 1 in 5 chance of developing Alzheimer’s, compared to a 1 in 11 chance for men. Out of the 5 million people living with Alzheimer’s in the U.S., 3.2 million are women (1).
One reason may be that at menopause, women’s estrogen tends to drop more precipitously than men’s testosterone falls with aging. Research suggests that replacing estrogen early in menopause does, in fact, make a measureable difference in brain health (2-7). One reason may be that it actually restores sleep architecture to a more normal pattern (8). Another is that loss of estrogen leads to loss of nerve connections in the memory center of the brain, the hippocampus which estrogen can help with (9). Further, estrogen helps other neurotransmitters in the brain that benefit cognition (9).
However, would estrogen help women who began it later for example, after 65 years old? The studies have not universally borne out that it does. But, consider the philosophy of the most famous Alzheimer’s researcher, Dale Bredeson.
According Dale Bredeson, author of “The End of Alzheimer’s,” “this disease is like a roof with 36 holes in it. If you only patch up one or two of the holes, the roof keeps leaking. That’s why studies of drugs to fight Alzheimer’s are notoriously unfruitful. These drugs at best can only patch up one hole.” Dr. Bredesen would argue that while estrogen may not be enough to reverse Alzheimer’s or even to universally prevent it after 65, it may still be a piece of the puzzle. It may patch up some holes in the roof.
So yes, this is a thoughtful discussion, and if you’d like to have that discussion, we’d be happy to talk.
-Bruce Thomas, MD
- Genazzani AR1, Pluchino N, Luisi S, Luisi M. Estrogen, cognition and female ageing. Hum Reprod Update. 2007 Mar-Apr;13(2):175-87.
- Jacobs D., Tang M., Stern Y., et al.: Cognitive function in nondemented older women who took estrogen after menopause. Neurology. 50:368-373 1998 9484355
- Sherwin B.: Estrogen effects on cognition in menopausal women. Neurology. 48 (suppl 7):S21-S26, 1997
- Kampen D., Sherwin B.: Estrogen use and verbal memory in healthy post-menopausal women. Obstet Gynecol. 83:979-983 1994 8190445
- Henderson V.: The epidemiology of estrogen replacement therapy and Alzheimer’s disease. Neurology. 48 (suppl 7):S27-S35 1997 9153164
- Tang M., Jacobs D., Stern Y., et al.: Effect of oestrogen during menopause on risk and age at onset of Alzheimer’s disease. Lancet. 348:429-432 1996 8709781
- Antonijevic, I Stalla, Günter K, Steiger, Axel Modulation of the sleep electroencephalogram by estrogen replacement in postmenopausal women American Journal of Obstetrics and Gynecology February 2000;182(2)277–282
- McEwen B, Alves S, Estrogen Actions in the Central Nervous System* Endocrine Reviews, Volume 20, Issue 3, 1 June 1999, Pages 279–307