Early menopause linked to increased risk of cognitive decline

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Early menopause linked to cognitive decline

Women with early menopause are at an increased risk of 2-year follow-up cognitive decline, according to a recent study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.¹

Women are disproportionately impacted by dementia compared to men, highlighting potential sex-specific risk factors. A link has also been established between early menopause and depression, which increases the risk of dementia. This led investigators to evaluate the association between early menopause and cognitive function.

“Since early menopause increases the risk of depression, which then increases the risk of dementia, we had to control for this factor to determine if early menopause in of itself was a direct risk factor,” said Miharu Nakanishi, PhD, lead author from the Tohoku University Graduate School of Medicine.

Evaluating menopause and cognitive health

Data was obtained from the English Longitudinal Study of Ageing, which collected an initial wave of data from 2002 to 2003 and obtained follow-up information every 2 years. Participants from waves 2 through 5 and 8 through 10 were included in the analysis.

Relevant variables included age at menopause, other reproductive factors, depressive symptoms, cognitive function, and covariates. Researchers asked women if they had menstruated in the last 12 months and when their last menstrual period occurred. Categories of age at menopause included under 40 years, 40 to 49 years, and 50 years or older.

Type of menopause, hormone replacement therapy use, years of reproductive periods, and the number of miscarriages, stillbirths, and abortions were reported as additional reproductive factors. The Center for Epidemiologic Studies Depression Scale was used to determine depression, with worse symptoms indicated by higher scores.

Cognitive measures and demographics

Orientation, immediate recall, delayed recall, and verbal fluency were reported as cognitive functions. Covariates included age, educational attainment, marital status, loneliness, obesity, hearing impairment, diabetes, hypertension, cancer, stroke, smoking status, alcohol consumption, physical activity, sleep problems, and sleep duration.

There were 4286 men and 4726 women included in the final analysis, aged a mean of 64 years at first participation. Menopause at under 40 years of age was reported in 10.2% of women. These patients were more often married, current or former smokers, and reported more severe depressive symptoms than those with menopause at the age of 50 years or older.

Depressive symptoms and cognitive functions

Depressive symptoms were more severe in patients undergoing menopause when aged under 40 years or 40 to 49 years vs those aged at least 50 years. Further reductions were reported in men compared to women with menopause at a later age. A significant link was reported between baseline depression and worse cognitive function.

Associations were also noted for worse orientation, immediate recall, delayed recall, and verbal fluency from menopause when aged under 40 years vs at least 50 years. However, women with menopause when aged 50 years or older had improved cognitive function compared to men.

Patients with a longer reproductive period reported improved immediate recall and verbal fluency, with improved verbal fluency also reported in those with a greater number of live births. However, lower orientation was reported in patients with increased miscarriages, stillbirths, or abortions.

Conclusion and future recommendations

While no association was reported between menopause because of surgery and cognitive function, menopause from chemotherapy was linked to low orientation. There was also no association between sleep measures and cognitive measures. Overall, the data highlighted a link between early menopause and reduced cognitive function.

“Dementia risk-reduction strategies should consider women who experience early menopause as a sex-specific high-risk group,” wrote investigators. “Further research is warranted to elucidate the underlying mechanisms.”

References

1. Menopause at an early age can exacerbate cognitive decline. Tohoku University. April 15, 2025. Accessed April 18, 2025. https://www.eurekalert.org/news-releases/1080697
2. Nakanishi S, Yamasaki M, Stanyon D, et al. Associations among age at menopause, depressive symptoms, and cognitive function. Alzheimer's & Dementia: The Journal of the Alzheimer's Association. 2025;21(4):e70063. doi:10.1002/alz.70063