Women who underwent earlier menopause were more likely to develop a greater amount of damaged white matter in the brain decades later, a new study led by UC San Francisco found.
This damaged white matter, visible on MRI, has been associated with difficulties in attention, focus, executive functioning, and information processing.
The study is the first to identify a significant effect of earlier menopause many years later. It was published in JAMA Network Openon Aug. 25 and funded by the National Institutes of Health.
Researchers analyzed data from about 2,600 women who were followed from an average age of 78 for up to 18 years. They estimated that over a 10-year period, a woman whose menopause occurred earlier might accumulate a 15% higher volume of damaged white matter than a woman whose menopause occurred five years later.
The researchers did not set a specific age cutoff for “earlier” menopause. In this study, they meant menopause occurring earlier than other participants. Among women who experienced natural menopause, the average age was 50. Among the roughly one-third who experienced surgical menopause, the average age was 43.
“Injury in the white matter becomes increasingly common as we age,” said senior author Riley Bove, MD, director of the UCSF Sex and Gender Enriched Program and Rosenberg Ach Family Endowed Professor in Neuroimmunology in the Weill Institute for Neurosciences.
“Along with aging itself, other conditions like hypertension, elevated blood sugar and cholesterol, and obesity can also contribute to this risk. Estrogen appears to provide some protection against these conditions, or against underlying brain vulnerability to injury, until it declines with menopause,” said Bove.
Earlier menopause was associated with a slightly faster decline in overall thinking ability and episodic memory, the brain’s ability to recall specific personal events and experiences. The researchers also found an association between earlier menopause and earlier onset of Alzheimer’s disease.
“These findings show that timing of menopause can influence how the brain ages, even decades later,” said first author M. Pia Campagna, PhD, postdoctoral fellow in the UCSF Department of Neurology and the Weill Institute for Neurosciences. “There is a major effort to study the menopause window to identify interventions that could optimize brain health as women age.”
The participants were enrolled from two long-term studies, the Rush Memory and Aging Study and the Religious Orders Study, led by co-author David A. Bennett, MD, at Rush University. In their analyses, researchers drew from MRIs, autopsy data, and cognitive testing.
Additional authors: Julie A. Schneider, MD, Lisa L. Barnes, PhD, Konstantinos Arfanakis, PhD, David A. Bennett, MD, from Rush University Medical Center; Galit Levi Dunietz, PhD, from University of Michigan.
Funding: National Institutes of Health and National Institute of Neurological Disorders and Stroke (P30AG10161, P30AG72975, R01AG15819, R01AG17917, U01NS100599, and R01AG064233). McKnight Brain Research Foundation McKnight Clinical Translational Research Scholarship in Cognitive Aging and Age-Related Memory Loss.
Disclosures: Please see the study.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical system, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at ucsf.edu.