Menopause causes multiple changes in a woman, and new research suggests one fundamental change occurs in the brain. Women in menopause were more likely to have elevated levels of a brain biomarker known as white matter hyperintensities than men or premenopausal women.
White matter hyperintensities are small, but abnormal changes in the brain tissues. They are visible in brain scans and frequently appear at old age or with uncontrolled high blood pressure. High amounts of white matter hyperintensities are associated with a greater risk for stroke, Alzheimer’s disease, and decreased cognition.
“White matter hyperintensities increase as the brain ages, and while having them does not mean that a person will develop dementia or have a stroke, larger amounts may increase a person’s risk,” says study co-author Dr. Monique M. B. Breteler, a researcher of the German Center of Neurodegenerative Diseases (DZNE), in a statement. “Our study examined what role menopause may have on amounts of these brain biomarkers. Our results imply that white matter hyperintensities evolve differently for men and women, where menopause or factors that determine when menopause starts, such as variations in the aging process, are defining factors.”
The team recruited 3,410 people for the study. The average age of the group was 54. Fifty-eight percent of participants were women and of the women, 59% were postmenopausal. About 35% of all participants had high blood pressure, and in half of that group, people had uncontrolled high blood pressure.
Everyone had an MRI brain scan. The researchers studied each scan and the amount of white matter hyperintensities for each person. The average volume for each brain biomarker was 0.5 milliliters. Brain volume was 1,180 ml for men and 1,053 ml for women. Between genders, men average about 490 ml of white matter hyperintensities and 430 ml for women.
Postmenopausal women had more brain biomarkers than men of similar ages. Postmenopausal women over 45 had an average of 0.94 ml of white matter hyperintensities volume compared to men at 0.72 ml. The rate at which the biomarkers formed accelerated at a faster rate with age and in women rather than men.
However, premenopausal women and men of similar ages showed similar amounts of white matter hyperintensities. Between women, postmenopausal women had more white matter hyperintensities than premenopausal women of a similar age. When both postmenopausal and premenopausal women showed signs of the biomarkers, the volume of white matter hyperintensities was greater in women with menopause.
There was no difference in biomarkers between postmenopausal and premenopausal women using hormone therapy. These findings suggest that hormone therapy may not protect the brain. While not related to menopause, the researchers also confirmed that women with uncontrolled high blood pressure showed elevated biomarker levels than men.
“It has been known that high blood pressure, which affects the small blood vessels in the brain, can lead to an increase in white matter hyperintensities,” explains Dr. Breteler. “The results of our study not only show more research is needed to investigate how menopause may be related to the vascular health of the brain. They also demonstrate the necessity to account for different health trajectories for men and women, and menopausal status. Our research underscores the importance of sex-specific medicine and more attentive therapy for older women, especially those with vascular risk factors.”
One study limitation was not knowing the exact age when women underwent menopause and not knowing if some participants were perimenopausal.
The study is published in the American Academy of Neurology’s official journal Neurology.