Women who go through menopause prior to age 40 may face elevated risks of long-term cognitive decline and depressive symptoms, according to a new population-based study.
The analysis drew on data from 9,012 older adults participating in the English Longitudinal Study of Ageing (ELSA), which followed 4,726 women and 4,286 men over multiple waves to examine how menopause timing relates to mental and cognitive health later in life.
The investigators found that women with menopause before age 40 had significantly lower scores in orientation, immediate recall, delayed recall, and verbal fluency compared with those whose menopause occurred at age 50 or later. These associations remained statistically significant after adjusting for baseline cognition, depressive symptoms, age, education, comorbidities, and lifestyle factors. Two years after baseline, early menopause was still associated with worse orientation (−0.05, P = .005), immediate recall (−0.15, P = .003), delayed recall (−0.15, P = .008), and verbal fluency (−0.56, P = .001).
Depressive symptoms were also more common among women with early menopause. On the CES-D scale, this group had higher scores compared with those with later menopause (beta = 0.19, P < .001), and this effect persisted even after accounting for baseline symptoms and dementia-related lifestyle risk factors.
Men in the cohort demonstrated poorer cognitive performance overall compared with women who experienced menopause at age 50 or older, despite reporting fewer depressive symptoms.
The study also explored other reproductive variables. A shorter reproductive period was associated with lower memory scores and verbal fluency, while women with more miscarriages or stillbirths showed poorer orientation. Hormone replacement therapy (HRT) use was not linked to cognitive benefit; notably, women who used HRT for more than 11 years had poorer immediate recall compared with nonusers.
Including sleep duration and sleep issues in the models did not change the observed associations between early menopause and cognitive outcomes.
According to the investigators, early menopause may represent an independent risk factor for cognitive decline.
"Women who experience early menopause may constitute a high-risk group and priority target for dementia risk-reduction initiatives,” said lead study author Miharu Nakanishi of the Leiden University Medical Center and colleagues.
"The association between early menopause and cognitive decline persists even after adjusting for baseline depressive symptoms and other modifiable risk factors,” they added.
Although the biological mechanisms were not addressed in this study, the authors noted the need for future research to explore how menopause timing, hormonal levels, depression, and cognitive function interact over time.
The authors reported no conflicts of interest.
Source: Alzheimer’s & Dementia