Alzheimers + Menopause

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I just read an interview between Deborah Copaken and Dr. Lisa Mosconi that my friend Laurie Smithwick sent to me. I was not expecting it, but I am sitting on the couch shaking with sadness and anger and frustration. The interview is about the connection between Alzheimers and Menopause. Did you know a connection between these two exists? I had no idea.

Eight other things I had no idea about:

-Twice as many women get Alzheimers as men. If you’ve heard this fact before, you may have also heard it attributed to women living longer than men, but that’s false. I mean, it’s true that women live, on average, four years longer than men, but that doesn’t account for the massive difference in the number of women and men dealing with Alzheimers.

-Women’s and men’s brains age very differently. And for women, Alzheimer’s is not a disease of old age. For women, it starts in middle age.

-If a woman is going to get Alzheimers, the plaques will start showing up in her brain as early as peri-menopause, but she likely won’t get diagnosed because the tests were developed for men’s brains. From Dr. Mosconi: …a few years ago, [it was discovered] that the tests we were using to diagnose Alzheimer’s were not sensitive enough for women at the early stages because women score better than men on cognitive tests and always have. The cognitive score declines a bit with menopause, and then after menopause, but even women with a diagnosis of early Alzheimer’s may score better than men with the same diagnosis of Alzheimer’s.

-Taking out the ovaries or the uterus increases the risk of dementia in women. From Dr. Mosconi: It’s true. There’s a strong association between early menopause and an increased risk of Alzheimer’s in women. And oophorectomy, which is the surgical removal of the ovaries, increases the risk up to 70%.

-We tend of think of the brain as running the rest of the body, but other body parts have a huge effect on the brain. Like gut health. And our ovaries also have a huge effect on our brains.

-From Dr. Lisa Mosconi: When you lose your sex hormones — your estrogen and progesterone, FSH, all these hormones — the rest of your body starts aging faster. Your arteries harden faster, your bones become more fragile faster, pretty much anything that can age, ages a bit faster than before.

-Smoking affects men’s and women’s brains differently, and it’s harder for women to quit smoking than men. From Dr. Mosconi: Men’s brains and women’s brains are wired slightly different, in a way that the effect of smoking on dopamine activates different parts of the brain. In men, it makes you crave the effect of nicotine, but in women, it stimulates the brain centers that are involved in addiction. So women tend to develop a habit that becomes more psychological. It’s a habit. And that’s why the rates of successfully quitting smoking are higher in men than women. Because you can give men a patch and then you have the nicotine, and the brain is happy. But for women, this patch doesn’t help you with the ritual of smoking a cigarette. So it’s harder to break a woman’s addiction than a man’s addiction.

-Fun fact: Estrogen is the most ancient of all the hormones, and it goes across species. It’s even found in plants.

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The interview is long (Medium estimates it as a 37 minute read), but it’s super interesting, and I hope you read it.

I’m not totally sure why I had such a reaction to it (I haven’t been touched closely by Alzheimers). I think I’m just mad that we know so little about women’s health.

I’m angry about the Women’s Health Initiative — it was started in 1993, and assumed every woman needed to take estrogen supplements as she hit menopause. The research did tons of damage to thousands of women so it was abandoned. But it was helping thousands of other women. Couldn’t we have dug into what was working and what wasn’t? I’m angry that the myth of the cervix being connected to sexual pleasure was only debunked in 2011. I’m angry that we didn’t get a 3-D model of the clitoris until two years ago. I’m angry that every test, every medical innovation, is developed for men, tested on men — then assumed to work equally well for women.

From Dr. Mosconi: Maybe at least we can change the bias that we have in health care and the fact that all the research that has been done so far, in all the medical textbooks, is based on the research of men. It’s either male cells, male mice, male animals, or men, and that leads to under-diagnosing women, misdiagnosing women, giving us the wrong drugs, and it’s just a disaster!

Did you already see this interview? Or have you had a chance to read it? I’d love to hear your thoughts. Do you suspect Alzheimers is in your future? Have you ever had that thing where you can’t remember a word? I experienced this the other day and it totally freaked me out.

P.S. — Two books mentioned in the interview that I want to check out:
Invisible Women: Data Bias in a World Designed for Men
– The XX Brain, Avery/Penguin Random House — it comes out in March 2020


My Alphabet of Menopause print by StudioKarenStanton.

29 thoughts on “Alzheimers + Menopause”

  1. As a 41-year-old woman who is in chemically induced menopause (I’m taking tamoxifen, an estrogen-suppressing drug, because I had estrogen positive breast cancer), I’m angry, too. But it’s a pretty impotent anger…I know I need tamoxifen to help protect against my cancer spreading or returning. But I am feeling all the negative side effects of being in menopause a good decade before I should be. I feel like I’ve aged so much in the past two years, and I don’t like the way I look anymore. Add to this the greater possibility of dementia? So frustrating.

    1. I can so commiserate with you, I am exactly in the same boat. In addition to the chemically induced menopause, I had a hysterectomy and oophorectomy at 45, so that plunged me right in there. I always felt young, but I feel that I have aged a lot in these few years, probably thanks to no estrogen in my body. The thought of getting dementia in addition to that, indeed frustrating. Please keep well!

    2. GREAT post, Gabrielle. Thank you for continuing to use your voice to improve the world for others.

      Same boat here too! And I’m comforted to read your posting here. Ovary removal at 44 after breast cancer. Would it be brazen of us to march into the oncologist office tomorrow and say we want to be alive, cancer-free AND not face risks of aging? I would like ALL the miracles please.

      I also recall my OB/GYN blanching when I conveyed the onco’s advice for the surgery. “But the estrogen protects you from so much!”. To this day (with all the unasked questions a cancer diagnosis brings), I’m afraid to ask my oncologist “Are you putting my whole body at risk because I’m that close to advanced cancer disease and death?”

      1. Oh, good health to both of you! Another thing: about a year ago, I asked my PCP what we could do about my nonexistent sex drive. The answer: nothing (because everything approved for that purpose involves estrogen). And that was it. I know Gabrielle has talked here about female sexual pleasure and the way our culture doesn’t value it–cancer adds another wrinkle to that, too.

        1. Oh boy, yeah, that fell by the wayside as well after all the “ectomies”; I talked to my oncologist about it (female) and she was very understanding and prescribed some low dose vaginal hormonal moisturizing cream that she promised would not be in the way of the cancer-avoidance efforts, but that does unfortunately not do much. We had a long talk about it, and she had to admit that this is something most oncologists don’t really think or talk about, but she absolutely acknowledges the problem, but could not really offer help. My husband and I had a very satisfying sex life up to the hysterectomy/oophorectomy, but it has gone a bit downhill since then, and I guess I need to have some new ideas. But I’d rather be alive with little sex than otherwise … wishing good health and happiness where you can get it to all the ladies who are in a similar position, and there are so many of us. Thank you Gabrielle for the topic, and also for your frank previous posts about sex (drive) and related things. So helpful, and good to read that other women are in the same boat. So, in summary, yes, I also suck it up, because all is better than advanced cancer and death, I just hope it works.

    3. Oh friends, I am right there with you too. I had ER+ breast cancer at 41 and am now on monthly goserelin shots and daily exemestane pills. When I fill out health forms that ask about age, I’m never quite sure what to say … my body is barely 47, but it’s acting so much older because of the hormones that are being completely removed. My brain is so much slower, I forget things that should be really obvious, I get easily overwhelmed when there’s lots going on, and often I just can’t find words. Sometimes it’s just terrifying. It often gets attributed to chemo by my doctors, but it’s been 5+ years and I wonder if my brain will ever come back, or if it’s just been destroyed by the of lack of estrogen. Reduced quality of life is better than no life at all, for sure — but if I get to live out the rest of a normal life expectancy, I wonder what that will look like … I wonder what version of me will be around for that long. All of these challenges seem to be something that we have to settle for because they’re the trade-off for not having cancer — which, again, I’m grateful for, but also we definitely don’t get to be the same people going back to the same lives after treatment! I want us to sign up for all the studies that should happen so that someone can figure out how to help women in our situations. And I’m with Angela too — let’s have all the miracles.

  2. Reading these articles makes me mad but I am certainly not shocked. As a 61 year old woman my experience with the medical field has always been the same three diagnosis: “You need to lose weight.”, “You are too hormonal, you just need to relax”, and “You will grow out of this/ You need to remember that you are aging.”

    I was once poopooed and told to stop being so histrionic when I had the ‘flu’, but by the time they finally took me in for vitals, I was actually coding. That was fun.

    I was more than once told that the pain I was experiencing was “in my head” because I had 5 kids and my husband was working out of town. Turned out to actually be kidney stones. That was fun also.

    I was told to come back once I stopped bleeding so that I could properly be examined to determine what exactly was causing me to hemorrhage profusely for the previous 6 months. I was literally saved by a RN who decided to schedule my next appt. “by accident” with a cancer specialist who happened to be female. I had a complete hysterectomy 3 weeks later due to cancer.

    I have found that the fastest most effective way to get treatment for *any* ailment from a splinter in my finger to cancer, has been to claim that “if this doesn’t get resolved soon it will affect *my husband*’s sex life.” When it has an opportunity for lessening *my husband*’s sexual pleasure, people begin to actually listen and try to help.

    I could go on and on about how invisible women are in medical discovery but instead I’m going to go find a way to fund women’s health research, because no, it wasn’t all in my head.

    1. “I have found that the fastest most effective way to get treatment for *any* ailment from a splinter in my finger to cancer, has been to claim that “if this doesn’t get resolved soon it will affect *my husband*’s sex life.” When it has an opportunity for lessening *my husband*’s sexual pleasure, people begin to actually listen and try to help.”

      Oh my gosh, I 100% believe this comment, and don’t know if you were trying to be funny but it also made me gasp and laugh out loud. I feel like that’s a lifehack we need to spread the word about.

      1. Not trying to be funny at all, in fact just the opposite.

        I mentioned that I had kidney stones. The *only* reason they were diagnosed is because my husband told the dr. “Well, if it’s all in her head you’d better call a psych down, because it’s real to her ->and I am not going home with her in this kind of pain – imagined or not.” *His* needs were listened to before my actual need of lithotripsy. It was also the point in time when husband went full on feminist.

        I have repeatedly given that ‘go to’ statement to several women when they have vented their frustrations at being ignored or patronized by their drs. “Use this sentence, with emphasis on how *your* health issue is causing your *husband’s* sexual pleasure to diminish because *you* are in pain and cannot *perform for him*. Because, *his* pleasure is much more important than *any* health problem you may be experiencing. I promise it will move mountains out of the way.”

        Every time I give it and they use it they will come back and report on how quickly it worked.

        THIS. This is our health system.

        1. That is sick. That is sick that you need to demean your problems like that to be able to get the care you need and that that’s why doctor’s listen. And it’s sick that I believe you.

          (Also, because tone is hard to convey, I’m going to clarify that the system is broken, not you).

      2. Your comment about how this will affect your husband’s sexual needs struck me cold. When beginning a long recovery from the affects of viral meningitis, a doctor I worked with was most concerned that my husband wouldn’t be ‘satisfied’ since I was mentally out of it. Again, putting female needs far below that of males – and this was from a female doctor!

  3. I read this article last week and while I also felt angry about the sexism, I mostly felt panicked. I was so excited to read Dr. Mosconi’s response to the question of what she would “tell a 50-year-old woman to do right now in terms of estrogen replacement,” but disappointed that the response is that it depends and we need to read her book (when it comes out next March!) or join the study/be a patient in NYC (don’t live there). While the article was revelatory and I appreciate it, I also found the jokiness of it distressing. Perhaps gallows humor, but for me it was dissonant.

    1. Agreeing, at that point in the article I felt it was more important to sell her book than give me a straight answer. While I can appreciate that each case *is* individual and that she actually shouldn’t diagnose or suggest any treatment in such a setting – she should have said so rather than inserting a commercial.

      I am 61, I had a complete hysterectomy at 48, I never took *any* HRTs- it was a time when they actually were thinking they were very harmful to you, -I’m doing the math. The only thing that gives me hope is that our family genetics seems good in this one area. That said, my mother and grandmother on both sides never ate one bite of GMO foods, where I -and more important to me- my daughters, DILs, and granddaughters- *have*.

      Elizabeth, I hope you can find your answers quickly, I understand your concerns!

  4. I’m reading Dr Mosconi’s Brain Food book while waiting for the XX Brain to come out, and feeling frustrated alongside you. It’s reminding me of another book, The End of Alzheimers by Dr. Bredesen. Knowing now about the hormone-Alzheimer link has me thinking of your PMDD post as well, and how all of this ties together for women while being overlooked by the medical community in so many ways.

  5. I recently read this article about the link between estrogen & schozophrenia (and the fact that no one wants to research it).

    Very hard not to feel like women’s health is not a priority and perhaps never will be.

  6. I hope the fact that more women than men are currently enrolled in medical school will lead to a change in more care for women’s health.
    Also on a tangent, I listened to a public radio interview about medications for geriatric people – medications are not tested on geriatric people, and they often take multiple medications, so you can see side effects that are not listed on the medication because they were tested on younger and presumably more healthy people. I found that pretty disturbing also.

  7. I read this article about a week ago, and I was angry and scared. My anger was the sort of existential depression anger that makes you scream while crying at the same time (dramatic, I know). I don’t know what we can do on a large scale (aside from donating to and for women’s health research), but on the personal level, each of us can advocate for ourselves. We can politely, but firmly insist that our health concerns be taken seriously.

    And on that note, today I’ll be making an appointment with a new obgyn to discuss the piece of copper IUD that’s been embedded in my uterus for the last 5 years. It broke when I was getting it removed, and when the doctor couldn’t get it out, he said that because I wasn’t planning on having more children, we could leave it there indefinitely. I asked other doctors, and they all basically shrugged and said that they didn’t know if it was safe, but also couldn’t say whether it was unsafe, and if the specialist thought it was okay, then it probably was. I trusted the doctor because he was a professional, but now I’m wondering if he would live with a 1-inch copper rod embedded near his prostate for the rest of his life.

    1. I would get it out. I had one stuck after having it in for five years. I was about to move overseas and I wanted to have my IUD changed (a new one put in). I have a female OBGYN. She was frustrated that she couldn’t pull the strings to get it out. Then she mentioned I might need surgery to remove it. Fortunately she tried one last painful tug and it came out. I think if it was me, I would have it removed for my own safety. I have had a friend that believed her cervical cancer came from the same type of IUD that I use. I did a bunch of research and concluded that I was okay to keep my IUD, but I would definitely not continue to have it if I could have the choice to remove it.

  8. I, too, read the article about a week ago and definitely found it disturbing. Both my mother and her mother had “dementia” in their later years and yes, I do have moments where I can’t find the word for something. I agree that more women entering the medical field will make a difference, but not for my generation. So I’ll keep trying to stay active and eat well. I’ll travel now, in my late fifties, and try to fit a lot of living in the next twenty years, because I really feel dementia will come for me, too. I’ll keep reading and trying to challenge my brain, but really, what advice do they have for me? The medical field does not have my back.

  9. I read that article when it was linked to FB a couple weeks ago, and it freaked me the eff out. I don’t know why…I don’t have any family history for dementia or Alzheimer’s whatsoever, but I guess I now view menopause in a much more sinister light. My goodness, it kind of sucks being a woman in so many ways.

  10. I just sent this to so many women I know. My jaw was on the floor through that entire article. Thank you as always for highlighting important issues!

  11. The book, “Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick” is a “good” read too. Good in that once I read it, I felt my experiences were validated (was told for 7 years I just had “bad cramps” before finally being diagnosed correctly with spine cancer) but not really “good” in terms of the anger!

  12. Thank you for your post and sharing the article. This has given me a lot to think about. I’m 36 and have the BCRA1 gene (discovered when my mother was diagnosed with Breast Cancer at 63). Though we don’t have a history of breast/ovarian cancers in our family, I was planning to excise my ovaries/etc. at some point. This makes me seriously reconsider.

    I also wonder about my mother- for years my father and I had thought chemo had aged her – but now I wonder if it was the removal of her ovaries? Recognizing she’d already gone through menopause… but her memory really seems to have taken a hit.

  13. I’ve had a crash course in this since my hysterectomy with bilateral salpingo-oophorectomy nine weeks ago. I found out the hard way that I can’t use estrogen in any form, even the patch, without dire consequences to my mental and physical health. I’m recovering from a pulmonary embolism right now, actually.

    My gyn surgeon and I have differing viewpoints on what caused my PE. I caught it myself. It definitely could have been just because of my surgery, but I took so many preventative measures, including injecting myself with heparin for two weeks following. A few days after I started using the estrogen patch, all hell broke loose in my brain and I also developed blood clots in my legs. So no more estrogen for me EVER.

    I know the risk I’m taking, but the more immediate danger is blood clots killing me. But oh boy, I am freaked out about the increased risk of degenerative brain diseases. I can deal with the osteoporosis and heart disease risk by sticking to the plan I made with my primary care doc. She’s the only one who seemed interested in discussing all of this with me. My (male) surgeon, who is awesome in every other way, totally shut me down when I tried to talk about not doing HRT. I don’t really want to die from a blood clot. At least he is aware of the risks and helping his patients make informed decisions. (Agree to disagree.)

    And yet, I will continue to be super worried about developing Alzheimer’s or dementia. I have too much more I want to do in my life than to suffer from a brain disease that will steal my cognitive function. Ugh.

    On another note, all of this has inspired me to go back to school to (hopefully!) become a doctor. My intention now is to go into women’s health with an emphasis on psychiatric care and hormones. (If I don’t get it, I’ll go the PhD route and still study it. ;) )

    I’m glad you’re bringing awareness about these issues. Women’s health is more than pregnancy and childbirth, or helping those with infertility issues. In reality, our childbearing years are shorter or roughly equal to the time we will spend in menopause.

    By the way, I don’t regret my hysterectomy and ovary removal one bit. I am a new, improved version of myself and it just keeps getting better. The cyclical symptoms were so debilitating. I am finally free! Hopefully I can follow through on the med school plans before Alzheimer’s gets me. :(

  14. I’m 50, post-menopausal for about 3 years or so, and this topic really concerns me. My maternal grandmother began showing signs of Alzheimer’s at age 55, and she passed away at age 65 (in 1975). Women’s health is starting to get some momentum as we clamor for attention. I found a great resource led by a Canadian woman, Shirley Weir, who is leading the charge for women and peri/menopause. She has a website, Menopausechicks.com, and she recently published a book, Mokita: How to Navigate Perimenopause with Confidence and Ease. She’s not afraid to tackle any issue. She hosts a private facebook page where women can share experiences, ask questions, and lend support. I’m not shilling here – I’m just sharing a resource that has been extremely helpful during a time when I felt like I had no one to talk to.

    1. Thanks for those resources! My paternal grandmother followed the same timeline as yours – dying in the early 80’s in her early 60’s. In my case, I can see that her diet was horrendous before and during Alzheimer’s, which along with her heavy smoking must have contributed heavily to her brain’s rapid decline. A lesson for the next generation.

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