Abstract
Introduction Previous studies have reported that the menopause is associated with deterioration in memory and mood in some women. Also, a significant body of research suggests that hormone “replacement” therapy (HRT) specifically with estrogen may act as a prophylaxis against the risk for developing Alzheimer's disease (AD) and a treatment for perimenopausal depression. The precise nature, and biological basis, of this relationship is still not fully understood. However, it probably involves a complex interaction between genes, the environment and the mode and timing of HRT prescription. Increasing our understanding of the interplay between these factors during the menopause may permit us to target more specific treatments to vulnerable individuals. Further, it offers a window of opportunity to understand the putative role of estrogen in psychiatric disorders at other times of the reproductive cycle. The current chapter will focus on the role of estrogen on Alzheimer's disease and depression during the menopause. Alzheimer's disease By the year 2050 it has been estimated that 30% of the population in Western Europe will be over the age of 65 and as many as 10% will have Alzheimer's disease [1]. Also, mild cognitive impairment (i.e. a preclinical stage of AD) has an estimated prevalence of 20–30% in elderly people [2]. Dementia currently costs the UK health-care system approximately £17 billion per year and is predicted to reach £35 billion within 20 years [3]. The social and economic implications of this are greatest among women because their life expectancy, and risk of developing AD, are greater than for men [4]. However it has been calculated that if severe cognitive impairment could be reduced by 1% per year, this would cancel out the estimated increases in the long-term health-care costs [5], as well as reducing the significant emotional costs. Support for the protective effect of sex hormones on cognition has come both from studies into the negative effects of early surgical oophorectomy, prior to the onset of menopause, and the positive effects of HRT prescribed post menopause. In the former category it has been reported, for example, that oopherectomy before 49 years of age is associated with a significant increased relative risk of dementia, and this risk increased the earlier the age of oophorectomy [6].
| Original language | English |
|---|---|
| Title of host publication | Managing the Menopause: 21st Century Solutions |
| Publisher | Cambridge University Press |
| Pages | 91-101 |
| Number of pages | 11 |
| ISBN (Print) | 9781316091821, 9781107451827 |
| DOIs | |
| Publication status | Published - 1 Jan 2015 |
