Low estradiol levels escalate menopausal symptoms leading to mild cognitive impairment in postmenopausal women
Abstract
BACKGROUND Women in menopause experience dramatic alterations in gonadal hormone concentrations, including diminished estradiol levels. It has been hypothesized that these hormonal changes may be responsible for the occurrences of menopausal symptoms, such as hot flushes, sleep disruption, night sweats, and irritability, as well as mild cognitive impairment (MCI) in postmenopausal women. Therefore, this study was aimed to determine if there is any association between hormonal changes and menopausal symptoms, including MCI in postmenopausal women.
METHODS A total of 245 postmenopausal women were recruited for this cross-sectional study and classified into 2 groups; MCI and non-MCI groups. Diagnosis of MCI was made using the modified Petersen criteria. Variables such as subjects’ age, duration of menopause, menopausal symptoms, anthropometric status, hormone levels, and cognitive status were assessed and statistically analyzed.
RESULTS Of the 245 subjects enrolled in this study, 53.9% had MCI. Multivariate analysis found that sleep disruption and estradiol levels were independent risk factors of MCI in postmenopausal women. No significant correlation was found between menopausal symptoms and estradiol concentration.
CONCLUSIONS Low estradiol levels were associated with higher risks of experiencing menopausal symptoms and MCI. Sleep disruption and estradiol levels were the most influential factors in the development of MCI in postmenopausal women.
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References
Amore M, Di Donato P, Berti A, Palareti A, Chirico C, Papalini A, et al. Sexual and psychological symptoms in the climacteric years. Maturitas. 2007;56(3):303-11. https://doi.org/10.1016/j.maturitas.2006.09.006
Takahashi T, Johnson KM. Menopause. Med Clin North Am. 2015;99(3):521-34. https://doi.org/10.1016/j.mcna.2015.01.006
Pimenta F, Leal I, Maroco J, Ramos C. Menopausal symptoms: do life events predict severity of symptoms in peri- and post-menopause? Maturitas. 2012;72(4):324-31. https://doi.org/10.1016/j.maturitas.2012.04.006
Lambert MN, Thorup AC, Hansen ES, Jeppesen PB. Combined red clover isoflavones and probiotics potently reduce menopausal vasomotor symptoms. PLoS One. 2017;12(6):0176590. https://doi.org/10.1371/journal.pone.0176590
Hestiantoro A, Wiwie M, Shadrina A, Ibrahim N, Purba JS. FSH to estradiol ratio can be used as screening method for mild cognitive impairment in postmenopausal women. Climacteric. 2017;20(6):577-82. https://doi.org/10.1080/13697137.2017.1377696
Henderson VW. Three midlife strategies to prevent cognitive impairment due to Alzheimer's disease. Climacteric. 2014;17:38-46. https://doi.org/10.3109/13697137.2014.929650
Henderson VW. Cognitive changes after menopause: influence of estrogen. Clin Obstet Gynecol. 2008;51(3):618-26. https://doi.org/10.1097/GRF.0b013e318180ba10
Nasrun MWS. Buku pedoman skoring: Hendaya Kognitif Non Demensia (HKND) pada Populasi "Brain at Risk" bagi Praktisi Kesehatan. Jakarta, Indonesia: Pusat Penerbitan Departemen Ilmu Penyakit Dalam; 2007. Indonesian.
Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015;57(Suppl 2):S222-32. https://doi.org/10.4103/0019-5545.161483
Zeki Al Hazzouri A, Stone KL, Haan MN, Yaffe K. Leptin, mild cognitive impairment, and dementia among elderly women. J Gerontol A Biol Sci Med Sci. 2013;68(2):175-80. https://doi.org/10.1093/gerona/gls155
Rossmanith W, Ruebberrdt W. What causes hot flushes? the neuroendocrine origin of vasomotor symptoms in the menopause. Gynecol Endocrinol. 2009;25(5):303-14. https://doi.org/10.1080/09513590802632514
Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44(3):497-515. https://doi.org/10.1016/j.ecl.2015.05.001
Nelson LR, Bulun SE. Estrogen production and action. J Am Acad Dermatol. 2001;45(3 Suppl):S116-24. https://doi.org/10.1067/mjd.2001.117432
Grantham JP, Henneberg M. The estrogen hypothesis of obesity. PLoS One. 2014;9(6):e99776. https://doi.org/10.1371/journal.pone.0099776
Deecher DC, Dorries K. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health. 2007;10(6):247-57. https://doi.org/10.1007/s00737-007-0209-5
Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes. 2005;3:47. https://doi.org/10.1186/1477-7525-3-47
Ratka A. Menopausal hot flashes and development of cognitive impairment. Ann N Y Acad Sci. 2005;1052:11-26. https://doi.org/10.1196/annals.1347.002
Haines CJ, Xing SM, Park KH, Holinka CF, Ausmanas MK. Prevalence of menopausal symptoms in different ethnic groups of Asian women and responsiveness to therapy with three doses of conjugated estrogens/medroxyprogesterone acetate: the Pan-Asia Menopause (PAM) study. Maturitas. 2005;52(3-4):264-76. https://doi.org/10.1016/j.maturitas.2005.03.012
Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Leserman J, Girdler SS. Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition. Menopause. 2016;23(3):257-66. https://doi.org/10.1097/GME.0000000000000528
Newhouse PA, Dumas J, Wilkins H, Coderre E, Sites CK, Naylor M, et al. Estrogen treatment impairs cognitive performance after psychosocial stress and monoamine depletion in postmenopausal women. Menopause. 2010;17(4):860-73. https://doi.org/10.1097/gme.0b013e3181e15df4
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