Post-menopause cognitive decline and depression

Menopause is often accompanied by a range of symptoms, including cognitive decline and depression, which can persist for years after the onset of menopause.

Learn more about this topic in the HealthCert online Professional Diploma program in Women's Health.

Defined as the permanent cessation of menstrual bleeding caused by ovarian failure, menopause is a natural physiological process that occurs in most women between the ages of 45 and 60, with the average age being 51.

Subjective cognitive decline is a common symptom of menopause, affecting up to 62% of menopausal women, and can manifest as issues with memory, attention, processing speed, and executive function, commonly referred to as "brain fog". Additional symptoms such as sleep disturbances, mood changes, anxiety, and vasomotor symptoms can exacerbate cognitive problems.

To assess cognitive decline in postmenopausal women, validated tools such as The General Practitioner Assessment of Cognition (GPCOG) or Mini-Mental State Examination (MMSE) should be considered. It is important to recognise that these symptoms may also indicate other conditions such as dementia, Alzheimer's disease, or depression.

Women should be assured that memory problems during midlife and beyond are common and likely influenced by multiple factors, including hormonal changes, stress, fatigue, and physical health.

Depression is more prevalent in peri- and postmenopausal women than in the general population, with up to 45% prevalence. Therefore, depression screening should be conducted in all patients using validated tools such as the Patient Health Questionnaire-9 (PHQ-9).

It should be noted that simple lifestyle measures and aids such as to-do lists, calendars, and reminders can help alleviate anxieties about forgetfulness. Regular physical exercise, a healthy diet, social and intellectual activities may also slow cognitive decline. Simple mental exercises such as crosswords, puzzles, and calculations can help keep the brain active.

Women should be advised to reduce their alcohol intake and to quit smoking, if applicable, as excess alcohol intake and smoking are both associated with cognitive decline, among other illnesses.

Depression in menopausal women is treated similarly to depression in the general population and may include cognitive behavioural therapy (CBT) or pharmacological therapy with antidepressant medications.

Hormone replacement therapy (HRT) has also been shown to improve depression in some menopausal women. It is essential to discuss the benefits and risks of hormone replacement therapy (HRT) in peri- and menopausal women. HRT is primarily used to relieve symptoms caused by oestrogen deficiency; however, it may also improve symptoms of cognitive decline and depression.

For women who may have dementia or other co-existing conditions, early referral to specialist secondary care services is advised.

Cognitive decline and depression are common and often interlinked conditions that affect postmenopausal women. To provide comprehensive and patient-centered care to women, it is essential to screen for other conditions, assess and manage cognition and mood disorders, and prevent future illness. Women should be reassured that memory problems during midlife and beyond are common, and there are effective treatments available.

Dr Samantha Miller, MBChB

Learn more about this topic in the HealthCert online Professional Diploma program in Women's Health.

References

1.    National Institute of Clinical Excellent (NICE)(2022). Clinical Knowledge Summary. Menopause. https://cks.nice.org.uk/topics/menopause/ 
2.    Conde, D. M., Verdade, R. C., Valadares, A. L. R., Mella, L. F. B., Pedro, A. O., & Costa-Paiva, L. (2021). Menopause and cognitive impairment: A narrative review of current knowledge. World journal of psychiatry, 11(8), 412–428. https://doi.org/10.5498/wjp.v11.i8.412 
3.    Dementia Australia (2022). Cognitive Screening and Assessment. https://www.dementia.org.au/information/for-health-professionals/clinical-resources/cognitive-screening-and-assessment 
4.    The General Practitioner Assessment of Cognition (GPCOG)(2016). http://www.gpcog.com.au/ 
5.    Standardised Mini-Mental State Examination (MMSE)(2019). https://www.ihacpa.gov.au/health-care/classification/subacute-and-non-acute-care/standardised-mini-mental-state-examination 
6.    Australasian Menopause Society https://www.menopause.org.au/
7.    Department of Health, State Government of Victoria, Australia. Better Health Channel: Menopause. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause 
8.    Australasian Menopause Society. AMS Guide to Equivalent MHT/HRT Doses. https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Guide_to_Equivalent_MHT-HRT_Doses_1020_V1.pdf 
9.    Department of Health, State Government of Victoria, Australia (2022). Better Health Channel: Hormone replacement therapy (HRT) and menopause. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hormone-replacement-therapy-hrt-and-menopause