Earlier Studies Have Also Linked Surgical Menopause To Early Cognitive Decline

Studies done in the past have also found a link between surgical menopause and cognitive decline. A study presented in the annual meeting of the American Academy of Neurology, held in San Diego, US in January 2013 also found an association between surgical menopause and decline in thinking and memory of the women. It found that women on hormonal replacement therapy showed a slower rate of decline of the cognitive functions.

For their study, the researchers, led by Dr. Riley Bove from the Harvard Medical School in Boston, enrolled 1,837 women between the ages of 53 and 100. All of these women were a part of the Rush Memory and Aging Project being carried out at the Rush University Medical Center, Chicago. 33% of these women had undergone surgeries which resulted in surgical menopause. The women were asked about their age at menarche and menopause, their menstrual cycles, and the details about their hormonal replacement therapy. All the participants of the study were also made to undergo several tests to measure their cognitive functions.

The researchers observed that the earlier the women were subjected to surgical menopause, the earlier and rapid was the decline in cognitive functions. The women who attained surgical menopause earlier performed badly in tests pertaining to concept and idea related memory, time and place related memory, and in tests related to overall thinking capabilities. The results were the same irrespective of the women’s age, smoking habits and education. These results were not seen in women who attained natural menopause. The brains of women who underwent surgical menopause also showed marked increase in the plaques associated with Alzheimer’s disease. However, the women who were put on hormonal replacement therapy soon after the surgical procedure showed a slower decline in their cognitive functions.

The study has opened the debate on whether hormonal replacement therapy has a protective effect against cognitive decline and whether women with surgical menopause should be put on long term hormone replacement?

Another study published in the journal Proceedings of the National Academy of Sciences in 2011 supports the protective action of estrogen on the brain. According to that study, prolonged deprivation of estrogen in aging rats led to a dramatic reduction in the number of estrogen receptors in the brain along with a reduction in the brain’s ability to prevent strokes. But the damage can be limited if estrogen replacement therapy is started shortly after the hormone level drops.

After surgical menopause, the unused estrogen receptors in the brain are eliminated. Starting estrogen replacement soon after the surgery can prevent this elimination. However, there is a critical window period for this. If hormonal replacement is started beyond this window period, it does not offer any protection to the brain. On the contrary, it may cause more damage as was seen in the Women’s Health Initiative study.

The Women’s Health Initiative study was a 12 years long study involving 161,808 women between the ages of 50 and 79. It was found in the study that the hormone replacement therapy increased the risk of stroke and other health problems. But it has been argued that the study involved women who were put on hormone replacement therapy much after they had attained menopause. This implies that the critical window period is very important if one wants to achieve the protective action of estrogen on the brain.

There is increasing evidence to conclude that surgical menopause is tied to increased risk of many chronic conditions like the coronary heart disease, stroke, and cognitive decline. Therefore, it is important to save the ovaries in women undergoing hysterectomy as far as possible. And in case removal of ovaries is mandatory, as in women suffering from conditions like breast or ovarian cancer, they should be considered for hormone replacement therapy at the earliest.