Think getting treatment for menopause makes you a wimp? Think again!

It’s about saving your health- and preventing dementia!

Lots of people think that “just a few hot sweats” are a minor issue. Why get treated? Because hot flushing, depression, anxiety and insomnia do more than give you a little glow. they can really play havoc with your health.

Treating peri and menopause could help prevent or delay dementia

Dementia is a women’s issue. Dementia is the biggest killer of women in Australia. Two out of every 3 people with dementia are women. Women are 55% more likely to get dementia than men. Once we hit mild cognitive impairment, women progress more quickly to dementia than men.  Brain scans tell us that the rate at which brain cells are dying in the brain is faster in women than in men.

According to Dementia Australia, in 2018, dementia is estimated to have cost Australia more than $15 billion. By 2025, the total cost of dementia is predicted to increase to $18.7 billion in today’s dollars, and by 2056, to more than $36.8 billion.

There is currently no effective treatment for dementia. But it can be prevented. But preventing dementia needs to start in midlife and it involves controlling your peri and menopause symptoms. In fact, according to the Centers for Disease Control (US), 40% of dementia could be either prevented or delayed.

How?

The SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT MIND) study took a subset of 2800 SPRINT participants to see whether these same aggressive targets would also reduce the risk of developing dementia or mild cognitive impairment. It was a hard yes again. In the group with the aggressive BP targets, new cases of Mild Cognitive Impairment or MCI were 19% lower, and the rates of dementia were 15% lower.

1. More aggressive blood pressure targets

The Systolic Blood Pressure Intervention Trial (SPRINT) hypothesized that intensive blood pressure (BP) control to a systolic (top number) blood pressure target <120 mm Hg would reduce heart disease outcomes and death more than treatment to the standard systolic BP target of <140 mm Hg. They ended up having to stop the trial early, because the benefits of more aggressively targeting lowering systolic BP (below 120), were so profound that it was deemed unethical to let anyone “just” target a systolic BP below 140 without going harder.

• A focus on midlife general health

A groundbreaking UK study of 10000 people found that it is your health at midlife that has the greatest impact on future dementia risk. Compared with people with no or one chronic condition, those with three or more chronic conditions (such as diabetes, heart or kidney disease or cancer) at age 55 had a nearly fivefold higher risk of dementia. But that the risk was only 1.7-fold higher when onset of multimorbidity was at age 70. 

• Taking midlife mental health seriously

WE now know that depression in midlife (40-55) increases the risk of subsequent development of dementia by 20%.

• Taking sleep in midlife seriously

Studies suggest people in their 50s and 60s who get less than 6 hours of sleep a night are 30% more likely to go on to subsequently get dementia.

• An empathetic, evidence based focus on achieving a healthier BMI

A 2016 review of 21 studies found that being obese before the age of 65 increased your risk of dementia by 40%.

What has all of this got to do with peri and menopause?

Menopause symptoms contribute to profound physical and mental health changes that are often interrelated.

1. High blood pressure (AKA hypertension) is often triggered by menopause. Worse menopause symptoms, including hot flushes or vasomotor symptoms and insomnia have both been linked to hypertension. The hypertension menopause link comes from both oestrogen loss from menopause, and changes in lifestyle that arise as a result of menopause symptoms.
2. Weight gain is common during peri and menopause. While some research suggests that women only gain 2.1kg over the course of the menopause transition, that does not reflect my practice. In a recent audit of my patient data, weight gain was one of the top 3 concerns identified by midlife women who see me. My friend and colleague, Nigel Danby of Harley Street at Home, a dietician who specialises in peri and menopause has audited his own clinical data of almost 10,000 women (unpublished). He has found that women actually gain an average of 1.5kgs/ year over the course of their peri journey with a total weight gain of 10kgs during menopause transition. Recent studies find that the worse the menopause symptoms, the higher the weight gain. Women experiencing menopause related symptoms such as joint aches and pains as well as hot flushes find it harder to exercise. Poor sleep is linked to weight gain. Insomnia and poor mental health can make snacking with poor food choices more likely and contribute to weight gain.
3. Peri and menopause cause poor sleep at the worst time. Studies report that prevalence rates of self-report sleep difficulties among perimenopausal women range between 40% and 56%, compared to premenopausal women – 31% of whom struggle with sleep. And that 26% of peri women experience severe symptoms that impact daytime function. This is only partly explained by the established link between vasomotor symptoms and insomnia.
4. Women at midlife (45 to 54 years of age) have the highest rates of depression of all women. Women with no previous history of depression in this age group are two to four times more likely to experience depression in the menopause transition compared with younger and older women. Depression has been linked to sleep disturbances, appetite dysregulation, and weight gain in women- all further exacerbating the link to the subsequent development of dementia. Unfortunately, peri and menopausal women have a poorer response to common antidepressants compared with pre-menopausal women.

Treatment for the symptoms of peri and menopause are so incredibly effective but are underutilised in Australia. The former president of the Australasian Menopause Society, Dr Karen McGraith wrote in the MJA, “Lack of clinician knowledge, poor access to services, negative attitudes, and lagging research have led to substandard menopause‐related health care.” We hear this every day.

But getting yourself the help you need matters. It will enhance your wellbeing and ability to stay at work. And it can help you stay health as well as prevent or delay dementia- the leading cause of death of Australian women.