Just to add a couple of my own anecdotes to the pile…
The Breastfeeding writer
A 35 year old newspaper columnist, 8 weeks post-partum and breastfeeding, calls me. “I can’t write! I’m sitting here staring at my computer and nothing is happening. I have a deadline tomorrow and I just can’t find the words I need to express myself.”
Breastfeeding is a time of low estrogen levels, and breastfeeding women will often complain of vaginal dryness. But this was a new complaint I had not heard before. She sounded just like my menopausal patients. So I gave her some estrogen. She called me several days later – “It’s like someone turned on a switch! I’m back!”
The Peri-menopausal Exec
49 years old, high functioning, multi-tasking, juggler of many things. This is a woman who can talk on the phone while typing an important email and hold a meeting all at the same time. Carries names in her head like a roladex.
Her ovaries were removed 6 months ago along with a hysterectomy. A totally unnecessary piece of surgery, by the way. All she needed was the uterus removed, but her doctor told her that if she were his wife, he’s take out the ovaries, so that’s what she agreed to…
Now, she finishes the day and realizes she has barely gotten anything done. Someone who could easily do three things at once is now down to one-at-a-time tasking, and even that is going slowly. “I can’t keep up with my pace. My brain just won’t make the connections fast enough” All her lab values are normal, including her thyroid functions and hematocrit.
We give her estrogen. Within a few weeks, she is almost back to her old self.
The Human Research Data
Now, these two stories are not typical. Most peri-menopausal and menopausal women don’t have such dramatic deficits or recovery. Some have no symptoms related to brain function at all. Those that do typically complain of problems with word recall or names, or a feeling of “fuzziness” in the brain. “Clogged up” is a phrase I hear often. These symptoms are sometimes relieved with estrogen, and sometimes they are not.
Results from research studies have been contradictory. No studies have found an effect of estrogen on memory in populations of women undergoing normal menopause. But in studies of women undergoing surgical menopause, estrogen has been found to improve memory, particularly verbal memory.
In my opinion, most of the studies that have been done to date have not used testing that measures the kind of brain function estrogen seems to affect. Most have used dementia screening or Alzheimer’s screening or basic tests of overall memory.
Menopausal women are not complaining about dementia or losing their memory. What they complain about is problems finding words and names, problems making sophisticated verbal constructions, problems writing fluently, and problems multitasking. And fuzziness.
I don’t think we have a good objective measure of brain fuzziness.
The Primate Data
Whenever I think about estrogen and the brain, I think about monkeys. If you look at the brains of primates, what you find is that estrogen increases the number of dendritic outgrowths – connectors, if you will – between brain cells. (They’re the little red things up there in the photo). The increase in dendritic outgrowths is rapid – within 24 -48 hours of giving estrogen, there is a measurably dramatic change in the number of connections between brain cells.
Take away estrogen, the number of brain cell connections decreases. Interstingly, if one adds progesterone continuously to the regimen, you attenuate the estrogen effect.
It’s the best evidence I’ve seen to date that correlates with what my patients tell me. Loss of estrogen leads to loss of connectivity between brain cells. It takes longer to find a word, find a name. Harder to write. Harder to multitask.
I’m not going to belabor the whole “Should I take HRT?” question here. You can read what I think about that issue here.
What I will say is that the story on estrogen is far from over.
What I believe is that for some women, estrogen is important for brain function. Who those women are, how to identify them and how to weigh this against the potential risks of HRT as we now know it, are all questions whose answers are too individual to answer for women as a whole.
Photo from J Neuropsychiatry Clin Neurosci 13:313-317, August 2001