Women are two times more likely1 to develop Alzheimer’s disease (the most common form of dementia) than men, according to a 2018 SAGE Journals review. Historically, it was believed that this correlation between dementia prevalence and sex was due to women’s longer lifespan—the theory was that a longer life left room for a brain aging disease to manifest.
Today, leading neurologists (many, if not most, are female) are discovering that other biological mechanisms likely play a larger role than age—including hormones and reproductive factors, like pregnancy and menopause.
Female hormonal risk factors for dementia.
In 2022, a U.K. cohort study published by PLOS Medicine took a look at which reproductive and hormonal health factors2 put women at a higher risk of developing dementia, and their results were quite illuminating.
These four risk factors, in particular, were found to increase women’s dementia risk:
- Surgical removal of reproductive organs: Women who have had a hysterectomy or oophorectomy are 12% and 7% more likely to have dementia than those who haven’t, respectively. Additionally, women who have had both their ovaries and uterus removed (in that order) are almost 2.5 times more likely to develop dementia.
- Age of first period: Women who had their first menstrual cycle under the age of 12 or over the age of 14 are approximately 20% more likely to have dementia than those who got their period at 13 years old.
- Being pregnant: Women who have been pregnant at least once are 85% less likely to have dementia than those who have never been pregnant before.
- Age during birth of first child: Women who gave birth for the first time under the age of 21 are 43% more likely to have dementia than women who gave birth for the first time between the ages of 25 and 26.
Why (& how) does reproductive health impact dementia risk?
As explained by neuroscientist, nutritionist, and associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, Lisa Mosconi, Ph.D., in a mindbodygreen podcast episode, reproductive hormones play a massive role in protecting our brains from damage (such as the amyloid plaques associated with Alzheimer’s disease).
“The interactions between the brain and the reproductive organs are really crucial for brain health and brain aging—especially in women,” she says. “We tend to think of testosterone [and] estrogens as involved in reproduction, having kids. But in reality, these hormones have a lot of effects inside our brains.”
“In particular, they literally push our neurons to bring glucose to make energy. So if your hormones are high, your brain energy is high. But then what happens to testosterone is that it doesn’t quite decline that much over time; whereas for women, estrogens pretty much plummet when women go through menopause,” Mosconi shares.
It’s this plummet in estrogen that leaves women’s brains especially vulnerable when they hit menopause in their 40s or 50s. “If you think of these hormones as having some kind of superpowers for the brain, women lose the super power around the time that menopause hits, right? And the brain is left a little more vulnerable,” Mosconi says.
Like menopause, having your uterus or ovaries removed (i.e., a hysterectomy or oophorectomy) also results in a drastic drop in estrogen levels. Other periods of hormonal fluctuations—such as puberty and pregnancy—influence estrogen levels as well, which explains why some hormonal health factors leave women at higher risk while others help protect their brains.
How can women best support their brain longevity?
Many of the brain-healthy habits you already know (e.g., getting good sleep, physical activity) can help women support their brains. When it comes to nutrition, Mosconi recommends the Mediterranean diet to women who are looking to promote optimal cognitive function.
Women who have a genetic predisposition to dementia, are showing early signs of cognitive decline, or have one of the hormonal risk factors listed above should consider working with an endocrinologist to support healthy hormone levels and/or a neurologist to get their brain assessed.
In addition to working with a health care provider and implementing brain-healthy lifestyle habits, women can also consider a targeted nootropic supplement with ingredients the target cognitive health.
For example: The bioactive citicoline has impressive neuroprotective benefits and can even improve cognitive impairment (as evidenced in clinical trials). Taking a supplement with citicoline can help support women’s brains as they go through menopause and beyond.
Hormonal health factors may play a larger role in women’s dementia risk than scientists previously thought. Thankfully, there are quite a few things that women can do to help support their cognitive function and brain longevity.