By Eloise Moliner Assistant Psychologist (Research), Daniel Earnshaw former Assistant Psychologist (Research), Dr Mar Matarin, Consultant Clinical Psychologist / Neuropsychologist, Dr Sara da Silva Ramos, Senior Research Fellow
With World Menopause Day approaching on 18 October, we have been reflecting on how menopause may affect people living with acquired brain injury (ABI).
This is an area that has received relatively little attention, despite considerable overlap between menopausal symptoms and the emotional, cognitive, and physical consequences of brain injury.
With our own study now underway, exploring experiences of menopause, menopause awareness, and access to menopause care among people with ABI, we wanted to share some of what we have learned so far.
What is the menopause?
The menopause is when periods stop due to lower hormone levels.
It affects people who menstruate, and most commonly begins between the ages of 45 and 55 years, although it can happen earlier. It affects 85 per cent of women and the symptoms can be psychological as well as physical [1].
Commonly reported symptoms include mood swings, brain fog, fatigue, irregular periods, difficulty concentrating, as well as different effects on desire for sex. If people have symptoms such as these but their period has not stopped, it is known as perimenopause.
Many of the psychological symptoms associated with perimenopause and menopause can also emerge after an ABI.
For example, increased anxiety, brain fog, fatigue, and mood swings are common psychological symptoms associated with both ABI and the menopause [2], which can lead to difficulties when diagnosing one or the other, or both.
One possible explanation for this overlap relates to changes in hormone levels. Oestrogen plays an important role in brain function, including memory, attention, mood regulation, sleep, and neuroprotection.
During the menopause transition, declining oestrogen levels may contribute to cognitive and emotional symptoms that resemble, or potentially exacerbate, difficulties already experienced following brain injury [3].
However, how symptoms of ABI and menopause interact remains unclear. There is some emerging research we can turn to.
For example, Rapport and colleagues’ study [4] found that menopausal symptoms which overlap with traumatic brain injury (TBI) were more severe in participants with a TBI and were less likely to be perceived as a change than in those without a TBI.
However, there is still much we do not know, such as how different types of brain injury (e.g. stroke or TBI) or injury severity may interact with menopausal symptoms.
What are the risks of the menopause?
Not knowing whether a person’s symptoms are due to a brain injury or menopause can have a significant impact. It can affect how and when people seek help, as well as whether they seek the “right” kind of help.
It can also lead to inaccurate diagnosis or the prescription of treatments that may not help, due to confusion between the two conditions and other pre-existing health conditions, such as premature ovarian insufficiency.
When the menopause occurs before the age of 40 to 45, and is left untreated, it is associated with an increased risk of osteoporosis, cardiovascular disease, cognitive decline, dementia, Parkinsonism, and reduced life expectancy [5].
Therefore, early identification and treatment may be key in helping to reduce these risks.
The potential for confusion between diagnoses is not only likely to delay appropriate intervention for people with ABI and other pre-existing health conditions, but may also make research into this area more challenging.
Identifying people who are both living with a brain injury and experiencing the menopause can be difficult, particularly during the earlier perimenopausal stages when symptoms may be less readily recognised.
What can we do to reduce symptoms and risks?
There is still a lot we do not know about how brain injury and menopause interact.
And while there are several options available to help relieve menopausal symptoms, their effectiveness and potential side effects have not yet been evaluated in people who have also experienced a brain injury.
These options include hormone replacement therapy (HRT), exercise, and cognitive behavioural therapy (CBT) [6].
Given these uncertainties, awareness of menopausal symptoms may be particularly important when supporting people with ABI who report new or worsening cognitive, emotional, or fatigue-related difficulties.
Considering menopause as a possible contributing factor, and discussing symptoms with a healthcare professional, may help ensure that individuals receive appropriate assessment and support.
In the meantime, more research is needed to provide further insight into how menopause is experienced following different types of brain injury and which interventions are most effective.
Through our ongoing study, we hope to contribute to a better understanding of how menopause affects people with ABI and improve the support available within brain injury services.
References
[1] Talaulikar, V. (2022). Menopause transition: Physiology and symptoms. Best Practice & Research Clinical Obstetrics & Gynaecology, 81, 3-7. [2] Harper, J. C., Phillips, S., Biswakarma, R., Yasmin, E., Saridogan, E., Radhakrishnan, S., C Davies, M., & Talaulikar, V. (2022). An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Women’s Health, 18. [3] Engler-Chiurazzi, E. B., Brown, C. M., Povroznik, J. M., & Simpkins, J. W. (2017). Estrogens as neuroprotectants: Estrogenic actions in the context of cognitive aging and brain injury. Progress in Neurobiology, 157, 188–211. https://doi.org/10.1016/j.pneurobio.2015.12.008 [4] Rapport, L. J., Kalpakjian, C. Z., Sander, A. M., Lequerica, A. H., Bushnik, T., Quint, E. H., & Hanks, R. A. (2024). Menopause and Traumatic Brain Injury: A NIDILRR Collaborative Traumatic Brain Injury Model Systems Study. Archives of Physical Medicine and Rehabilitation, 105(12), 2253–2261. https://doi.org/10.1016/j.apmr.2024.07.021 [5] Faubion, S. S., Kuhle, C. L., Shuster, L. T., & Rocca, W. A. (2015). Long-term health consequences of premature or early menopause and considerations for management. Climacteric, 18(4), 483–491. https://doi.org/10.3109/13697137.2015.1020484 [6] NHS. (2022). Menopause
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