Extended Hormone Therapy During Menopause Aids Cognition

Emerging research suggests a longer period of estrogen replacement therapy provides a prolonged cognitive benefit. However, investigators acknowledge that the risk-to-benefit balance of hormone therapy use is complicated and must be individualized.

Research has determined that estrogen has a significant role in overall brain health and cognitive function. This knowledge has fostered various studies on the prevention of cognitive decline as related to reduced estrogen levels during the menopause transition.

The new study suggests a cognitive benefit from a longer reproductive window complemented with hormone therapy. The study, “Lifetime estrogen exposure and cognition in late life: The Cache County Study,” appears online in Menopause, the journal of The North American Menopause Society (NAMS).

Because women comprise two-thirds of the 5.5 million cases of Alzheimer disease in the United States, researchers have long suspected that sex-specific factors such as estrogen may contribute to women’s increased risk for the disease. Moreover, multiple studies have suggested a role for estrogen in promoting memory and learning.

In this newest study involving more than 2,000 postmenopausal women, researchers followed participants over a 12-year period to examine the association between estrogen and cognitive decline.

More specifically, they focused on the duration of a woman’s exposure to estrogen, taking into account such factors as time of menarche to menopause, number of pregnancies, duration of breastfeeding, and use of hormone therapy.

Investigators concluded that a longer duration of estrogen exposure is associated with better cognitive status in older adult women. Furthermore, they documented that these beneficial effects are extended with the use of hormone therapy, especially in the oldest women in the sample.

Women who initiated hormone therapy earlier showed higher cognitive test scores than those who started taking hormones later, providing some support for the critical window hypothesis of hormone therapy.

“Although the assessment of the risk-to-benefit balance of hormone therapy use is complicated and must be individualized, this study provides additional evidence for beneficial cognitive effects of hormone therapy, particularly when initiated early after menopause.

This study also underscores the potential adverse effects of early estrogen deprivation on cognitive health in the setting of premature or early menopause without adequate estrogen replacement,” says Dr. Stephanie Faubion, NAMS medical director.

Source: The North American Menopause Society (NAMS)

When Abuse Involves Controlling a Partner’s Education

A new study offers a closer look at a lesser-known form of psychological abuse: educational sabotage. This type of abuse involves behaviors aimed at hindering or stopping another person’s educational efforts.

“This form of violence is used by one of the partners as a means for furthering their own power and control over the other partner,” said Dr. Rachel Voth Schrag, a domestic violence expert and assistant professor in the School of Social Work at The University of Texas at Arlington. “Pursuing higher education can be perceived as a threat by the abusing party.”

Educational sabotage is a form of coercive control that directly affects a survivor’s efforts to obtain educational credentials, said Voth Schrag. Tactics may include disruption of financial aid or academic efforts, physical violence and/or inducing guilt related to academic efforts.

These strategies are a serious hindrance to the successful completion of educational programs and, ultimately, the economic independence and safety of survivors, she said.

For the study, the researchers conducted 20 interviews with community college students who reported current or recent intimate partner violence  (IPV). The participants identified several ways in which educational sabotage had impacted their lives. Impacts included reduced academic achievement, emotional or mental health challenges, but on a more positive note, an increased desire to overcome such obstacles.

Educational sabotage is considered a form of IPV, which is a factor in 16.5% of all homicides in the U.S., according to The Centers for Disease Control and Prevention. The agency estimates one in four women and nearly one in 10 men have experienced intimate partner violence during their lifetime.

Pursuing higher education can be a catalyst for breaking out of the isolation and cycles of dependency that often accompany IPV. According to Voth Schrag’s study, “by understanding, addressing, and preventing school sabotage, scholars, institutions of higher education, and their community partners have an opportunity to make an important contribution to the well-being and safety of students.”

The study is published in the journal Violence Against Women.

Source: University of Texas at Arlington


Self-Silencing Women May See Increased Risk of Stroke

A new study shows that women who do not speak up for themselves — called self-silencing — have increased carotid plaque buildup, which could lead to a stroke or other cardiovascular problems.

People engage in a range of behaviors to maintain close relationships, some of which may be costly to their own health, researchers note. One of those damaging behaviors is self-silencing, which is sometimes used to avoid conflict or relationship loss. Although self-silencing has been linked to worse mental and self-reported physical health in women, it has not been previously examined in relation to women’s cardiovascular health, researchers note.

In this new study of 304 nonsmoking women, researchers tested whether self-silencing was associated with carotid atherosclerosis. They found that greater self-silencing was related to increased odds of plaque, independent of socio-demographics, cardiovascular disease risk factors, and depression.

The results were based on women’s self-reporting on a range of factors, such as how often they expressed anger or put someone else’s needs before their own, the researchers reported. Ultrasound imaging was used to quantify carotid plaque.

“Given increased public health interest in women’s experiences in intimate relationships, our results suggest that women’s socio-emotional expression may be relevant to their cardiovascular health,” said lead author Karen Jakubowski from the Department of Psychiatry at the University of Pittsburgh.

The study was presented at the 2019 North American Menopause Society (NAMS) annual meeting.

Source: The North American Menopause Society

Menopausal Night Sweats Linked to Impaired Cognitive Performance

A new study suggests that women who experience night sweats are more vulnerable to cognitive dysfunction as their sleep duration increases.

Previous studies have shown a link between daytime hot flashes and worse memory performance.

In this new study involving women with a history of breast cancer, however, researchers focused on night sweats and how they relate to total sleep time. Surprisingly, more frequent night sweats were associated with greater sleep duration, according to the researchers.

Even more surprising, they said, was the finding that these same women experiencing night sweats became more vulnerable to prefrontal cortex deficits, including decreased attention and executive function, as their sleep duration increased.

Total sleep time, however, was unrelated to memory performance, they noted.

The researchers also discovered that daytime hot flashes had no impact on total sleep time.

“This work presents novel insights into the influence of menopause symptoms on cognitive performance among women with a history of breast cancer and raises the possibility that hot flash treatments could benefit cognition in these women through effects on sleep,” said lead author John Bark, doctoral student in behavioral neuroscience the University of Illinois at Chicago.

“Studies like this are valuable in helping health care providers develop effective treatment options for menopausal women complaining of cognitive decline as they focus on modifiable risk factors,” added Dr. Stephanie Faubion, medical director for The North American Menopause Society.

The study findings were presented during 2019 North American Menopause Society (NAMS) annual meeting.

Source: The North American Menopause Society

How and Why Parkinson’s Hits Men, Women Differently

A new review from Italian scientists adds to the growing body of evidence describing how Parkinson’s disease (PD) affects women and men differently.

In the study, published in the Journal of Parkinson’s Disease, researchers present the most recent knowledge about these gender differences and highlight the significance of estrogens, which appear to play an important role in the sex differences in PD.

PD is a slowly progressive disorder that affects movement, muscle control, and balance. It is the second most common age-related, neurodegenerative disorder, affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age.

The risk of developing PD is twice as high in men than women, but women experience a more rapid disease progression and a lower survival rate.

“It is becoming increasingly evident that PD differs in women and men,” said lead author Fabio Blandini, M.D., scientific director of the IRCCS Mondino Foundation, National Institute of Neurology, Pavia, Italy. “Recent research findings suggest that biological sex also impacts on disease risk factors and, potentially, on molecular mechanisms involved in the pathogenesis of PD.”

This review looked at the most recent knowledge concerning differences between women and men with PD including quality of life, genetic and environmental risk factors, drug therapies for motor and non-motor symptoms, surgical procedures, steroids and the impact of gender on disease progression.

Recent research has shown that women and men have distinctive motor and non-motor symptoms as their PD progresses.

For example, motor symptoms tend to emerge later in women; tremor is a common first presenting symptom associated with recurrent falls and more severe pain syndromes with specific characteristics such as reduced rigidity and a higher likelihood of developing postural instability (unstable while standing).

Conversely, male PD patients show more serious postural problems and have worse general cognitive abilities. In addition, “freezing of gait” — the most disabling motor complication of PD,  in which people get “stuck” in place and temporarily have a hard time moving their feet forward — develops later in men. But men have a higher risk of developing camptocormia (abnormal severe forward flexion of the trunk when standing or walking).

Non-motor symptoms have been the subject of a study of more than 950 PD patients, which concluded that symptoms such as fatigue, depression, restless legs, constipation, pain, loss of taste or smell, weight change and excessive sweating are more common and severe in women.

Other studies have shown that male PD patients have worse general cognitive abilities and being male is the main risk factor for mild cognitive impairment and its more rapid progression in the severe stage of the disease.

A diagnosis of PD with dementia has a greater impact on life expectancy of women than men; in addition, women show distinctive symptoms as well as differences in the response to drug therapies and deep brain stimulation, and in their personal evaluation of the quality of life compared to men.

The authors highlight the significance of estrogens, which play an important role in the sex differences in PD, providing disease protection as demonstrated by the similar incidence of the disease in men and post-menopausal women.

“Sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of sex-related behavior and functions,” added Silvia Cerri, Ph.D., head of the Laboratory of Cellular and Molecular Neurobiology of the IRCCS Mondino Foundation and first author of the article.

“Neuroinflammation is an important piece of the pathogenic puzzle of PD. Current evidence suggests that the physiological role exerted by microglial and astrocytic cells could become compromised during aging, thus contributing to PD onset and progression.

“Since estrogens have anti-inflammatory properties, their actions throughout the lifespan could partially account for sex-related risk and manifestation of PD.”

Source: IOS Press

Depression is the Strongest Predictor of Substance Use in Pregnancy

A new Canadian study finds that depression is the single largest driver of substance use during pregnancy, highlighting the need for greater support for the mental health of pregnant women.

According to the Centers for Disease Control and Prevention (CDC), the rate of pregnant women with a depression diagnosis at delivery increased by seven times from 2000 to 2015. And it is well known that drug and alcohol use during pregnancy is linked to poor birth outcomes, but some women continue to use these substances while pregnant.

For the study, a research team from Western University in Ontario and its affiliate, Brescia University College, investigated the potential predictors of cannabis, tobacco and alcohol use among pregnant women. They analyzed the health and geographical data of more than 25,000 pregnant women in Southwestern Ontario.

The research, published in the Journal of Neonatal-Perinatal Medicine, is the first Canadian study with a sample size this large to show that depression during pregnancy is the primary risk factor for cannabis, tobacco and alcohol use. In fact, depression was found to be a stronger predictor than education, income or age.

“Pregnant women who were depressed were 2.6 times more likely to use cannabis and twice as likely to smoke cigarettes and use alcohol while pregnant,” said Jamie Seabrook, PhD, an associate professor at Brescia and Western’s Schulich School of Medicine & Dentistry, and scientist at Children’s Health Research Institute, a Lawson program.

“We don’t know when the substance use first began, but we do know that it was continuing during pregnancy and that is a big risk factor for poor maternal and infant health outcomes.”

First author Rachel Brown says that the study really emphasizes the importance of focusing on pregnant women’s mental health. This might include better promotion of mental health strategies, psychotherapy and/or safe and proper mental health medication during pregnancy.

“The research shows that there is an effect later on in life as well with infants who are born preterm or low birth weight. To intervene or advocate for mental health programs for the mom, the idea is that it sets up the health of the infants later on in life,” said Brown, an MSc candidate.

The research team points out that this research is especially important in Canada with the recent legalization of recreational cannabis.

“Let’s help women with their mental health to improve their overall health and in doing so, improve the health of their baby,” said Seabrook.

Source: University of Western Ontario