Worst Menopause Symptoms May Start in Brain

Study challenges old notion that menopause starts in the ovariesSome of the most unpleasant symptoms of menopause, such as hot flashes and night sweats, have long been believed to originate in the ovaries.

But new research challenges that assumption, and instead suggests that menopausal symptoms, at least in part, may begin in the brain.

That's because the hypothalamus and the pituitary gland stop reacting normally to estrogen in some women, suggesting they may have developed a reduced sensitivity to estrogen, researchers at the New Jersey Medical School report in the Dec. 22/29 issue of the Journal of the American Medical Association.

"This is an important new concept: Menopause doesn't just originate in the ovary, but also in the brain," said Laura Goldsmith, a professor of obstetrics and gynecology and women's health at the New Jersey Medical School of the University of Medicine and Dentistry of New Jersey.

These findings may lead the way to further research that will ultimately help doctors predict the type of menopausal transition a woman might have, and help to design non-estrogen medications that could help reduce symptoms that women experience as they enter this phase of life, said Dr. Gerson Weiss, chairman of obstetrics and gynecology and women's health at the New Jersey Medical School.

Menopause refers to the time when menstruation stops. A woman is not considered menopausal until she has not had a period for 12 consecutive months, according to the North American Menopausal Society. The time before menopause, which is often rife with symptoms due to hormonal fluctuations, is called perimenopause. During perimenopause, common symptoms include hot flashes, trouble sleeping, vaginal dryness, mood swings and irregular periods.

This study stemmed from research done for the Study of Women's Health Across the Nation (SWAN), which was funded by the National Institutes of Health, that examined women's' health as they approached menopause.

The SWAN study included more than 3,300 women between the ages of 42 and 52 at the start of the study. A subset group of 840 women provided daily urine samples, which were tested for hormone levels. The samples were collected daily for one full menstrual cycle or 50 days, whichever came first.

From that group, the researchers learned that 160 did not ovulate. After further analyzing the hormone levels from the non-ovulating women, the researchers discovered that these women fell into three distinct groups.

The first group had an increase in their levels of estrogen, and then had an appropriate surge of luteinizing hormone (LH) that should have triggered ovulation, but didn't. According to Weiss, this lack of response indicated a problem originating in the ovary.

In the second group, estrogen levels peaked, but there was no correlating surge in LH, which Weiss said should be triggered by the hypothalamus and pituitary gland responding to higher estrogen levels.

The third group had similar estrogen levels early in their cycles, but didn't have an increase in estrogen later as the first and second groups did. LH levels didn't surge, but were higher for most of the cycle than they were in the other groups.

According to Weiss, this is "clear evidence that the brain is not responding to hormones," suggesting the second and third groups showed different kinds of decreased sensitivity to estrogen in the brain.

The women in the third group were also the ones most likely to report symptoms, such as hot flashes and night sweats.

Goldsmith said the researchers hope to continue studying these women. She said they'd especially like to learn how the timing of menopause correlates with their findings. For example, the researchers would like to see if the women in the third group were, perhaps, further along in the menopausal process.

"It appears that what's going on in menopause isn't only ovarian," said Dr. Steven Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine. "We thought the pituitary responded to lower levels of estrogen, but there may be a lack of sensitivity to estrogen in the hypothalamus and pituitary."

What's important for women to know, said Goldsmith, is that there are "real biochemical changes occurring during menopause." Researchers are beginning to understand how those changes start to occur, which is the first step in trying to come up with more effective treatments.

SOURCES: Gerson Weiss, M.D., professor and chairman, obstetrics and gynecology and women's health; Laura Goldsmith, Ph.D., professor, obstetrics and gynecology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark; Steven Goldstein, M.D., professor , obstetrics and gynecology, and obstetrician/gynecologist, New York University School of Medicine and Medical Center, New York City; Dec. 22/29, 2004, Journal of the American Medical Association

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03:39 - Thursday, March 20, 2008 - comments {0} - post comment

Menopause Symptoms and Memory Loss

While you may experience the misery of hot flashes and mood swings as you enter menopause, one thing you can't blame on the "change" is memory loss.

In the latest study that exonerates menopause as a cause of impairing the ability to recall, Taiwanese researchers compared the memory of hundreds of women before they had any menopausal symptoms to their memory as they entered menopause.

They found the women who were going through the menopausal process scored as well or nearly as well on five different cognitive function tests. Results of the study are to be presented Oct. 4 at the American Neurological Association annual meeting in Toronto.

"When women go into perimenopause, they don't need to worry about cognitive decline," said Dr. Jong-Ling Fuh, an attending physician at Taipei Veterans General Hospital and an associate professor of Yang-Ming University School of Medicine.

The researchers said the myth of memory loss during menopause is a perception some women have because as they went through menopause, they felt their memory wasn't as sharp as it had been before. Studies suggesting that hormone replacement therapy might protect against dementia strengthened that belief. However, a large study later found that in older women, hormone replacement therapy not only didn't help protect women from dementia, but could actually increase the risk.

To try to answer the question of whether menopause did have any effect on memory, Fuh and her colleagues studied nearly 700 premenopausal women living on a group of rural islands between Taiwan and China. The Taiwanese government restricted access to these islands until the 1990s, so the authors report that the study's population was nearly homogeneous, which would help rule out other potentially causative factors of memory loss.

The women were between the ages of 40 and 54. None of them had had a hysterectomy, and none took hormone replacement therapy during the study.

All took five cognitive tests designed to assess their memory and cognitive skills at the start of the study, and then again 18 months later.

During the study period, 23 percent of the women began to have symptoms of menopause.

The researchers then compared the memory of the women who had entered menopause to those who had not, and found very little difference. In four of the five tests, there were no statistically significant differences in the two groups of women.

Only on one test was the difference statistically significant, and that difference, said Fuh, was very slight. This test was designed to assess verbal memory and involved showing the women 70 nonsensical figures. Some of the figures were repeated during the test, while most were not. The women were asked whether they had seen the figure earlier.

"For women, menopause does not mean you'll develop memory loss," said Dr. Raina Ernstoff, an attending neurologist at William Beaumont Hospital in Royal Oak, Mich. As you're going through perimenopause and experiencing symptoms like hot flashes, she said, you may feel lousy and have trouble sleeping, which might temporarily affect your cognitive skills.

"I don't think declining estrogen levels are what causes memory loss," said Dr. Steven Goldstein, an obstetrician/gynecologist at New York University Medical Center in New York City. "It's not like your memory is bopping along, doing fine and then takes this big dive during menopause, like bone density can."

Both Ernstoff and Goldstein said they weren't aware of many women who believed that menopause might cause significant memory loss. They also both felt that results from this group of women who were so homogeneous might not apply to different groups of women, such as those living in more industrialized society. And they both said that other factors that weren't studied could play a role in memory loss, such as hypertension, which can contribute to vascular dementia.

Ernstoff also pointed out that the education backgrounds can play a large role in memory loss. Fuh acknowledged the researchers did attempt to control the data for educational differences.

SOURCES: Jong-Ling Fuh, M.D., attending physician, Taipei Veterans General Hospital, and associate professor, Yang-Ming University School of Medicine, Taipei, Taiwan; Steven Goldstein, M.D., obstetrician/gynecologist, New York University Medical Center, and professor, obstetrics/gynecology, New York University School of Medicine, New York City; Raina Ernstoff, M.D., attending neurologist, William Beaumont Hospital, Royal Oak, Mich., and member, Alzheimer's Board of Detroit; Oct. 4, 2004, presentation, American Neurological Association, Toronto.

03:35 - Thursday, March 20, 2008 - comments {0} - post comment