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Home / The menopause and brain injuries: How do they affect each other?
By Daniel Earnshaw Assistant Psychologist (Research), Dr Mar Matarin, Consultant Clinical Psychologist / Neuropsychologist, Dr Sara da Silva Ramos, Senior Research Fellow
Looking back to World Menopause Day on 18 October, we spent some time considering how the menopause may be experienced by people with brain injury. As we prepare to start our own study into this, we thought we would share some of what we learned so far with our readers.
The menopause is when periods stop due to lower hormone levels. It affects anyone who has periods and the most common age range that the menopause starts is 45-55 years old, but it can happen earlier. It affects 85% 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 menopause symptoms such as these but their period has not stopped, it is known as perimenopause.
Many of the psychological symptoms associated with the perimenopause and the menopause are also commonly associated with acquired brain injury (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.
How symptoms of ABI and menopause interact is still unclear but there is some new research we can turn to. For example, Rapport and colleagues’ study [3] found that menopause symptoms which overlap with traumatic brain injury (TBI) were worse in participants with a TBI and were also less likely to be perceived as a change than for those who did not have a TBI. However, there is still much we don’t know, such as how the type of brain injury (e.g. stroke or TBI) or its severity may interact with menopausal symptoms.
Not knowing whether a person’s symptoms are due to a brain injury or to the menopause can have great impact on them. It can affect how and when people seek help, and whether they seek the “right” kind of help.
It can also lead to inaccurate diagnosis, or being prescribed medications that may not help, due to confusion between the two conditions as well as other pre-existing health conditions, such as premature ovarian insufficiency.
When experienced before the age of 40 to 45, if untreated, menopause increases the risk of osteoporosis, cardiovascular disease, cognitive decline, dementia, Parkinsonism, and reduces life expectancy [4]. Therefore, early identification and treatment may be key in helping reduce these risks.
The possible confusion between diagnoses is not only likely to delay intervention, for people with ABI and/or other pre-existing health conditions, but may also make research into this area even harder, as it is difficult to identify participants who may have a brain injury and are also going through the menopause and compare symptoms, especially in the earlier perimenopausal stages.
What can we do to reduce symptoms and risks of the menopause for people with brain injury?
There is still a lot we don’t know about how having a brain injury interacts with the menopause. There are many options to relieve symptoms of the menopause, but their effectiveness and side effects have not yet been evaluated in people who also have a brain injury.
Options include hormone replacement therapy (HRT), exercise, as well as cognitive behavioural therapy (CBT) [5]. Because of these unknowns, it is important that people with ABI, or those who support them, speak to their doctor and highlight their history alongside any chronic or new symptoms they might be experiencing.
In the meantime, we hope that there will be more studies to provide further insight into how people with brain injury experience the menopause, and what the most effective interventions for them might be.
[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. https://doi.org/10.1177/17455057221106890
[3] 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
[4] 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
[5] NHS. (2022). Menopause. https://www.nhs.uk/conditions/menopause/
