Lifetime estrogen exposure linked to stroke after menopause

 FYI, ask your doctor what this means.

Lifetime estrogen exposure linked to stroke after menopause

Women in China may be at greater risk for stroke events following menopause, according to a study published in Neurology.

“Lifetime cumulative estrogen exposure due to reproductive factors could potentially be a useful indicator of patients’ risk of stroke events following menopause,” Leying Hou, PhD, of Zhejiang University School of Medicine in China, and colleagues wrote. “However, further research is needed on the underlying biological, behavioral and social mechanisms linking estrogen exposure with stroke risk across female patients’ lifespans.”

Lifetime cumulative exposure to estrogen was found to be associated with stroke events after menopause. Source: Adobe Stock

Researchers conducted a population-based, longitudinal, prospective cohort study using data from the China Kadoorie Biobank study to evaluate the link between lifetime cumulative estrogen exposure and stroke. They included 122,939 postmenopausal women, aged 40 to 79 years, without prior history of stroke from 2004 to 2008.

Hou and colleagues assessed cumulative estrogen exposure using reproductive lifespan (RLS), endogenous estrogen exposure (EEE) and total estrogen exposure (TEE).

During a median follow-up of 8.9 years, researchers identified 15,139 new-onset stroke cases, subcategorized as 12,853 ischemic stroke (IS), 2,580 intracerebral hemorrhage (ICH) and 269 subarachnoid hemorrhage (SAH), using health insurance data and a disease registry system.

According to results, compared with the lowest quartile of RLS, the highest quartile had a lower risk for total stroke (adjusted HR = 0.95; 95% CI, 0.92-0.98), IS (aHR = 0.95; 95% CI, 0.92-0.98) and ICH (aHR = 0.87; 95% CI, 0.81-0.94).

Further, when comparing the highest quartile with the lowest, EEE and TEE showed a graded association with descending risk for total stroke (EEE: aHR = 0.85; 95% CI, 0.82-0.89; TEE: aHR = 0.87; 95% CI, 0.84-0.9), IS (aHR = EEE: 0.86; 95% CI, 0.83-0.9; TEE: aHR = 0.86; 95% CI, 0.83-0.89) and ICH (EEE: aHR = 0.73; 95% CI, 0.65-0.81; TEE: aHR = 0.83; 95% CI, 0.76-0.91).

“Lifetime cumulative estrogen exposure due to reproductive factors, as indicated by RLS, EEE and TEE, is associated with stroke events among postmenopausal patients,” Hou and colleagues wrote. “For RLS, those in the highest quartile were found to have a lower risk of total stroke, IS and ICH. As for EEE and TEE, higher quartiles were found to have a graded association with a descending risk of total stroke, IS and ICH.”

Brain Changes Diverge Between Men and Women

Ask your doctor EXACTLY what to do to prevent problems from these white matter hyperintensities.

My doctor told me I had a bunch of white matter hyperintensities but never showed me them on any scan, so I don't know the size, location or any intervention needed, because my doctor knew nothing and did nothing. I have zero cognitive impairment and I'm 16 years out.

Brain Changes Diverge Between Men and Women

White matter hyperintensities volume accelerate after menopause

by Judy George, Deputy Managing Editor, MedPage Today June 30, 2022

White matter hyperintensities -- small brain lesions associated with cognitive impairment or stroke risk -- were more common in post-menopausal women than they were in men of similar age, cross-sectional data showed.

Premenopausal women and men of the same age, however, had no difference in white matter hyperintensities burden, according to Monique Breteler, MD, PhD, of the German Center of Neurodegenerative Diseases in Bonn, and co-authors.

As age advanced, white matter hyperintensities volume accelerated in both men and women, but acceleration was faster in women, the researchers reported in Neurology.

White matter hyperintensities are a subclinical marker of cerebrovascular disease and brain aging.

"White matter hyperintensities increase as the brain ages, and while having them does not mean that a person will develop dementia or have a stroke, larger amounts may increase a person's risk," Breteler said in a statement.

"Our results imply that white matter hyperintensities evolve differently for men and women, where menopause or factors that determine when menopause starts -- such as variations in the aging process -- are defining factors," she added.

"They also demonstrate the necessity to account for different health trajectories for men and women, and menopausal status," Breteler emphasized. "Our research underscores the importance of sex-specific medicine and more attentive therapy for older women, especially those with vascular risk factors."

Earlier research from the U.K. Biobank suggested the effect of aging on brain structure is different between women and men and that this difference may be biologically linked to menopause. Sex differences in the trajectory of cognitive aging also have been observed.

The current study by Breteler and colleagues "adds to a growing body of evidence that the period of 10 years after menopause in women may be important with respect to risk of developing brain changes that are linked to a future risk of dementia," noted Velandai Srikanth, MBBS, PhD, of Monash University in Victoria, Australia, who wasn't involved with the study.

"This research adds to previous work showing that there is also a similar predisposition after menopause to brain atrophy and indeed the build-up of tau, which is often linked with brain atrophy," Srikanth told MedPage Today.

"It seems the period after menopause in women represents an important time for maintaining a healthy lifestyle and careful management of vascular health," he added.

Breteler and co-authors studied 3,410 people in the Rhineland Study, an ongoing prospective, single-center, community-based cohort study in Bonn. Menopause status was self-reported at baseline.

The overall sample had a mean age of 54.3 and 1,973 participants were women (57.9%). Of those, 1,167 (59.1%) were postmenopausal. Premenopausal women were 30 to 59 years old; postmenopausal women were 45 to 95.

Hypertension was present in 1,208 participants (35.4%) and about half -- 660 people -- had uncontrolled hypertension.

Among participants 45 and older, median white matter hyperintensities volume was 0.94 mL for postmenopausal women and 0.72 mL for men, after adjusting for age and vascular risk factors.

Among those 45 to 59 years old, postmenopausal women had a median white matter hyperintensities volume of 0.51 mL, compared with 0.33 mL for premenopausal women.

Women with uncontrolled hypertension had a higher white matter hyperintensities burden than men, which was not related to menopausal status.

A study limitation was that menopausal status was self-reported, Breteler and co-authors acknowledged. The researchers did not have information about the age of menopausal onset or whether participants were perimenopausal.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

The study was funded by the German Center for Neurodegenerative Diseases (DZNE).

The researchers reported no disclosures relevant to the manuscript.

Primary Source

Neurology

Source Reference: Lohner V, et al "The relation between sex, menopause, and white matter hyperintensities: The Rhineland Study" Neurology 2022; DOI: 10.1212/WNL.0000000000200782.

Menopause really does affect memory, researchers find

So is your doctors expectations wrong for womens' memory skills post-stroke?
https://www.bostonglobe.com/lifestyle/health-wellness/2016/11/20/menopause-really-does-affect-memory-researchers-find/n2oOYjcEMfWy3g1xHlNaOL/story.html
The greatest known risk factor for Alzheimer’s disease is, unsurprisingly, age. The second is gender. At age 65, healthy women have a one in six chance of developing the memory loss disease during their lifetime, compared with a one in 11 chance for men — a statistic that cannot be solely explained by the fact that women generally live longer than men. Other biological factors appear to be at play.
In a study published this month in the journal Menopause, researchers at Brigham and Women’s Hospital and Harvard Medical School explore what may be a related phenomenon: how menopause affects memory. According to the study, between the ages of 45 and 55, women outperform men in memory function, but some types of memory appear to fade as estrogen declines. Postmenopausal women were worse at learning new information and retrieving new memories than premenopausal women.
The findings suggest that hormonal changes play an important role in maintaining memory in women, and could help identify which women are at highest risk for developing Alzheimer’s or other forms of memory loss, the authors say.
“Understanding healthy aging will provide clues to how the brain goes awry in men and women, and who might be at highest risk for the disease earlier in life,” says senior author Jill Goldstein, director of research at the Connors Center for Women’s Health and Gender Biology.
Many studies have found that women perform better on verbal memory tasks than men — from post-puberty through old age — but little is known about how that memory is affected by hormonal changes. Goldstein and colleagues invited 212 healthy men and women, ages 45 to 55, from the New England Family Study to participate in a battery of verbal memory and learning tests, such as associating names with faces, learning new information, and recall of that information.
As expected, women outperformed men of the same age on all the cognitive measures. But women who had not yet experienced menopause performed better than postmenopausal women in two key areas of memory: the ability to learn new associative memories — relationships between unrelated items, like a face and a name — and to retrieve them. That performance decline was associated with lower levels of estradiol, the main form of estrogen in the brain, in the blood of the participants.
The finding supports the idea that “brain fog,” a type of forgetfulness that springs up during midlife, may be associated with hormonal changes rather than job stress or other midlife factors. The researchers are now studying the postmenopausal women who performed best on the memory tests to see if they can discover biological factors, such as genetics or the immune system, that may help maintain a strong memory.
The impact of gender will be a key part of understanding risk for dementia and finding treatments for it, Goldstein emphasizes. “We’re in this day and age of precision medicine. What could be more central than one’s sex in developing more efficacious treatments?”

Heart disease, stroke risk factors may increase in severity before menopause

Women be careful out there.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=166592&CultureCode=en
The severity of key risk factors for heart disease, diabetes and stroke appears to increase more rapidly in the years leading up to menopause, rather than after, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
The study also found that this pattern of rapidly increasing risk factors before menopause appears to be more pronounced among African-American women.
The risk factors, together known as metabolic syndrome, include a large waistline, high triglyceride (a blood fat) levels, low HDL (the “good” cholesterol) levels, high blood pressure and high blood sugar when fasting.
“Previous research showed that after menopause, women were at much greater risk for metabolic syndrome than before menopause began,” said Mark DeBoer, M.D., MSc., M.C.C., study senior author and an association professor of pediatric endocrinology at the University of Virginia in Charlottesville. “This latest study indicates that the increased risk observed earlier may be related more to the changes happening as women go through menopause and less to the changes that take place after menopause.”
Researchers analyzed the records of 1,470 African-American and white women participating in the Atherosclerosis Risk in Communities Study, a national study of the causes and health effects of hardening of the arteries. Participants were selected based on whether they went through menopausal changes over a 10-year period. Each participant was assigned a metabolic syndrome severity score based on a formula the authors developed that has been adopted by other researchers.
After taking into account hormone replacement therapy and other factors that might bias results, the study found:

• Women experienced rapid increases in metabolic syndrome severity during the last years of pre-menopause and the transition years to menopause, known as perimenopause.
• African-American women experienced a much more rapid increase in metabolic syndrome severity before menopause, but a slower rate of increase after menopause, than white women.
• Overall, African-American women had higher rates of metabolic syndrome, particularly high blood pressure and high fasting blood sugar levels, than white women at the beginning of the study.

These findings confirm many previous studies that show African-American women are at greater risk for cardiovascular disease and diabetes than white women.
DeBoer said study results provide physicians and other healthcare providers with an opportunity to motivate women to make lifestyle changes that will decrease their risk of having a heart attack, stroke or developing diabetes.
“Of course, you could argue that all of us should be eating better and making sure we’re getting enough exercise,” he said. “That’s definitely true, but the years transitioning to menopause may represent a ‘teachable moment,’ when patients are especially receptive to learning and putting into practice healthy habits that can make a difference in their cardiovascular disease risk.”
DeBoer noted that their approach to assessing metabolic syndrome severity was originally created to assess risk in children. Adapting the formula to adult patients, he said, advanced the researchers’ hope of one day incorporating risk factor information into an electronic medical record so that metabolic syndrome severity is calculated automatically and available to all patients throughout their lifetime.
Co-authors are Matthew J. Gurka, Ph.D.; Abhishek Vishnu, Ph.D.; and Richard A. Santen, M.D.
Author disclosures are on the manuscript.
The National Institutes of Health supported the study.
http://newsroom.heart.org/news/heart-disease-stroke-risk-factors-may-increase-in-severity-before-menopause?preview=bbe6b80d65da82a56ff05c00af0e6cd4

• Full bibliographic informationProgression of Metabolic Syndrome Severity during the Menopausal Transition
  Co-authors are Matthew J. Gurka, Ph.D.; Abhishek Vishnu, Ph.D.; and Richard A. Santen, M.D.
  Journal of the American Heart Association
  (Manuscript number: JAHA/2016/003609R1)

Study findings may help explain why risk of stroke changes after menopause

I hate these articles that don't link to actual research. You're on your own here unless you think your doctor will be useful.
http://www.news-medical.net/news/20160120/Study-findings-may-help-explain-why-risk-of-stroke-changes-after-menopause.aspx

Risk of stroke in women may come down to a compound the body produces from estrogen known as 2-methoxyestradiol (2-ME). Furthermore, the compound's therapeutic potential may extend beyond treating stroke in women to healing brain injuries in men, a new study in American Journal of Physiology—Endocrinology and Metabolism reports.
Microglia, the immune cells of the brain, maintain the brain and protect it from infection by consuming damaged cells and bacteria—a process called phagocytosis—and releasing toxic molecules to induce injured cells and bacteria to die. The same processes help "clean up the mess" after brain injury, such as after stroke or a head impact, says Edwin Jackson, PhD, of the University of Pittsburgh and the study's collaborating investigator. However, overactive microglia may kill brain cells that otherwise would have survived the injury, worsening instead of healing the damage, Jackson explains.
Mouse microglial cells exposed to 2-ME multiplied less and had reduced immune activity: 2-ME stopped phagocytosis and the release of toxic molecules by microglia. "2-ME prevented microglia from becoming overly active," Jackson says.

The findings help explain why risk of stroke in women changes after menopause. Menopause occurs when the ovaries stop producing the female sex hormones estrogen and progesterone. Prior to menopause, women have a lower risk of stroke compared to men. After menopause, women are at a higher risk. "Our study shows that microglia can metabolize (change) estradiol into 2-ME. So the female advantage before menopause may be in part the result of microglia making 2-ME from estradiol. Once estradiol levels collapse with menopause, the female advantage is lost. Administration of 2-ME could restore the female advantage," Jackson says. Estradiol is an estrogen and the primary female sex hormone.
The use of 2-ME is not limited to women. "Although 2-ME is derived from estradiol, 2-ME is not estrogenic and can be used in both women and men," Jackson notes. Because 2-ME "calms" microglia, it may be useful in treating or preventing other brain injuries including traumatic brain injury and chronic traumatic encephalopathy—the injury commonly found in professional football players and athletes in other contact sports, he says.
According to Jackson, current research on 2-ME supports that the compound is safe. "Unlike estradiol, 2-ME has anti-cancer activity, is cardio-protective and has beneficial activity in models of pulmonary artery hypertension. In fact, a slow-release formulation of 2-ME was developed and validated in a phase I clinical trial for pulmonary artery hypertension."
The next step is to corroborate 2-ME's effects, says Raghvendra Dubey of the University of Zurich and the study's lead investigator. These findings in cells "provide important leads which need to be further confirmed using in vivo (animal) models of brain injury," he says.

Menopausal 'Foggy Brain' Confirmed in Tests

Now is your memory problem from these seven or this latest one? Don't let your doctor use Occams' razor just because your stroke was the  most recent happening. I bet your neurologist is not reading the journal Menopause.
http://news.yahoo.com/menopausal-foggy-brain-confirmed-tests-150941726.html

Memory problems are a common complaint of women going through menopause, and now a new study provides more evidence linking mood and hot flashes to loss of memory abilities during menopause.

Researchers found that women who felt their memory wasn't functioning well scored lower in a series of psychological tests of attention and memory. The women's cognitive performance was still within the normal range, but their ratings of their own memory abilities lined up with how well they performed in the tests.

The study also revealed links between memory abilities and mood, and the severity of menopause symptoms. Women who reported more negative emotions did worse on the tests than women who had felt less negative. Similarly, women who experienced severe hot flashes did worse on the tests, compared to women who had fewer hot flashes.

"The good news for women is that there's proof that their perception about their performance is real," said Dr. Margery Gass, the executive director for The North American Menopause Society and a gynecologist at Cleveland Clinic, who was not involved in the study.

More at link.

Menopause vs heart attack or stroke

Women, be careful out there. Not sure what you can do about it but ask your doctor.
http://updatednews.ca/2012/06/28/menopause-vs-heart-attack-or-stroke/
Women who go through menopause before the age  of 46 are twice as likely to have a heart attack or stroke as women who go  through the change later in life, a study has found.
The findings from a diverse group of  U.S.  women support results of earlier studies that had only focused on  white  women.
Lead author Dr Melissa Wellons, from the  University of Alabama at Birmingham, said women who had the menopause early  should make extra efforts to reduce their risk.
‘My advice to them would be to get your  traditional risk factors checked and do the things that we know, based on  evidence, can improve your risk of developing heart disease, like keep your  cholesterol in check and keep your blood pressure in check,’ she  said.
Wellons and her colleagues collected health  information through surveys of 2,509 women, including 331 Chinese, 641 black and  550 Hispanic women.
Close to 700 of them, or 28 per cent, had  gone through menopause early – before age 46. The average age when women stop  having periods is 51 in the U.S and 52 in  the UK.
The younger group included women who went  through menopause naturally or had a hysterectomy – surgery to remove the uterus  – which can cause early menopause.
None of the women had cardiovascular disease  at the beginning of the study. Researchers tracked them for an average of five  years to see who ended up having a heart attack or stroke.
They found 23 of the women who had gone  through menopause early, and 27 who hadn’t, suffered a heart attack or cardiac  arrest or died from heart disease, according to findings published in the  journal Menopause.
That translates to 3.3 per cent of women in  the early menopause group and 1.5 percent of the other group.
Similarly, 18 women – or 2.6 per cent – of  the early menopause group had a stroke during the study, compared to 19 (one per  cent) of women who hit menopause later.
It’s not clear why early menopause might be  linked to cardiovascular disease. Some scientists have theorised that estrogen  could play a role as the hormone drops following the change. However,  a Women’s Health Initiative study on hormone replacement therapy was stopped  early because women taking hormones after menopause were actually found to have  a higher risk of heart disease and certain cancers.
‘It could be a genetic association, (where)  genes that are related to ovarian function may also be associated with  cardiovascular disease, and those two things are related but not through a  common causal pathway,’ Dr Wellons added.
She said more research is needed before  doctors can know how to intervene to try to reduce the higher heart disease risk  among women with early menopause.
Heart disease is the leading cause of death  among U.S. women. Combined with strokes, it is responsible for almost one in  three deaths, according to the Centers for Disease Control and  Prevention.