First Alzheimer’s Plaques Form During Menopause
A woman’s health shifts significantly during menopause and results in a plethora of symptoms, most of which are a result of declining estrogen and progesterone levels. Decreased estrogen levels can raise risks for certain health problems, negatively impact bone health and cardiovascular, cognitive, and immune function and potentially cause depression, insomnia, and other issues.
“We need to be paying attention to these symptoms. It’s not just being uncomfortable, it’s someone’s health,” says Dr. Polly Watson, an OBGYN and founder of Hormone Wellness MD. “It’s a really important time to look at your overall health.”
Menopausal symptoms often signal underlying health concerns and can be used as a preventative health tool to get better health outcomes. Hot flashes, for example, are a cardiovascular risk marker and for those who have a genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain during the menopausal period, says Watson. Low levels of estrogen during this transition can raise risk of heart disease, stroke, and osteoporosis, so monitoring estrogen levels and supplementing them with hormone replacement therapy (HRT) is one solution that can aid in the treatment of menopausal symptoms and prevention of these diseases.
“We’re learning more about estrogen potentially having protection against neurocognitive diseases, like Alzheimer’s and dementia.”
For women, the challenge is how to take advantage of the science.
More women are coming into their doctors’ offices with nuanced questions surrounding HRT and many times they are living with or supporting a family member with Alzheimer’s. Many physicians are unable to answer the questions, nor do they have the time to in a standard appointment.
In a 2019 study of family medicine, internal medicine, and OBGYN residents, fewer than 7 percent of residents reported feeling adequately prepared to manage women experiencing menopause. For example, many women started to ask their doctors about the risks of estrogen after a 2002 Women’s Health Initiative study found that estrogen plus progestin therapy raised a woman’s risk of breast cancer. But most of the participants studied were more than a decade past their menopausal period, and the risks were not as alarming as they initially appeared, according to JoAnn Manson, a professor in the Department of Epidemiology at Harvard T.H. Chan School of Public Health.
Watson, who worked as an OBGYN at a large health system, saw the demand for expanded women’s healthcare, specifically among menopausal women, and started Hormone Wellness MD, a functional medicine practice in Raleigh, North Carolina, that focuses on hormone health. “We are scheduled six months to a year out. The demand is exceptionally high because people aren’t getting their needs met in the conventional system.”
Another startup, Tia, is a self-proclaimed “modern medical home for women” that offers whole-person care by integrating primary care, mental health, fertility services, gynecological care, and wellness services like acupuncture. Tia, which is on path to serving 100,000 women nationwide by the end of 2023, recently expanded its integrated mental health offering to include group therapy and coaching. In 2021, Tia partnered with CommonSpirit Health, which operates 137 hospitals and more than 1,000 clinics, to launch Tia-branded women’s health clinics, and the company recently announced a partnership with Cedars-Sinai to open clinics in Los Angeles.
Excerpted from BRG’s Women’s Healthcare Report, 2023. H. Landi., B. Cote