After menopause, the extent of certain brain damage is greater in women than in men of the same age. This is the conclusion reached by researchers at the German Center for Neurodegenerative Diseases (DZNE) based on the study of more than 3,400 adults in the Bonn Rhineland Study. The tissue damage studied is considered a possible risk factor for dementia and stroke. The current findings underscore the importance of gender-responsive medicine.
Particularly in older adults, bright spots can be seen on images of the brain obtained by magnetic resonance imaging (MRI). These spots indicate abnormalities in the so-called white matter, an area of the brain made up of nerve fibers that lies below the cerebral cortex inside the brain. In technical jargon, this is referred to as “white matter hyperintensities”. “These are signs of tissue damage associated with circulatory problems, increased blood pressure, stroke, and cognitive impairment,” explains neuroscientist Valerie Lohner, first author of the current paper. “It is known that these abnormalities in brain tissue increase with age. Our research now shows differences between men and women. This has been discussed for some time, but the data were inconclusive. We therefore included a larger group of people and a wider age range than previous studies. We found no significant differences in pre-menopausal women compared to men of the same age. However, the situation changes after menopause. This therefore affects those women who have already had their last menstrual period. In them, the damage to the white matter of the brain was more extensive than in men of the same age.”
Data from the Rhineland Study
These findings are based on investigations of the so-called Rhineland Study, a large-scale population study of the DZNE in the Bonn urban area. Valerie Lohner, together with expert colleagues from the DZNE, evaluated data from nearly 2,000 women and more than 1,400 men. Their ages ranged from 30 to 95, with a median age of about 54. In addition to differences between the sexes, the researchers generally registered a greater extent of abnormalities in the white matter of the brain in subjects with hypertension. This is consistent with previous research.
Gender specific medicine
“Our study results show that women who have already started menopause are more susceptible to changes in the brain vessels and thus to brain diseases than women before menopause, even if they have a similar age. Damage to the white matter of the brain does not necessarily lead to dementia or stroke, but it does increase the risk of them,” says Prof. Dr. Dr. Monique M. B. Breteler, head of the Rhineland Study and Director of Population-Based Health Research at the DZNE. “Our findings further indicate that specific differences between men and women should be considered when assessing these brain lesions. This underscores the relevance of gender-specific research and therapy.”
Causes unclear
The reasons for these gender differences are unclear. It has long been speculated that the hormone estrogen may have a protective effect that is lost in old age because the female organism gradually stops producing it with menopause. In their data, however, the scientists of the Rhineland study could not detect any influence of a therapy that compensates for the hormone deficiency: Post-menopausal women who regularly took hormone preparations were, on average, similarly affected by abnormalities of the white matter of the brain as post-menopausal women who did not take hormones. “It is unclear whether the hormonal change in the course of menopause is a decisive factor or whether factors related to the onset of menopause play a role. We will continue to investigate this topic in the Rhineland study,” Breteler said.
Original publication:
Relation between sex, menopause, and white matter hyperintensities: the Rhineland Study, Valerie Lohner et al, Neurology®, the medical journal of the American Academy of Neurology (2022), URL:
https://n.neurology.org/lookup/doi/10.1212/WNL.0000000000200782
