I've continued to take Estratest since menopause, resisting my gynecologist's pressure to stop, partly to support brain health. This suggests the trade-off is worth it.

Menopause triggers changes in brain that may promote Alzheimer’s

Menopause causes metabolic changes in the brain that may increase the risk of Alzheimer’s disease, a team from Weill Cornell Medicine and the University of Arizona Health Sciences has shown in new research.

The tests revealed the women who had undergone menopause or were peri-menopausal had markedly lower levels of glucose metabolism in several key brain regions than those who were pre-menopausal. Scientists in prior studies have seen a similar pattern of “hypometabolism” in the brains of patients in the earliest stages of Alzheimer’s –...

“Our findings show that the loss of estrogen in menopause ... means the loss of a key neuroprotective element in the female brain and a higher vulnerability to brain aging and Alzheimer’s disease."

Menopause has been known to cause brain-related symptoms, including depression, anxiety, insomnia and cognitive deficits. Scientists widely believe they are caused largely by declines in estrogen levels.  Estrogen receptors are found on cells throughout the brain and evidence suggests that reduced signaling through these receptors due to low estrogen levels can leave brain cells generally more vulnerable to disease and dysfunction.

“Our work indicates that women may need antioxidants to protect their brain activity and mitochondria in combination with strategies to maintain estrogen levels,” Mosconi said,...

Brighter colors indicating more brain activity. The scan to the right (menopause) looks 'greener' and overall darker, which means that the woman's brain has more than 30 percent less brain activity than the one to the left ...

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