From midlife challenges to mental well-being: the interplay between stress, menopause, & brain function

<p dir="ltr">The menopause transition, commonly associated with menopausal symptoms, such as hot flushes, night sweats, sleep issues, psychological distress and much more, can negatively impact women’s quality of life. However, the relationships between mid-life challenges, psychological distress (stress, depression, and anxiety), cognitive function (memory), exercise behaviour, and menopausal hormone therapy (MHT) use during the menopausal transition remain unclear. </p><p dir="ltr">The overarching aim of this thesis was to explore the relationships between psychological stress, menopause, mental health, and cognitive function. A UK-based observational study investigated the differences between the level of psychological complaints (depression, anxiety, poor memory) and perceived stress levels across different menopausal stages (Chapter 3) and found that older women reported lower levels of stress and anxiety, but that early perimenopausal women were significantly more bothered by depression symptoms. In addition, resilience, self-efficacy, and social support were identified as protective psychosocial factors that may buffer the negative effects of stress and negative life events on psychosocial quality of life (Chapter 4). Engagement with physical activity and yoga, but not mindfulness, was associated with lower perceived stress and better psychosocial quality of life (Chapter 5). While MHT remains a common treatment for menopausal symptoms, its association with poorer psychosocial QoL and memory issues suggested a need for further research (Chapter 5). Poor mental health and subjective memory complaints are both risk factors for later life dementia. It is unclear whether MHT can prevent dementia given its lack of longer term benefit in improving mood and memory.</p><p dir="ltr">A systematic overview of national registries on MHT use and later-life dementia risk (Chapter 6) indicated that MHT was safe for use for up to 10 years in healthy women under 60 years old, but not in older women (60+), highlighting the importance of timing for initiation. Further research is needed to confirm whether these findings apply to ethnic minority women, those with low socioeconomic position, and/or individuals at higher risk of cardiovascular disease and diabetes and those with severe hot flushes and night sweats affecting sleep quality (Chapter 7). These findings suggest that while MHT may address vasomotor issues, it might not be suitable for treating and improving mood and cognitive function or preventing cognitive decline. Non-pharmacological treatments such as CBT in groups and phytoestrogens like tempe may offer a promising alternative. </p><p dir="ltr">This thesis contributes to the literature, highlighting the importance of psychosocial factors, lifestyle changes, diet, and non-hormonal treatments in managing psychological distress and enhancing cognitive function. Future research should examine the long-term effects of these psychosocial interventions on the emotional well-being and cognitive functions of larger, more diverse groups of menopausal women who have different health statuses and socioeconomic backgrounds.</p>