More women get Alzheimer’s than men. Are menopause hot flashes to blame?

Frequent hot flashes during menopause may be an early indicator of Alzheimer's disease (AD), according to a new paper.

In the paper, which has not yet been published and is currently under review, researchers studied the frequency of hot flashes in a group of 248 late-perimenopausal and postmenopausal participants, who were also tested for AD biomarkers. Data was collected between 2017 and 2022 via the MsBrain Study—and study results were shared at the 2023 Annual Meeting of The Menopause Society this September.^[]

The researchers found that people with a higher frequency of hot flashes, particularly during sleep, were more likely to be positive for AD biomarkers. They concluded that VMS symptoms during sleep may be a marker of AD risk, adding that menopause patients with a high frequency of VMS symptoms during sleep “may warrant AD dementia risk reduction efforts.”

Going forward, the findings may aid in better understanding the gravity of menopause symptoms and their contribution to AD risk.^[]

Menopause and sex-based AD risk

Women make up the majority of Americans with AD—almost two-thirds, according to the Alzheimer’s Association, but experts do not know why this is the case. The new findings add to the debate of whether the menopause period plays a role in sex-based AD risks.

Previous studies on menopause and AD risk have hypothesized that the drop of estrogen levels (that occurs during menopause) may increase risk. Menopause VMS symptoms have also been linked to poor memory and alterations in brain structure, function, and connectivity—which are also seen in AD. 

Despite the association between hot flashes and AD risk, neither the new study nor previous research confirms causation.

Asima Ahmad, MD, chief medical officer and co-founder of Carrot Fertility and a practicing reproductive endocrinologist, says that “future studies, including studies following people with more VMS during sleep over time, may help further delineate if this is true.”

Dr. Ahmad adds that this study may be significant in helping further research about what causes AD in women and how to guide treatment in the future.

“It is very important to determine what factors increase the risk of developing Alzheimer’s or what things can be an early sign of someone who is at risk,” Dr. Ahmad says. “Determining this can help us develop potential therapies to intervene early and possibly prevent or delay the onset of this medical condition.”

Talking to menopause patients about AD risk

Unfortunately, there is no known way to avoid Alzheimer’s. For patients who are experiencing hot flashes and worried about their risk, you may want to have a calm conversation with them about ways they can maintain good brain health and manage their symptoms at this time.

“Though there is not a way to completely prevent Alzheimer’s, there are data that suggest there may be some way to reduce your risk for developing dementia and maintain better brain health,” Dr. Ahmad says. She encourages healthy lifestyle habits like:

• Practicing good nutrition.

• Being physically active.

• Practicing brain enrichment activities, like puzzles, quizzes, or reading a book.

• Eliminating or avoiding smoking. 

• Managing your cholesterol.

In addition to recommending a healthy lifestyle, you may want to remind your patients that it is still not proven that frequent hot flashes increase risk of AD. If this is the case in the future, let them know you will be on top of prescribing them with necessary, science-backed treatments when and if they are available. (Before you promise the latter, however, make sure that is true. Stay up to date on news regarding menopause studies and treatment advice.)