Treatment considered for menopausal women who can’t focus
PHILADELPHIA — After C. Neill Epperson, a psychiatrist who directs the Penn Center for Women’s Behavioral Wellness, listened to many patients complain about their brains as they approached and entered menopause, she had an idea.
Women would tell her that they couldn’t juggle as much as they used to. They had to write something down instantly or the thought would disappear. They felt foggy and disorganized. Some worried that they had dementia.
The symptoms didn’t sound like dementia to Epperson, but they did sound like something else: attention deficit disorder.
She thought, “Wow, these issues are really similar to what you see in ADHD. We need to do something about this.”
She knew the women didn’t really have ADHD — a developmental disorder that starts in childhood — but she wondered if drugs for attention-deficit patients might also help distracted women.
She tried one of them, lisdexamfetamin (Vyvanse), in a small study funded by the drug’s maker, Shire. On average, the 32 patients’ scores rose by 20 points on the 120-point Brown Attention-Deficit Disorder Scale after four weeks on the drug.
Lest you think that a psychostimulant might boost anyone’s performance, Epperson said the drug didn’t help everyone. “The people it helped, it really helped,” she said.
But most of the patients didn’t want to stay on the drug because insurers wouldn’t cover the cost.
Psychostimulants can increase heart rates and blood pressure, so they’re not for everyone.
Epperson discussed her study at two professional meetings last week. It has not yet been published.
She doesn’t know what percentage of women develop executive function symptoms or whether aging men get them at the same time. She studies only women.
She attributes the cognitive changes to the drop in estrogen during menopause. The hormone supports chemical signaling in the brain and promotes healthy brain cells. It is present in both male and female brains.
Pauline Maki, a psychologist at the University of Illinois at Chicago who studies cognition during the transition to menopause, said Epperson’s approach is unusual. “It’s definitely novel,” she said. “It’s a hypothesis that’s certainly worth studying.”
Maki said recent studies have found changes in age and memory as women go through menopause. She is “cautiously optimistic” that most women return to baseline within three or four years after official menopause. Thinking seems most disrupted in the two years before and the two years after menopause.
Maki worries that the prolonged period of hormonal disruption may somehow make women more vulnerable than men to Alzheimer’s disease. She is studying whether early, limited estrogen treatment can help women emerge from this transition with healthier brains.
Estrogen causes changes that are independent of normal brain aging, which also is associated with a decline in executive function. Maki said that going through menopause is the equivalent of feeling about four years older than you are, brain-wise.
Later, most women will feel themselves again. Researchers don’t yet know whether the brain begins producing more estrogen or begins solving problems in different ways.
Andrea LaCroix, a menopause expert at the University of California, San Diego, said the average age for periods to stop is 51. Typically, women have symptoms from, say, 45 to 55.
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