Young onset dementia: perimenopause and menopause

Perimenopause is the time leading up to menopause. A woman will still have periods – although they may be different from usual – and many have physical and mental symptoms caused by their changing hormone levels.  

Menopause occurs when a woman has her last period. If you have not had a period for 12 consecutive months, you are post-menopausal.  

The average age for menopause is 51, but it can happen earlier or later.  

Perimenopause can last for months or even years before menopause. Women often start to notice symptoms in their early 40s, or sometimes younger.  

Common symptoms include:  

• changes in periods, including the frequency, pattern or flow  
• hot flushes and/or night sweats  
• poor sleep  
• fatigue 
• mood changes, anxiety or stress  
• ‘brain fog’ or poor concentration  
• loss of interest in sex  
• joint pains and/or muscle aches  
• migraines and headaches  
• hair loss  
• dry skin  
• vaginal dryness and soreness  
• needing to pass urine more often, leaking urine and/or urinary tract infections (UTIs)  

Because many symptoms of perimenopause also occur in dementia, some women worry that they are showing signs of young onset dementia, particularly if they have a family history of dementia.  

For example, ‘brain fog’ is a very common symptom of menopause, with many women saying their brain feels like cotton wool. They may have difficulties with:  

• memory 
• concentration  
• word-finding 
• memory  
• multi-tasking  
• mood and emotions    

However, while people with young onset dementia do experience memory and concentration problems, these are not usually early symptoms; changes in vision and spatial awareness, language problems and changes in behaviour are more common in the initial stages.  

Because it can be difficult to tell if these symptoms are related to perimenopause/menopause, young onset dementia or both, it is important to see a GP if you have any concerns.  

Before your appointment, spend some time thinking about your symptoms, what treatments are available, and what outcomes you would like to achieve.  

If you are supporting someone with young onset dementia, you can help by: 

• working with them to keep a record of their periods and possible symptoms 
• doing some research into menopause symptoms and what treatment may suit the person best, especially if they may need support to manage their treatment 
• attending the appointment with them 
• helping them explain the changes you and/or they have noticed and why you think they may be due to hormonal changes  

At your appointment, your doctor should discuss the stages and symptoms of menopause, lifestyle changes that may help, possible treatments and how menopause may affect your future health.  

Women over 45 do not need tests to diagnose perimenopause, however, if a woman is under 45, her GP may run some tests to rule out other conditions.  

Be aware that some healthcare professionals are not fully aware of the variety of menopause symptoms and might put changes down to the person’s dementia. Be patient but persistent – it may take several appointments to agree on a treatment plan. 

The most common and effective treatment for perimenopause/menopause is hormone replacement therapy (HRT), which can be prescribed by a GP. HRT replaces or tops up the hormones that fall during this time.  

It also reduces the risk of future health problems, including:  

• heart disease  
• osteoporosis 
• type 2 diabetes  
• clinical depression  

There are different types and doses of HRT, and different ways of taking it.  

Oestrogen  

This is the main hormone in HRT and is usually taken through the skin via a patch, gel or spray. It also comes in tablet form, but this may increase the risk of blood clots. 

Progesterone  

Women who still have a womb will need to take progesterone to keep the womb lining thin and healthy. The safest types of progesterone are Utrogestan, which comes in capsule form, or the Mirena coil: a small plastic T-shaped device that is inserted into the womb.  

Testosterone  

Taking a testosterone replacement alongside oestrogen and progesterone may help improve energy levels, sex drive, bone and muscle strength, brain fog and sleep. It comes as a cream or gel.  

However, many GPs do not prescribe testosterone so you may want to seek advice from a menopause specialist: visit thebms.org.uk/find-a-menopause-specialist  

Vaginal oestrogen  

Vaginal oestrogen medication is used to improve symptoms like vaginal dryness and soreness, frequent urination, urine leakage, thrush and UTIs.  

HRT should not interfere with medications for dementia, but it is important to discuss any treatments you are currently taking with your GP, psychiatrist or neurologist. 

For the vast majority of women, the benefits of HRT far outweigh any risks, and perimenopausal or menopausal symptoms will usually improve after several months.  

However, if you have any concerns, be sure to discuss these with your GP or a menopause specialist who can help you decide on the best type of HRT to meet your individual needs.  

Although HRT is a very effective treatment, it may not be the right choice for everyone.  

There are many other things that may help manage symptoms – either alongside HRT, or as an alternative. These include:  

• regular exercise  
• other prescription medicines, eg antidepressants 
• cognitive behavioural therapy (CBT) 
• herbal medicines: scientific evidence is mixed on how effective they are, and they may also have side effects or interfere with other medicines you might be taking, so it is important to speak to your GP or another healthcare professional before using these remedies  
• massage, acupuncture or aromatherapy 
• prioritising good sleep  
• relaxation techniques eg meditation or mindfulness 
• a healthy diet: the NHS Eatwell guide is a useful model   
• stopping smoking 
• drinking alcohol only in moderation  

To speak to a dementia specialist Admiral Nurse about young onset dementia and perimenopause or menopause or any other aspect of dementia, please call our free Helpline on 0800 888 6678 (Monday- Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December) or email helpline@dementiauk.org

If you prefer, you can book a phone or video appointment at a time to suit you at dementiauk.org/closer-to-home  

Dementia UK information 

Capacity and decision making 
dementiauk.org/capacity

Managing anxiety and depression in dementia 
dementiauk.org/ managing-anxiety

Staying healthy 
dementiauk.org/ staying-healthy

Lasting power of attorney 
dementiauk.org/lasting-power-of-attorney 

Dementia and sleep 
dementiauk.org/good-habits-for-bedtime  

Young onset dementia 
dementiauk,org/young-onset-dementia 

Other resources

Balance app and website 
balance-menopause.com/balance-app 

The Menopause Charity 
For information and symptom questionnaire
themenopausecharity.org

The British Menopause Society 
thebms.org.uk

NHS Eatwell guide 
nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide 

NHS alcohol advice 
nhs.uk/live-well/ alcohol-advice

NHS stop smoking advice 
nhs.uk/live-well/quit-smoking