New Insights for Hormone Therapy in Perimenopausal Women Neuroprotection
Chapter 12 New Insights for Hormone Therapy in Perimenopausal Women Neuroprotection Manuela Cristina Russu and Alexandra Cristina Antonescu Additional information is available at the end of the chapter http://dx.doi.org/10.5772/intechopen.74332 Abstract Perimenopause is a mandatory period in women’s life, when the medical staff may initiate hormone therapy with sex steroids for the delay of brain aging and neurodegenerative diseases, during the so-called “window of opportunity.” Animals’ models are helpful to sustain the still controversial results of human clinical observational and/or randomized controlled studies. Estrogens, progesterone, and androgens, with their nuclear and mem- brane receptors, genes, and epigenetics, with their connections to cholinergic, GABAergic, serotoninergic, and glutamatergic systems are involved in women’snormalbrainorin brain’s pathology. The sex steroids are active through direct and/or indirect mechanisms to modulate and/or to protect brain plasticity, and vessels network, fuel metabolism—glucose, ketones, ATP, to reduce insulin resistance, and inflammation of the aging brain through blood-brain barrier disruption, microglial aberrant activation, and neural cell survival/loss. Keywords: perimenopause, “window” of opportunity, neuroprotection, sex steroid hormones 1. Introduction The months/years of perimenopause represent an important moment during women’saging, when sex steroids and their receptors decline are evident in the hippocampal and cortical neu- rons, after estrogen exposure during the reproductive years. The sex steroid hormones decline is associated/acts synergic to other factors as hypertension, diabetes, hypoxia/obstructive sleep apnea, obesity, vitamin B12/folate deficiency, depression, and traumatic brain injury to promote diverse pathological mechanisms involved in brain aging, memory impairment, and AD.
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