Your Age at Menopause May Predict Your Brain Health Years Later

Our bodies change a lot during and after menopause, from hot flushes to hair loss to hormone swings. But research increasingly shows that our brains aren't exempt. In fact, the age at which we start menopause could go on to affect our brain health years later.

The takeaway comes from a recent study published in JAMA Network Open. After analysing data for 2,603 older women, the researchers found that those who went through menopause at an earlier age experienced faster cognitive decline than those who went through menopause at a later age. Specifically, each additional year earlier was associated with faster memory decline, earlier Alzheimer's disease onset and greater white matter hyperintensity accumulation – bright spots in the brain that signify damage and are linked to neurodegenerative conditions such as dementia.

So, if you go through menopause earlier, should you be concerned? Ahead, experts break it down.

What do the findings tell us?

When many of us think about menopause, brain health doesn't come to mind. But these findings help to shift that understanding. "They reinforce something we're only beginning to fully appreciate: Menopause isn't simply a reproductive event. It's a brain event as well," explains Dr David Perlmutter, a neurologist and author of Brain Defenders: Harness the Power of Your Immune Cells to Protect Your Brain for Life. "And reports like these may help us explain why women are twice as likely to be diagnosed with Alzheimer's disease in comparison to men."

"Cognitive decline is a big problem in our ageing society," adds Dr Riley Bove, a professor of clinical neurology and co-author of the study. "There's a need to understand which lifespan factors contribute to this decline, and whether any of these are in some ways modifiable. In women, menopause represents such a midlife factor, where the timing (earlier) and type (surgical) of menopause are linked to greater risk of later-life declines in brain function."

Importantly, in the study, the links between menopause timing and cognitive health were still apparent decades afterwards – not just as the transition was happening. "We studied women who made it to their mid- to late 70s largely cognitively intact," Dr Bove explains. "Even in these women, we were able to see a lasting signature of menopause timing – where earlier menopause was associated with worse later-life brain health." And those associations were present across several different brain health outcomes, including "cognitive tests, Alzheimer's risk and age of onset, and even MRIs," she adds.

To be clear, that doesn't mean going through menopause at an earlier age means for sure that your brain health will tank. "We also want readers to know what these results don't mean," explains Pia Campagna, a postdoctoral scholar in neurology and first author of the study. "They describe averages across more than 2,600 women and are not a forecast for any individual – many women who go through menopause earlier also keep their cognitive health as they age."

While Pia points out that the effect of menopause age on total brain volume was small, what stands out more is the frequency of "white matter injury in women with earlier spontaneous menopause, which is where addressing general dementia risk factors in midlife, and across the menopause transition itself, could help maintain cognitive health in later life."

"So this isn't simply about experiencing 'brain fog' around menopause," Dr Perlmutter says. "The study suggests that the timing of menopause may be associated with important changes in brain ageing that remain detectable many years later."

How does menopause affect the brain?

This all raises the question: What exactly does menopause do to the brain? After all, the cognitive health impacts of menopause aren't very widely discussed.

"I think this is one of the most important parts of the conversation," Dr Perlmutter says. "Oestrogen, particularly oestradiol, does important work in the brain. It supports the connections between brain cells, influences energy production, and helps regulate inflammation and the brain's immune response. So when oestrogen levels fall during menopause, the effects extend well beyond the reproductive system."

Dr Perlmutter also notes that other studies, including a recent article in Science, have "identified changes in blood proteins related to brain function, inflammation and neurodegeneration" among women going through menopause.

He says that may give us an intriguing biological clue: "Menopause may alter the inflammatory and immune environment of the brain at the same time that oestrogen's protective influence is declining." That's important, because it could help explain some of the common cognitive effects of menopause. "This may also help us understand why many women experience problems with memory, concentration and word finding – the symptoms commonly called 'brain fog' – during the menopausal transition."

If you go through menopause “early,” should you be concerned?

First, you may be wondering what age is considered 'too early' to go through menopause, but there isn't one clear answer that should give you cause for concern. "We didn't divide women into early and late groups explicitly," Pia explains. (For context, the average age at natural menopause for women in the study was 50, which is roughly in line with the average of 51 given by the American College of Obstetricians and Gynecologists.)

Instead, the researchers analysed menopause age as a continuous measure, showing results as differences across a span of years. "For example, women whose menopause came 10 years earlier had, on average, close to two fewer years free of Alzheimer's disease, and women whose menopause came five years earlier accumulated about 15 per cent more white matter injury over a decade," Pia says.

"The takeaway isn't that women who go through menopause early should panic," Dr Bove says. "Rather, the proactive and optimistic message is that they, along with us as a medical field and a society, should be empowered to consider menopause as a midlife window during which to think about preventive health."

Dr Perlmutter agrees. "I wouldn't want any woman to read this study and conclude that because she experienced menopause early, Alzheimer's disease is somehow in her future. Risk is not destiny."

But to Dr Bove's point, it may be a sign to take stock of the things you can do to protect your brain health as you get older. "The message here should be empowering, not frightening," Dr Perlmutter says. "If you experience menopause particularly early, it makes sense to discuss that history with your healthcare provider and pay especially close attention to the modifiable factors we know influence brain ageing: exercise, sleep, blood pressure, blood sugar, metabolic health, smoking, diet, social connection and intellectual engagement."

After all, you don't necessarily have control over when you'll go through menopause, which he says is "influenced strongly by biology and genetics." But many of those lifestyle factors can be adjusted.

Paying closer attention to all of those factors that may influence brain health throughout your life is exactly what Dr Bove hopes the research will inspire. "We want readers to appreciate the importance of looking at women's health globally," she says.

The bottom line

The results of the study add to a growing body of evidence showing that menopause is a full-body event – not just a reproductive one. But there's more to consider. Dr Bove points out that the menopause age data was self-reported, which means the researchers weren't able to completely verify its accuracy with hormonal tests or medical records.

And because it was an observational study, the results can show an association between menopause age and brain health, but not a direct cause-and-effect relationship. "Earlier menopause could also be a marker of other aspects of biological ageing," Dr Perlmutter points out. "Sleep, cardiovascular health, metabolic health, smoking, body weight and other factors can influence both menopause and brain health. The authors themselves acknowledge that it can be difficult to separate these effects."

But while some of the study's results may seem troubling – especially if you're going through or have gone through menopause at an earlier age – Dr Perlmutter warns not to panic. "Perspective is important," he says. "Menopause is something virtually all women with intact ovaries experience, yet most women don't go on to develop Alzheimer's disease. For me, the most important takeaway is that menopause may help identify vulnerability, but vulnerability is not destiny. It gives us another reason to act earlier to protect the brain."