There is a lot happening in the body during menopause, and new research suggests this life stage may also reshape the brain. Specifically, menopause appears to be linked to changes in the amount of grey matter in key brain regions.
The study, published in the journal Psychological Medicine, analysed data from nearly 125,000 women who took part in the UK Biobank, a large biomedical database. Researchers grouped participants into three categories: women who had not yet gone through menopause, women who were post-menopause and had never used hormone therapy (also known as HRT), and women who were post-menopause and had used hormone therapy. Hormone therapy replaces hormones such as oestrogen to help ease menopausal symptoms.
Participants completed detailed questionnaires covering menopause symptoms, mental health, sleep habits and overall health. The average age at menopause was 49.5, and women who used hormone therapy typically started around age 49. Some women also completed cognitive tests measuring memory and reaction time, and about 11,000 underwent MRI scans so researchers could examine their brain structure.
How does menopause impact the brain?
The researchers found that women who had been through menopause were more likely than those who had not to seek help for anxiety and depression. They were also more likely to score higher on depression questionnaires and to have been prescribed antidepressants.
Post-menopausal women were more likely to report insomnia, shorter sleep and feeling tired overall. Women using hormone therapy were the most likely to say they felt tired, even though their reported sleep patterns were similar to post-menopausal women who were not taking hormone therapy.
On cognitive testing, women who were post-menopause and not using hormone therapy had slower reaction times than women who were using hormone therapy and those who had not yet reached menopause.
What did brain scans show?
Among the women who had MRI scans, those who were post-menopause showed significant reductions in grey matter volume. Grey matter helps with processing information, supporting memory and regulating emotions. These reductions were seen regardless of hormone therapy use.
The changes were most marked in:
- The hippocampus, which is crucial for forming and storing memories
- The entorhinal cortex, which passes information between the hippocampus and the rest of the brain
- The anterior cingulate cortex, which supports emotional regulation and decision-making
“Our findings suggest that menopause is linked to adverse mental health outcomes and reductions in grey matter volume in key brain regions,” the researchers concluded. “These results have important implications for understanding the neurobiological effects of hormone therapy and highlight the unmet need for addressing mental health problems during menopause.”
Why might menopause impact the brain?
Researchers did not unpack the exact “why” in this study, but many of the changes seem to trace back to shifting hormones, says obstetrician-gynaecologist Dr Jessica Shepherd.
“There are many changes that occur in the body due to menopause,” she explains. “However, in the brain, there are molecular, cellular changes as an impact of oestrogen decline.”
Falling oestrogen can influence processes that affect the size, shape and density of neurons. “This impact can be seen in the change of the brain’s structure,” Dr Shepherd says. “It can create a shift in energy metabolism, and create menopausal symptoms that are neurological in nature, such as hot flushes, disturbed sleep, mood changes and forgetfulness.”
Women are more likely than men to develop Alzheimer’s disease. Current estimates suggest a lifetime risk of about one in five for women and around one in ten for men. The exact reason is not clear, but theories include longer life expectancy and hormonal shifts over time. More research is needed to understand the connection.
What can you do about it?
Previous research has suggested that starting hormone therapy within five years of menopause may be linked with a lower risk of Alzheimer’s disease, so it is difficult to make firm statements that hormone therapy has no cognitive benefit. This remains an active area of study.
“Hormone replacement therapy is known to improve physical symptoms of menopause,” says lead study author and neuroscience researcher Katharina Zuhlsdorff. “However, it is possible that the mechanisms in the brain are more complex and can’t be mitigated by replacing hormones. We need more research in this area to try to understand this.”
The current evidence does not support using hormone therapy purely to prevent dementia or cognitive decline, says obstetrician-gynaecologist Ashley Parr. “Hormone therapy is intended to treat menopausal symptoms that affect quality of life, not to prevent ageing or chronic disease.”
Dr Shepherd agrees that more work is needed to understand how menopause shapes the brain and how timing of treatment might matter. “In this study, it did not showcase what outcomes were if women started hormone therapy in the perimenopausal timeframe rather than post-menopausal, where there is the advantage of less oestrogen depletion, improved metabolism and less grey matter changes,” she notes.
The findings “do not mean that women cannot take hormone therapy for overall health and a decrease in symptoms,” Dr Shepherd says. Decisions about treatment are still highly individual.
To support brain health before, during and after menopause, Dr Zuhlsdorff recommends focusing on everyday habits:
- eating a nutritious, mostly whole-food diet
- staying physically active
- aiming for consistent, good-quality sleep
- keeping alcohol intake low
- continuing to challenge the brain with learning and new activities
“Lifestyle habits have a great impact on brain health,” she says. “Additionally, keeping the brain active and learning something new can help.”
Ultimately, it is worth speaking with a healthcare provider about personal risk factors, symptoms and goals. Together, it is possible to map out a plan—whether that includes hormone therapy or not—that supports both day-to-day wellbeing and long-term brain health.
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