Menopause is a natural stage of life that every woman will experience, yet its effects on the brain and mental health are still not fully understood.
New research from the University of Cambridge now suggests that menopause is linked to clear changes in brain structure, as well as higher levels of anxiety, depression, sleep problems, and slower reaction speed. The findings add to growing evidence that menopause is not only a physical transition but also a neurological and psychological one.
Menopause happens when a woman’s menstrual periods permanently stop, usually between the ages of 45 and 55. This change is driven by a sharp drop in hormones such as estrogen and progesterone. Many women are familiar with physical symptoms like hot flushes, night sweats, and weight changes.
However, emotional changes, poor sleep, low mood, and problems with concentration are also very common. In recent years, scientists have begun to ask whether these symptoms reflect deeper changes happening inside the brain.
To explore this question, researchers used data from the UK Biobank, one of the largest health databases in the world. The study included nearly 125,000 women.
They were divided into three groups: women who had not yet reached menopause, women who were post-menopause and had never used hormone replacement therapy, and women who were post-menopause and had used hormone replacement therapy, often called HRT.
Participants provided detailed information about their mental health, sleep quality, and overall wellbeing. Some completed tests that measured memory and reaction speed.
Around 11,000 women also had brain scans using MRI, allowing scientists to directly examine differences in brain structure. On average, menopause occurred at around 49.5 years of age, and women who used HRT usually began treatment around the same time.
The results showed that women who had gone through menopause were more likely to seek medical help for anxiety, nervousness, and depression than women who had not yet reached menopause.
They also scored higher on questionnaires that measure depressive symptoms and were more likely to have been prescribed antidepressants. Sleep problems were also much more common after menopause, including difficulty falling asleep, shorter sleep time, and ongoing tiredness during the day.
Interestingly, women who used HRT reported higher levels of anxiety, depression, and fatigue than women who did not use HRT. However, the researchers found that these emotional difficulties were already present before menopause began.
This suggests that HRT was often prescribed to women who were already struggling, rather than HRT causing these problems. In other words, doctors may have been trying to prevent symptoms from getting worse, rather than treating new ones.
The study also looked at thinking skills. Memory performance was similar across all three groups, which may reassure many women who worry about memory loss during menopause. Reaction time, however, told a different story.
Women who were post-menopause and not using HRT responded more slowly than women who had not yet reached menopause. Women using HRT showed slightly faster reaction times, suggesting that HRT may slow this aspect of brain ageing.
Brain scans provided some of the most striking findings. Women who were post-menopause showed reduced grey matter volume in several important brain regions, regardless of whether they had used HRT. Grey matter contains the main bodies of nerve cells and is essential for thinking, memory, emotional control, and decision-making.
The areas most affected included the hippocampus, which is critical for forming memories, the entorhinal cortex, which helps transfer information across the brain, and the anterior cingulate cortex, which plays a role in managing emotions and attention.
These brain regions are also known to be vulnerable in Alzheimer’s disease. This does not mean that menopause causes dementia, but it may help explain why women develop dementia at nearly twice the rate of men.
Menopause-related brain changes could make some women more vulnerable later in life, especially when combined with other risk factors such as genetics, lifestyle, and cardiovascular health.
When reviewing these findings, it is important to understand both their strengths and limitations. The study included a very large number of participants and used high-quality brain imaging, which strengthens the reliability of the results.
However, it was observational, meaning it cannot prove that menopause directly causes these brain changes. It also does not show whether the changes are permanent or whether the brain can adapt over time.
Overall, the study suggests that menopause is linked to measurable changes in brain structure, mental health, sleep, and reaction speed. HRT did not prevent these brain changes, but it may slightly slow cognitive ageing in some areas.
The findings highlight the need for better mental health support, lifestyle guidance, and open conversations about menopause. They also point to the importance of long-term brain health research focused specifically on women.
If you care about Alzheimer’s disease, please read studies that bad lifestyle habits can cause Alzheimer’s disease, and strawberries can be good defence against Alzheimer’s.
For more information about brain health, please see recent studies that oral cannabis extract may help reduce Alzheimer’s symptoms, and Vitamin E may help prevent Parkinson’s disease.
The study was published in Psychological Medicine.
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