By Wellington Jopelo
A major UK study has found that menopause is associated with changes in the brain similar to those seen in Alzheimer’s disease, offering new insight into why women face a significantly higher risk of dementia than men.
The research, published in Psychological Medicine, analysed data from nearly 125,000 women, including around 11,000 who underwent MRI brain scans, making it one of the largest investigations into menopause and brain health to date.
Scientists observed a loss of grey matter in key regions of the brain responsible for memory, learning, attention and emotional regulation. These areas are among the first to be affected in Alzheimer’s disease, raising concerns that menopause may leave women biologically vulnerable to dementia later in life.
According to the study, the brain regions affected include:
- The hippocampus, crucial for learning and memory
- The entorhinal cortex, essential for memory formation and spatial navigation
- The anterior cingulate cortex, involved in attention and emotional regulation
Grey matter contains neuronal cell bodies that process information, while white matter consists of nerve fibres that transmit signals across the brain. Although both are vital, the study found menopause-related changes were concentrated in grey matter.
Professor Barbara Sahakian of the University of Cambridge, the study’s senior author, said the findings may help explain the gender gap in dementia rates.
“The brain regions where we saw these differences are ones that tend to be affected by Alzheimer’s disease. Menopause could make these women vulnerable further down the line. While this is not the whole story, it may help explain why we see almost twice as many cases of dementia in women than in men.”
The study also examined the impact of hormone replacement therapy (HRT), widely prescribed to ease menopausal symptoms such as hot flushes and sleep disturbance. Researchers found that HRT did not appear to prevent grey matter loss, and women taking HRT were more likely to report poor mental health. However, many had existing mental health challenges before starting treatment, complicating conclusions.
Dr Christelle Langley, a co-researcher, stressed the importance of recognising menopause as both a physical and psychological transition.
“We all need to be more sensitive to not only the physical, but also the mental health challenges women experience during menopause. There should be no embarrassment in asking for help.”
Experts not involved in the study say the findings add to a growing but still incomplete body of evidence. Professor Channa Jayasena, a hormone specialist at Imperial College London, noted that previous large clinical trials have failed to definitively answer whether HRT protects brain health.
“The effect of HRT on the brain during menopause remains a topic of debate. However, this is an issue affecting millions of women in the UK and deserves close attention going forward.”
According to the Alzheimer’s Society, women account for around two-thirds of people living with Alzheimer’s disease in the UK. While longer life expectancy plays a role, hormones are increasingly believed to be a key factor.
Michelle Dyson of the charity welcomed the study but urged caution.
“This research adds to evidence showing that menopause impacts the brain, including physical changes such as loss of brain volume. However, without long-term tracking to see whether these women go on to develop dementia, we cannot be certain these changes directly increase risk.”
She emphasised that lifestyle choices remain critical, noting that regular exercise, avoiding smoking, and limiting alcohol intake can significantly reduce dementia risk.
While menopause is a natural stage of life, this landmark study suggests its neurological effects may be deeper and longer-lasting than previously understood—underscoring the need for further research, early support, and greater awareness of women’s brain health.