New research from the University of Cambridge suggests that menopause is associated with measurable changes in brain structure, alongside higher rates of anxiety, depression and sleep problems. In the study, women who had been through menopause showed reduced grey matter volume in several brain regions considered important for memory and emotional regulation.
The findings, published in Psychological Medicine, also explored the role of hormone replacement therapy (HRT). HRT did not appear to prevent the brain or mental health changes linked with menopause, but it was associated with a slower decline in reaction speed.
What Menopause Is And Why It Matters
Menopause is the life stage when menstrual periods permanently stop as hormone levels decline. It most commonly occurs between the ages of 45 and 55 and is often linked with symptoms such as hot flushes, low mood and disrupted sleep. Earlier research has also connected menopause with changes in thinking abilities, including memory, attention and language.
HRT is frequently prescribed to help manage menopause-related symptoms, particularly low mood and sleep difficulties. In England, 15% of women were prescribed HRT in 2023. Despite its widespread use, researchers say there is still limited understanding of how menopause and HRT influence the brain, cognitive performance and mental health.
How The Study Was Carried Out
Researchers analysed data from nearly 125,000 women in the UK Biobank. Participants were divided into women who had not yet reached menopause, post-menopausal women who had never used HRT and post-menopausal women who had used HRT.
Participants completed questionnaires about menopause symptoms, mental health, sleep and overall health. Some also completed cognitive tests measuring memory and reaction speed. Around 11,000 women underwent MRI scans, allowing researchers to compare brain structure across the groups.
The average age of menopause in the dataset was approximately 49.5 years. Women prescribed HRT generally started treatment at around age 49.
Mental Health And Sleep After Menopause
Compared with women who had not yet reached menopause, post-menopausal women were more likely to seek support from a GP or psychiatrist for anxiety, nervousness or depression. They also scored higher on depression questionnaires and were more likely to use antidepressant medication.
Women in the HRT group showed higher levels of anxiety and depression than post-menopausal women who did not use HRT. However, additional analysis suggested these differences already existed before menopause. Researchers believe this may indicate that clinicians are more likely to prescribe HRT to women already vulnerable to worsening symptoms.
Sleep problems were also more common after menopause. Post-menopausal women more frequently reported insomnia, shorter sleep duration and persistent fatigue. Women using HRT reported the highest levels of tiredness, even though their total sleep duration was similar to women who were post-menopausal without HRT.
Why Lifestyle And Support Still Matter
Dr Christelle Langley from the Department of Psychiatry noted that menopause can be a major life transition regardless of HRT use and emphasized that healthy lifestyle habits become especially important during this period. Staying physically active and maintaining a balanced diet may help reduce some of menopause’s effects.
She also stressed the importance of taking women’s mental health concerns seriously during menopause and recognizing when additional support is needed. Seeking help, she said, should never be viewed as a source of shame.
Reaction Time Changes While Memory Remains Similar
The study also identified differences in cognitive performance. Women who were post-menopause and not using HRT showed slower reaction times than women who had not yet reached menopause and women who were using HRT. Memory performance, however, did not differ significantly between groups.
Dr Katharina Zühlsdorff from the Department of Psychology explained that reaction speed naturally slows with age in both men and women, but menopause appeared to accelerate this process. According to the findings, HRT was linked with a smaller decline in reaction speed, suggesting it may modestly slow one aspect of cognitive ageing.
Grey Matter Loss In Regions Linked To Memory And Emotion
MRI scans showed that post-menopausal women had lower grey matter volume regardless of HRT use. Grey matter contains many neuronal cell bodies and plays a central role in information processing, movement control, memory and emotional regulation.
The most affected regions included the hippocampus, which is essential for forming and storing memories; the entorhinal cortex, which helps transfer information between the hippocampus and other brain areas; and the anterior cingulate cortex, involved in emotional regulation, attention and decision-making.
What It Could Mean For Dementia Risk
Professor Barbara Sahakian, the senior author of the study, noted that the brain regions showing changes are also commonly affected in Alzheimer’s disease. She suggested that menopause may increase vulnerability later in life, potentially contributing to why dementia is diagnosed in women at nearly twice the rate seen in men.
The researchers emphasize that more long-term studies are needed to fully understand how menopause, hormones and brain ageing interact. However, the findings add to growing evidence that menopause affects not only reproductive health but also broader neurological and emotional well-being.
