CAMBRIDGE, England, February 7, 2026 — Menopause isn’t just about hot flashes; it’s linked to measurable changes in brain structure, and a heightened risk of anxiety and depression, according to new research. A large-scale study from the University of Cambridge found reduced grey matter in key brain regions among women experiencing menopause, raising questions about long-term cognitive health.
Brain Changes and Mental Wellbeing During Menopause
New research reveals a complex relationship between menopause, brain structure, and mental health.
- Menopause is associated with reductions in grey matter volume in brain areas crucial for memory and emotional regulation.
- Women experiencing menopause were more likely to seek help for anxiety and depression.
- Hormone replacement therapy (HRT) didn’t prevent brain changes but appeared to slow down declines in reaction speed.
- Lifestyle factors, like exercise and a healthy diet, are crucial for mitigating the effects of menopause.
The study, published in Psychological Medicine, adds to a growing body of evidence demonstrating that menopause impacts more than just reproductive health. While hormone replacement therapy (HRT) didn’t appear to reverse these changes, it was associated with a slightly slower decline in reaction time.
Understanding the Menopausal Transition
Menopause, typically occurring between ages 45 and 55, marks the end of a woman’s menstrual cycles due to declining hormone levels. Common symptoms include hot flushes, mood swings, and sleep disturbances. Previous research has hinted at cognitive changes, affecting memory, attention, and language skills, but the underlying brain mechanisms remained largely unknown.
In England, approximately 15% of women were prescribed HRT in 2023 to manage menopause-related symptoms, particularly depression and sleep problems. Despite its widespread use, the precise effects of both menopause and HRT on the brain have remained a mystery—until now.
A Deep Dive into UK Biobank Data
Researchers analyzed data from nearly 125,000 women participating in the UK Biobank, a large-scale biomedical database. Participants were categorized into three groups: women who hadn’t yet reached menopause, post-menopausal women who had never used HRT, and post-menopausal women who had used HRT.
Participants completed detailed questionnaires about their menopause symptoms, mental health, sleep patterns, and overall health. A subset of around 11,000 women also underwent magnetic resonance imaging (MRI) scans, allowing researchers to visualize differences in brain structure. The average age at menopause was approximately 49.5 years, and women who were prescribed HRT generally started treatment around age 49.
Anxiety, Depression, and Sleep Disruption
Women who had experienced menopause were significantly more likely to consult with a doctor or psychiatrist for anxiety, nervousness, or depression compared to pre-menopausal women. They also reported higher scores on depression questionnaires and were more frequently prescribed antidepressant medications.
Interestingly, women in the HRT group initially showed higher levels of anxiety and depression. However, further analysis revealed that these differences were often present *before* menopause began, suggesting some doctors may have proactively prescribed HRT anticipating potential worsening of existing symptoms.
Sleep problems were also more prevalent after menopause, with post-menopausal women reporting increased insomnia, reduced sleep duration, and persistent fatigue. Women using HRT reported the highest levels of fatigue, even though their total sleep time didn’t differ significantly from those not taking HRT.
Lifestyle and Mental Health: A Holistic Approach
“Most women will go through menopause, and it can be a life-changing event, whether they take HRT or not,” said Dr. Christelle Langley from the Department of Psychiatry. “A healthy lifestyle – exercising, staying active, and eating a nutritious diet – is particularly important during this period to help mitigate some of its effects.”
“We all need to be more sensitive to not only the physical, but also the mental health of women during menopause, and recognize when they are struggling. There should be no embarrassment in letting others know what you’re going through and asking for help,” Dr. Langley added.
Reaction Time and Cognitive Performance
Menopause was linked to slower reaction times, particularly in women who were post-menopausal and not using HRT. However, memory performance remained relatively stable across all three groups.
“As we age, our reaction times naturally slow down – it’s a normal part of the aging process that affects both men and women,” explained Dr. Katharina Zühlsdorff from the Department of Psychology at the University of Cambridge. “You can imagine being asked a question at a quiz – while you might still arrive at the correct answer, younger people would likely respond much faster. Menopause seems to accelerate this process, but HRT appears to slightly slow it down.”
Grey Matter Loss and Potential Dementia Risk
Brain imaging revealed significant reductions in grey matter volume in post-menopausal women, regardless of HRT use. Grey matter, which contains nerve cell bodies, is vital for information processing, movement control, memory, and emotional regulation.
The most affected brain regions included the hippocampus (responsible for forming and storing memories), the entorhinal cortex (a key gateway for information flow to and from the hippocampus), and the anterior cingulate cortex (involved in emotional management, decision-making, and attention).
What brain regions are most affected by menopause? The hippocampus, entorhinal cortex, and anterior cingulate cortex all showed reductions in grey matter volume.
A Possible Link to Alzheimer’s Disease
“The brain regions where we saw these differences are also commonly affected by Alzheimer’s disease,” noted Professor Barbara Sahakian, the study’s senior author from the Department of Psychiatry. “Menopause could potentially increase vulnerability to dementia later in life. While it’s not the complete picture, it may help explain why women are diagnosed with dementia almost twice as often as men.”
