New research from the University of Cambridge has revealed a link between menopause and changes in brain structure, as well as increased levels of anxiety, depression, and sleep disturbances. Women who had gone through menopause were found to have reduced gray matter volume in several key areas of the brain.

The Impact of Menopause and Hormone Replacement Therapy

The study also examined the effects of hormone replacement therapy (HRT). While HRT did not prevent changes in the brain or mental health, it was associated with a slower decline in reaction speed.

Menopause is a stage in a woman's life when menstruation permanently stops due to a decrease in hormone levels. It typically occurs between the ages of 45 and 55 and is often accompanied by symptoms such as hot flashes, mood swings, and sleep problems. Previous studies have also linked menopause to changes in cognitive functions, including memory, attention, and speech. To ease symptoms—especially depression and sleep disorders—many women are prescribed HRT. In England, 15% of women received this therapy in 2023. Despite its widespread use, the effects of menopause and HRT on the brain and mental health remain insufficiently studied.

Study Design

To gain a deeper understanding of these effects, researchers analyzed UK Biobank data from nearly 125,000 women. Participants were divided into three groups: women who had not yet reached menopause; postmenopausal women who had never used HRT; and postmenopausal women who had used HRT.

All participants completed questionnaires about menopausal symptoms, mental health, sleep patterns, and overall health. Some underwent cognitive tests for memory and reaction speed, and about 11,000 women had MRI brain scans. The average age of menopause among participants was about 49.5 years, and women who were prescribed HRT began treatment at around 49 years old.

Main Findings

Postmenopausal women were more likely to seek help from therapists or psychiatrists for anxiety, nervousness, and depression than those who had not yet reached menopause. They also scored higher on depression questionnaires and were more likely to be prescribed antidepressants.

Among women using HRT, levels of anxiety and depression were higher compared to those who did not use HRT. However, further analysis showed that these differences existed even before menopause began, suggesting that doctors may have prescribed HRT to women who already had pronounced symptoms, anticipating they might worsen after menopause.

Sleep problems were also more common after menopause: women reported insomnia, shorter sleep duration, and persistent fatigue. Women using HRT felt the most fatigued among all groups, although their sleep duration did not differ from others.

Cognitive Functions and Brain Structure

Menopause was found to be associated with changes in cognitive functions. Postmenopausal women who did not use HRT showed slower reaction speeds compared to women who had not reached menopause and those who used HRT. Memory performance did not differ significantly between the groups.

MRI scans revealed a significant reduction in gray matter volume in postmenopausal women, regardless of HRT use. Gray matter contains the bodies of nerve cells and plays a key role in information processing, movement control, memory support, and emotional regulation. The most affected areas included the hippocampus (responsible for forming and storing memories), the entorhinal cortex (connecting the hippocampus with the rest of the brain), and the anterior cingulate cortex (involved in emotion regulation, decision-making, and attention).

Expert Opinions

Dr. Christelle Langley from the Department of Psychiatry noted that most women go through menopause, and it can be a pivotal moment in life, regardless of HRT use. She emphasized the importance of a healthy lifestyle—physical activity, movement, and proper nutrition—to help mitigate the effects of menopause. She also stressed the need to pay attention not only to physical but also to mental health during this period and not to hesitate to seek help.

Dr. Katharina Zuelzdorf from the Department of Psychology at the University of Cambridge added that reaction speed typically declines with age in everyone, but menopause appears to accelerate this process, while HRT may slightly slow down aging.

Professor Barbara Sahakian, senior author of the study, pointed out that the brain areas where differences were found are usually affected in Alzheimer's disease. Menopause may make women more vulnerable in the future, which could help explain why dementia cases among women are nearly twice as high as among men.