WOMEN’S HEALTH

MENOPAUSE, THE BRAIN AND MENTAL HEALTH

New research links menopause to loss of grey matter, poorer mental health and sleep disturbance

New research from the University of Cambridge has added an important layer to our understanding of menopause, suggesting that this life stage is associated with reductions in grey matter volume in key brain regions, alongside increased anxiety, depression and sleep disturbance.

Published in Psychological Medicine1-2, the study analysed data from almost 125,000 women in the UK Biobank. Participants were categorised as pre-menopausal, post-menopausal without hormone replacement therapy (HRT), or post-menopausal with HRT. Around 11,000 women also underwent MRI brain scans, enabling researchers to explore structural brain differences.

WHAT DID THE STUDY FIND?

Post-menopausal women were more likely to report symptoms of anxiety and depression, to have sought support from their GP or a psychiatrist, and to have been prescribed antidepressants. Sleep disruption was also more common, with increased reports of insomnia, shorter sleep duration and persistent tiredness.

From a cognitive perspective, reaction times were slower in postmenopausal women not taking HRT compared with those who were pre-menopausal or using HRT. Interestingly, memory performance did not significantly differ between groups.

On brain imaging, both groups of post-menopausal women – regardless of HRT use – showed reductions in grey matter volume in regions including the hippocampus, entorhinal cortex and anterior cingulate cortex. These areas are involved in memory processing, emotional regulation and attention.

While these regions are also implicated in Alzheimer’s disease, the authors are careful to stress that the study does not claim menopause or HRT alters Alzheimer’s risk. The clinical significance of the grey matter changes remains unclear, and further longitudinal research is needed.

WHERE DOES HRT FIT IN?

HRT did not appear to prevent grey matter reductions. However, it was associated with relatively preserved reaction times, suggesting a modest protective effect on certain aspects of cognitive ageing. Importantly, higher rates of anxiety and depression in the HRT group appeared to pre-date menopause, raising the possibility that some women were prescribed HRT because they were already vulnerable to worsening symptoms.

A WIDER CONVERSATION ABOUT MIDLIFE BRAIN HEALTH

For clinicians working in women’s health, these findings reinforce something many patients already articulate: menopause is not just a reproductive transition, but a neurological and psychological one too.

The authors emphasise the importance of lifestyle measures – physical activity, good nutrition and especially sleep hygiene – in supporting midlife brain health. Just as crucial is validation.

For practitioners, this research offers an opportunity to broaden consultations beyond vasomotor symptoms and bone health, and to proactively address mood, sleep and cognitive concerns as integral components of menopause care.