Brain changes during menopause may affect mental health, finds new study

Cambridge researchers report reduced grey matter and increased anxiety in post-menopausal women, highlighting the need for better mental health support

Menopause is often discussed in terms of hot flashes and mood swings. However, a growing body of evidence shows that it may also affect the brain in ways many women do not expect.  A major new study suggests that when a woman’s hormone levels fall during menopause, this can be accompanied by structural brain changes and an increased likelihood of anxiety and sleep difficulties. These findings expand understanding of menopause beyond physical symptoms and place mental health in the spotlight.

 

What the Cambridge researchers examined

 

The research, conducted by scientists at the University of Cambridge, was published in the peer-reviewed journal Psychological Medicine under the title “Emotional and cognitive effects of menopause and hormone replacement therapy.”

 

By analysing data from nearly 125,000 women in the UK Biobank, the study compared groups who were premenopausal, post-menopausal with no hormone therapy, and post-menopausal with hormone replacement therapy (HRT). Roughly 11,000 women also underwent magnetic resonance imaging (MRI) scans, allowing researchers to examine brain structure directly.

 

Key findings of the menopause study

 

• Grey matter reduction: Post-menopausal women showed significant declines in grey matter volume in several brain regions, including areas important for memory, decision-making and emotional regulation
• Regions affected: The most notable changes were found in the hippocampus (area linked to memory), the entorhinal cortex (information gateway to memory systems), and the anterior cingulate cortex (important for managing emotions and attention)
• No complete reversal with HRT: While hormone replacement therapy was associated with slightly better reaction times in some cases, it did not fully prevent the observed brain changes in grey matter

 

“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 not the whole story, it may help explain why we see almost twice as many cases of dementia in women than in men,” added Professor Barbara Sahakian, the study’s senior author from the Department of Psychiatry, at the University of Cambridge.

 

Mental health and sleep during menopause

 

The study did not stop at brain scans. It also collected self-reported data on mental health and sleep quality:

 

• Women who were post-menopausal reported higher levels of anxiety and depression than those yet to reach menopause
• Difficulties with sleep and persistent tiredness were commonly reported after menopause
• Many women also sought help from healthcare professionals for anxiety or mood symptoms following the transition

 

These outcomes persisted regardless of whether women used hormone replacement therapy, suggesting that the emotional and sleep-related effects of menopause can stand on their own.

 

What the findings mean for women’s health

 

Understanding these findings matters because many women feel unprepared for the psychological shifts that can accompany menopause. The research makes it clear that this life stage is not only physical but neurological as well. While hormone replacement therapy has long been used to ease physical symptoms, the study suggests that it does not fully prevent structural brain changes and may have limited impact on mental health outcomes.

 

Speaking about the findings, Dr Christelle Langley from the Department of Psychiatry said, “We all need to be more sensitive to not only the physical, but also the mental health of women during menopause, however, and recognise when they are struggling. There should be no embarrassment in letting others know what you’re going through and asking for help.”

 

Experts say that by encouraging open conversations and timely professional guidance, healthcare providers and families can help women navigate this transition with greater confidence and support.     

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This report is for informational purposes only and is not a substitute for professional medical advice.