Menopause linked to changes in the brain’s gray matter, new study finds

Brain changes during menopause could help explain why some people experience neurological symptoms such as anxiety, depression and memory problems

By Jackie Flynn Mogensen edited by Claire Cameron

Everyone who menstruates and lives long enough experiences menopause in one form or another. Despite this, research into what happens during this natural cessation of menstruation and why is limited. Scientists know that menopause can cause a myriad of neurological symptoms, from hot flashes to poor sleep to depression. But what happens in people’s brains during this period is still unclear. NOW new search offers clues to a link between menopause and changes in the brain’s gray matter, as well as anxiety and depression.

Using brain scans of 10,873 people in the UK, researchers found that postmenopausal participants had lower volumes of gray matter in the entorhinal cortex and hippocampus, involved in storing and retrieving memories, and in the anterior cingulate, involved in emotional regulation.

Researchers also examined whether hormone replacement therapy (HRT), a first line but still rarely prescribed Treating menopausal symptoms may alleviate some of these changes.

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Barbara Sahakian, professor of psychiatry at the University of Cambridge and author of the study, says she and her colleagues theorized that HRT might influence people’s experiences, easing their neurological symptoms, for example. “That was the hypothesis,” she says, “but it doesn’t seem to come true completely that way.”

They found that people treated with HRT for menopause had lower gray matter volumes in certain areas of the brain than those who did not receive HRT. The HRT group also showed higher rates of anxiety and depression. More importantly, Sahakian says their work does not reveal that HRT treatment causes brain changes or menopausal symptoms. Previous research suggests that HRT prescribed during the period before menopause and early postmenopause may reduce anxiety, depending on the type of HRT and dose, in at least some women. And a subsequent analysis found that participants who were prescribed HRT were more likely to have reported anxiety and depression before HRT treatment, the study explains.

It’s not clear what type of hormone therapy the participants received, says Roberta Brinton, director of the Center for Innovation in Brain Science at the University of Arizona, who was not involved in the study. “The type and regimen of menopausal hormone therapy is a critical factor in the effectiveness, or lack thereof, of neurological disorders. [and] functions related to the brain,” she says.

Sahakian and his colleagues did not have access to participants’ treatment regimens or the dose of HRT they took, which could also confound the results. “These are good questions,” she admits. “They are important. But I think the fundamental conclusions still hold, regardless of that.”

One potential benefit of HRT that emerged from the data was its beneficial effect on psychomotor slowing, or the tendency for reaction times to slow with age. Without HRT, postmenopausal women had slower reaction times in a card-matching speed game than those who were premenopausal. But study participants who were treated with HRT had similar reaction times to participants who were not postmenopausal.

“This indicates that HRT may have a protective effect against psychomotor slowing after menopause,” says Sahakian.

She hopes the findings will serve as a basis for future studies on the brain and aging, including the potential role of menopause in Alzheimer’s syndrome and dementia. Women are more likely than men to develop Alzheimer’s disease, although it is I don’t really understand why. The tendency for women to live longer could play a role, but a growing number of researchers, including Sahakian, are wondering whether menopause could also play a role. Indeed, the brain areas singled out in this study are also often among those affected by Alzheimer’s disease.

A next step would be to take a deeper look at what’s happening in the brains of study participants to try to understand what exactly is causing the decrease in brain volume, whether it’s stress, hormones, or something else.

In the meantime, Sahakian recommends that postmenopausal people focus on behaviors known to improve brain health: exercising, sleeping well, keeping an active mind, eating healthily, and maintaining a positive social network.

“If women tried to do these things, especially during menopause, then they would be in the best possible shape to cope well,” she says.