A research team from Puerto Rico that carried out a literature review to compile findings on how menopause may reshape the brain identified consistent patterns that might help explain the changes in thinking, mood and overall health that often occur during menopause.
Medical News Today reports that during their review of studies published between 2020 and 2025, the team, affiliated with BRAVE Lab at Ponce Health Sciences University, noted patterns in these changes caused by hormones that may help explain many of the common menopause-related symptoms.
They presented their findings last month at the 2025 Annual Meeting of The Menopause Society in Orlando, Florida.
Drop in grey matter
Considering the impact menopause transition can have, the researchers wanted to review existing studies to see what links they could find between menopause and brain structure changes, searching various databases for studies published within the past five years related to menopausal symptoms and brain structure.
They focused on the most recent research and only included peer-reviewed studies in their review.
One pattern they noted was that grey matter volume in the brain decreased. Grey matter is significant in terms of day-to-day functioning, and a decrease is associated with cognitive decline.
While this may sound concerning, the researchers said some studies suggest that grey matter volume may partially recover in post-menopause, indicating that the brain may adapt and reorganise itself over time.
They also noticed a pattern in findings related to menopause and white matter hyperintensities. These show up as bright areas on MRI scans and may reflect stress or damage to the brain’s communication pathways.
These spots can affect everyday thinking, memory, and mood, and may signal an increased vulnerability to certain neurological conditions over time. The hyperintensities were more pronounced in women who went through early menopause and who had frequent vasomotor symptoms (hot flushes, night sweats).
Overall, the findings suggest menopause may lead to measurable changes in brain structure, which may have an impact on memory, thinking, and mood.
Should women be concerned about long-term brain impacts?
Stephanie Faubion, MD, Medical Director of the Menopause Society (based in Florida), cautioned against becoming overly concerned about some of the links found between menopause and grey matter volume loss.
“While we know that menopause is related to some structural brain changes, we don’t have a clear understanding of whether these cause functional changes or cognitive decline,” she said, adding that women who experience forgetfulness or trouble concentrating during menopause should not assume it signals something more serious.
“There is no evidence that symptoms of ‘brain fog’ at this time are associated with later risk of dementia, which is reassuring,” Faubion told MNT.
Rhonda Voskuhl, MD, Professor of Neurology at UCLA and Inventor of CleopatraRX, highlighted the importance of hormone replacement therapy (HRT) during menopause.
“Early treatment with oestrogen for menopause is better than later treatment,” she said. “Women are thought to become less responsive to oestrogen treatment over the years.”
It’s important to note that people who still have a uterus will also need progesterone.
Voskuhl also touched on long-term cognitive concerns for women who experience brain fog during menopause. Not all menopausal women get Alzheimer’s disease, but it does affect women disproportionately.
“Loss of neuroprotective oestrogen during menopause may contribute to susceptibility to getting Alzheimer’s disease 10 to 20 years later,” she said, adding that this would have to be further studied, including treating menopausal women with HRT to determine whether a “cause and effect relationship” exists.
Do different hormone therapies affect memory after menopause?
A study has found that oestradiol, a form of oestrogen, may improve cognition and memory, but the specific effects vary with the mode of administration.
Women using transdermal oestradiol (patches or gels) showed improvements in episodic memory, and those taking oral oestradiol had improved prospective memory.
The study, published in Neurology, suggests that transdermal oestradiol has different memory effects from oral oestradiol, improving recall of past experiences, while oral oestradiol improved participants’ ability to remember to do future tasks.
“This study highlights the discrepancies on hormone therapy influence on cognition, the varying effects on the type of oestrogen used, the association between when a woman goes into menopause impacting cognitive decline supporting early intervention, and how best to counsel patients regarding hormonal therapy and cognition,” said Sherry Ross, MD, OB/GYN and Women’s Health Expert at Providence Saint John’s Health Centre in Santa Monica, California.
Positive memory effects from hormone therapy
The researchers used data from 7 251 post-menopausal women in the Canadian Longitudinal Study on Ageing (CLSA) in their cross-sectional study. At the start, those who had undergone menopause at an average of 50.5 years averaged 60.5 years old.
All participants underwent numerous tests of cognitive function, which assessed:
Episodic memory – the ability to form, store, and recall conscious memories of specific past events;
Prospective memory – the ability to remember to perform a planned action or intention in the future;
Executive function – mental processes needed for planning and problem solving.
For all participants, an earlier age of menopause was associated with reduced performance on all three areas of cognitive function.
In total, 6% of the cohort were using oestradiol (E2) therapy – 4% transdermal and 2% oral – at the time of testing.
Those using transdermal E2, but not oral E2, performed better on episodic verbal memory (word list recall). Those using oral E2 had better prospective memory (eg remembering an appointment, or to take a medication), compared with those who had never used E2.
Neither therapy had any observed effect on executive function.
Anand Singh, consultant gynaecologist at the Cadogan Clinic, London, told MNT why the study found no impact on executive function:
“Executive functioning depends on complex networks in the prefrontal cortex, which may be less sensitive to oestrogen levels in midlife compared with memory-related regions like the hippocampus. In this cohort, most women were cognitively healthy, leaving limited scope for measurable improvement in executive function,” he said.
“Additionally, cognitive benefits may require early or prolonged exposure to menopausal hormone treatment (MHT), and the average duration and timing of therapy in this study may not have been sufficient to produce detectable effects.”
He also suggested that the tests used for memory are often more sensitive to subtle hormonal influences than those assessing executive function, which could explain the lack of observed effects in this domain.
Mode of administration may change memory
Study author Lisa Galea, PhD, of the Centre for Addiction and Mental Health in Toronto, explained why transdermal and oral oestradiol might have different effects on memory.
“When we take drugs or hormones orally, they undergo a chemical breakdown in the liver and this can alter how the drugs/hormone work. In the case of oral oestradiol, it converts to a less potent oestrogen called oestrone. Oestrone is not as effective at interacting with the oestrogen receptor.”
Patches vs pills
“We don’t know why transdermal oestradiol leads to better episodic memory but it could be the number of oestrogen receptors in the medial temporal lobe which is the region important for episodic memory (and oestradiol interacting with them more effectively).”
Need for further studies
Galea said none of the oestradiol therapies was associated with reduced memory.
The authors acknowledged several limitations of the study, including that the women using hormone treatment were predominantly white, and wealthier. The study also focused only on E2s, not any other hormones used for menopause treatment, and did not differentiate between those taking only E2 and those using it with progestogens. Also, because of its cross-sectional design, the study cannot prove any causative effect.
However, Ross emphasised that memory improvements could be a benefit of hormone therapy for menopause:
“Brain fog and cognitive decline are common symptoms in menopause and with ageing. While there are many factors, including lifestyle habits and genetic influences, affecting the decline in cognitive health, hormone therapy may also help to slow cognitive decline in menopause.”
And Singh said: “Transdermal administration may offer the most promising profile for memory support, but further longitudinal studies are needed to clarify long-term cognitive outcomes.”
Menopause Meeting study abstract not available
See more from MedicalBrief archives:
FDA plan to change ‘black box’ warning on HRT sparks concern
Suggested link between HRT and dementia – Danish study
HRT should be given earlier as menopause ‘reshapes the brainʼ – Nature Scientific Reports
HRT not linked to increased risk of dementia — Largest study yet
Hormone therapy associated with improved cognition