Sex, gender and dementia risk

Menopause may help explain why more women develop dementia than men.

During and after menopause, levels of the hormones oestrogen and progesterone fall. This might increase dementia risk.

Oestrogen plays an important role in brain health, including memory and learning. Although it’s often described as a “female hormone”, oestrogen is also present in men’s brains. In men it is made from testosterone throughout life. After menopause, women have lower levels of oestrogen in the brain than men of the same age.

Oestrogen helps brain cells communicate with each other. When oestrogen levels fall, these signals may become less efficient. This may affect memory and thinking over time.

Some research suggests that women who experience menopause before age 45 have a higher risk of dementia later in life. This may be because they spend longer without the protective effects of oestrogen on the brain.

Forgetfulness and “brain fog” are common during menopause. For most people, these symptoms are not dementia and do not get worse over time.

If memory or thinking problems affect everyday life, speak to a GP.

The NHS website has tips to help people manage menopause symptoms.

HRT is often prescribed during menopause to replace falling levels of oestrogen and progesterone. It can help with symptoms such as hot flushes, sleep problems, low mood and “brain fog”.

Research into HRT and dementia risk has produced mixed results. Some large studies, particularly in older women, have found a small increase in dementia risk with certain types of HRT. Other studies have not found the same effect. Overall, there is no clear evidence that HRT causes or prevents dementia.

HRT is not recommended to reduce dementia risk. Anyone considering HRT should speak to a qualified health professional about the potential benefits and risks, based on their personal circumstances.

The relationship between sex, menopause and dementia risk is complex, and remains an active area of research.

Although women are more likely to develop dementia overall, men are diagnosed with young onset dementia more often than women. Young onset dementia is when symptoms start before the age of 65. The reasons for this are not fully understood.

Researchers think the difference may be partly related to risk factors that are more common earlier in life, such as traumatic brain injury or some cardiovascular conditions. Differences in how symptoms are recognised and diagnosed may also play a role.

More research is needed to understand why young onset dementia may affect men and women differently.

There is currently very little evidence about dementia risk in transgender and non‑binary people. This is because dementia research has historically included limited data on gender identity.

As a result, it is not yet possible to say whether or how gender identity affects dementia risk. More inclusive and representative research is needed to better understand dementia risk across all communities.

People in the LGBT community with dementia might face additional challenges when it comes to seeking a diagnosis and support. Visit Dementia UK’s website for helpful information and advice.