Menopause and Dementia Risk: What We Know So Far

 

Menopause is a major life transition that affects each woman differently, yet its impact on long‑term brain health is still not fully understood.

Women make up nearly two‑thirds of people living with dementia – yet we still don’t fully understand why they are more affected by the condition – even when we take longer life expectancy into account.

It’s important that we seek to understand this difference. Several factors may play a role and researchers are working to uncover how hormonal changes during menopause may influence memory, thinking and future dementia risk.

New studies are beginning to shed light on this complex relationship, but it is a multifaceted area and there are still gaps in our knowledge, highlighting why investment in women’s brain‑health research is urgently needed.

We take a closer look at what we know so far and what research is happening in this space.

Hormonal changes and dementia risk

Menopause is shaped by a series of biological changes. During and after this transition the levels of hormones oestrogen and progesterone fall, which may lead to changes in the brain that affect memory and thinking. Understanding why this happens, could help identify new approaches to support the brain during this stage in life.

Researchers have explored the link between menopause and dementia by studying women later in life; looking at Alzheimer’s related proteins in their brains and comparing this with menopause symptoms, the age symptoms began, and any treatments used. Some studies suggest that going through menopause earlier may be linked to higher levels in the brain of the protein tau. Tau is known to play an important role in Alzheimer’s disease.

Another exciting new development to this work is a shift towards measuring hormonal changes in women as they happen during the menopause while also tracking signs of brain changes. This has the potential to increase our understanding who might be at higher risk of developing Alzheimer’s in the future.

 

New findings from recent research

A recent large-scale study using health information from the UK Biobank suggests that women going through menopause experience higher levels of anxiety, depression and sleep difficulties. To look at what might be causing these changes to mental health, the researchers studied brain scans and found a reduction in parts of the brain essential for learning and memory. Use of hormone replacement therapy (HRT) did not appear to reduce these effects.

Although this study cannot tell us exactly how these brain changes unfold over time, it does offer researchers important clues about the underlying biology driving these changes. It also underlines why we need more research to understand how menopause and HRT might shape long-term brain health.

Does Hormone Replacement Therapy play a role?

Over the years, there have been mixed reports about the effect HRT may have on dementia risk. In fact, some studies have found a small increased risk in those who have taken HRT, while other studies have found the opposite, suggesting HRT could protect against dementia.

More recently a major review of 10 studies involving over one million women found no evidence that hormone replacement therapy increases or reduces the risk of dementia or mild cognitive impairment. The conclusion was the same no matter the type, timing or duration of treatment.

Looking at a wide range of studies is necessary to increase our understanding and helps alleviate concerns that women might have. Trials like this can often take years, before scientists can report whether a potential therapy has an impact on person’s memory and thinking skills.

The findings reinforce that HRT should be recommended for managing menopausal symptoms, and not as a way to prevent dementia.

If you’re worried about changes in your memory or thinking, it’s important to speak to your doctor first. You can also talk to a qualified healthcare professional if you’d like to understand more about the benefits and risks of using HRT to manage menopause symptoms.

Addressing gaps in the data

Despite this progress, there are still significant gaps in what we know. Longer studies in more diverse groups of women are needed to fully understand the impact on women’s brain health.

Including questions about menopause symptoms in health studies, supported by data from tracking apps and wearable devices, can help build a more complete picture of what is happening to the body during this transition

Changes in the brain can happen years before dementia symptoms developed, therefore longer studies are needed to see how menopause may impact memory and thinking in later years.

Without this information, researchers are limited in the conclusions they can draw and cannot inform future prevention strategies.

Research investment is accelerating progress

We are proud to support research which has led to new discoveries around sex specific risk factors and menopause.  One recent study suggests that women with Alzheimer’s disease had lower levels of protective unsaturated fats, including omega‑3 fatty acids in their blood compared with healthy women, suggesting these nutrients could play an important role in supporting brain health.

Insight 46, a long-running UK study, part-funded by Alzheimer’s Research UK, found that women who go through menopause later tend to perform better on memory and thinking tests, suggesting that the timing of hormonal changes across life may play an important role in supporting brain health.

Since 2024 we have been part of the MESSAGE project which brings together research funders and partners across the UK to develop a national sex‑ and gender‑inclusive research framework. This will help ensure that researchers consider sex and gender from the very first stages of study design, paving the way for better, more representative science.

Meanwhile, a powerful new investment into women’s brain health is the Wellcome Leap CARE programme led by neuroscientist Dr Lisa Mosconi. This 50 million (US dollar) initiative aims to cut women’s lifetime risk of developing disease by half. By exploring how hormonal changes interact with brain health and dementia risk, the programme hopes to pave the way for new treatments and interventions during this pivotal stage of life.

Conclusion

While there is still much to learn, momentum is building. With new investment, better data and more inclusive research, scientists are finally beginning to answer long‑standing questions about women’s brain health. We hope this brings us closer to answers that could transform women’s brain health for generations to come.

It’s important to remember that this research will not move forward without the people who volunteer to take part in studies. Now, more than ever, we need more people to get involved so that can create a world free from the fear, harm and heartbreak of dementia. Read more about how you can take part here.