September 30, 2026, 11:46 am | Read time: 7 minutes
Menopause not only affects the female body but can also be associated with changes in memory, concentration, and mood. Previous studies have already examined how menopause influences mental health and cognitive performance. A new study now looked more closely at whether the age at which women reach menopause is related to later brain health.
Why Menopause Also Affects the Brain and Psyche
Menopause marks the end of natural menstrual cycles. From this point on, the production of female sex hormones decreases significantly, especially estrogen. This hormone is involved in numerous important processes in the body: It plays a central role in fertility, helps maintain bone density, and also affects blood vessels and metabolism, including influencing fat metabolism and supporting blood vessel function.
Also interesting: How women can prepare for menopause
In addition to physical effects, estrogen is also significantly involved in processes affecting the nervous system. These include communication between nerve cells, the formation and maintenance of their connections, and the function of mitochondria, which are considered the cell’s energy suppliers. It is evident that the hormonal transition during menopause also affects the brain and psyche.
Previous studies, also reported by FITBOOK, have already shown a connection between the timing of menopause and an increased risk of cognitive decline and Alzheimer’s.1 However, it remained unclear whether and how these connections could be recognized in measurable changes in brain structure decades later. This is where the present study comes in.2
Study on the Role of Menopause Timing on the Brain
The researchers first wanted to determine whether the age at menopause is related to how cognitive performance develops later in life, when an Alzheimer’s diagnosis is made, and how much the brain loses volume over the long term.
They were also interested in whether the way menopause occurs makes a difference. In natural menopause, the hormone production of the ovaries gradually decreases. However, if both ovaries are surgically removed, the production of estrogen and other ovarian hormones drops abruptly, immediately triggering menopause. The researchers therefore examined whether the later connections with brain health differ between natural and surgically induced menopause.
Details of the Study
The study was a long-term observational study. The researchers analyzed data from two U.S. research projects, the Religious Orders Study and the Rush Memory and Aging Project.3,4 Both have been studying the mental and physical health of older people for many years.
The main analysis included data from 2,603 women with an average age of 78.3 years at the start of the study. The follow-up period was up to 18 years (median around seven years). The participants underwent regular medical examinations and completed standardized memory and cognitive tests. Brain tissue examinations from after death were also available for some participants.
Information on Data Collection
For imaging analyses, 774 women with repeated MRI scans were available. Magnetic resonance imaging (MRI) can detect changes in brain structure without surgical intervention. The researchers recorded the total brain volume and the amount of so-called white matter hyperintensities. These are bright areas in certain MRI scans often associated with changes in small blood vessels and damage to the white matter of the brain.
The age at menopause was determined based on the women’s self-reported last menstrual cycle. Additionally, the researchers calculated their reproductive lifespan, the years between the first menstrual period and menopause. The analysis considered factors such as age, education, body weight, smoking, genetic risk factors, and the use of menopausal hormone therapy. Statistical methods helped the researchers account for differences between participants and potential biases due to the selection of the MRI group.
Results: Early Menopause, More Changes in the Brain
The analysis showed various connections between the age at menopause and later brain health.
Cognitive Performance and Memory
Women who experienced menopause earlier showed a faster decline in overall cognitive performance during the observation period. Episodic memory also declined more rapidly. This is important for the ability to recall personal experiences and recent events.
In other cognitive areas, such as semantic memory (which stores general and factual knowledge) and working memory, there were also connections in the same direction. However, after statistical correction for multiple comparisons, these were no longer clear. Additionally, the researchers found no connection between menopause age and processing speed or spatial abilities.
Timing of an Alzheimer’s Diagnosis
In the overall data analysis, earlier menopause was associated with an earlier onset of an Alzheimer’s diagnosis. The statistical model showed a time ratio of 0.998 per year of earlier menopause age. Simply put, this means that for each year menopause occurred earlier, the timing of the Alzheimer’s diagnosis was statistically slightly earlier. Important: This value describes a statistical connection–it does not indicate how likely it is for an individual woman to develop Alzheimer’s.
When analyzed separately by menopause type, a different picture emerged. For women with natural menopause, no statistically significant connection between the timing of the Alzheimer’s diagnosis and the timing of menopause could be established. Women with surgical menopause showed a similar trend, but after correction for multiple comparisons, it was no longer clear.
Altered Brain Structure
In women with earlier menopause, the total brain volume decreased slightly faster. However, the connection was very small–even below the threshold usually considered a small effect. The researchers therefore caution against overinterpreting this finding.
The connection was much more pronounced with the so-called white matter hyperintensities. These involve changes in the white matter of the brain. In women with natural menopause, an earlier onset of menopause was associated with a significantly faster increase in these changes.
The connection increased with age. Based on a projection from the observed annual differences, the study authors estimate that women whose menopause occurred five years earlier could have about 15 percent more of these white matter changes over a ten-year period than women with later menopause. This connection was not observed in women with surgical menopause.
Similar results were found for a shorter reproductive lifespan: Women who menstruated for fewer years overall in their lifetime also showed more of these vascular changes in old age.
In women whose brains were examined postmortem, the researchers found no statistically significant connection between the age at menopause and the overall burden of Alzheimer’s-type changes in brain tissue.
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Possible Significance of the Results
The data analysis suggests that the age at menopause could be related to the long-term development of brain health. Notably, these connections were not only evident in memory and performance tests but also in MRI scans of the brain–sometimes decades after menopause.
Particularly interesting is the finding regarding changes in the white matter of the brain. This consists mainly of nerve fibers that connect different areas of the brain. An increase in these changes could indicate greater stress on the white matter. However, the study does not show that these changes necessarily led to dementia in the participants.
The results currently provide valuable starting points for further research. Based on the observations, it is conceivable that the age at menopause could help identify women at a potentially higher risk for certain brain changes earlier. Whether such changes can be influenced by targeted measures or hormone therapy remains open.
Limitations
One of the main limitations of the study is its nature as an observational study. Although various influencing factors were considered, other unrecorded factors could have influenced the results. An earlier onset of menopause could, for example, also be an indication of other aging processes and may not itself cause later brain changes.
Additionally, the age at menopause could not be determined with certainty. The data used were based on the participants’ recollections. Systematic information on other factors of reproductive history, such as pregnancies, hormonal contraception, or breastfeeding, was also lacking. In the case of surgical menopause, it was not always possible to clearly distinguish what type of procedure was performed.
Another limitation concerns the MRI evaluations. The women who participated were, on average, healthier and more cognitively capable than the overall group. As a result, women who were more affected may have been underrepresented in these analyses.
Finally, some results were only evident in certain subgroups. The differences between natural and surgical menopause therefore need to be confirmed by further studies.