Researchers highlight overlap between menopause and TBI symptoms, calling for hormone-informed tools in brain injury assessment.
Despite increasing recognition of sex differences in traumatic brain injury (TBI) outcomes, the interaction between menopause and brain injury remains largely unexplored. New research presented at The Menopause Society’s 2025 Annual Meeting in Orlando emphasizes the need to consider hormonal transitions when diagnosing and treating TBIs in women.1,2
The study, Toward Hormone-Informed Brain Injury Care: Unifying Assessment for Menopause and TBI in Women, was led by Katherine E. Buzzanca-Fried, PhD, of the University of Florida College of Public Health and Health Professions. The research team sought to examine how the menopause transition, a period characterized by significant neuroendocrine changes, may influence post-concussive symptom expression, recovery, and chronicity among women.
“Emerging evidence suggests that hormonal changes can significantly influence both physiological and cognitive functioning after traumatic brain injury, even in milder injuries such as concussion,” said Buzzanca-Fried. “It’s essential that health care providers consider hormonal factors, particularly during the menopause transition, so we can better understand recovery trajectories, design targeted interventions, and communicate more inclusively with patients.”
Currently, standard TBI assessment tools, such as the Sports Concussion Assessment Tool (SCAT-5), General Symptom Checklist (GSC-30), and Rivermead Post-Concussion Questionnaire (RPQ), do not account for hormonal status. According to the investigators, this omission may delay recovery, increase symptom burden, or obscure accurate symptom attribution in women.
To address this gap, the research team conducted a qualitative review and comparative analysis of validated assessment instruments used in both TBI and menopause. These included the Menopause Rating Scale (MRS) and the Menopause-specific Quality of Life (MenQOL) questionnaire. The researchers extracted 108 symptom items across tools and mapped them into symptom domains to identify overlap and divergence between menopause- and TBI-related symptoms.
The review identified substantial overlap in symptoms associated with menopause and TBI, particularly in neurocognitive, somatosensory, and mood/affective domains. The team organized symptoms into six higher-order categories:
This structure highlights the physiological and psychological convergence between menopause and TBI symptoms. The findings also revealed opportunities to expand current concussion tools to incorporate neuroendocrine and vasomotor symptoms, which could improve identification of hormone-related risks in brain injury recovery.
“Standard TBI assessment tools do not account for hormone status,” the authors wrote. “This lack of consideration could potentially delay recovery or increase symptom burden in women, as well as lead to missed opportunities for accurate diagnoses, risk stratification, and individualized treatment.”
The investigators emphasized that recognizing hormone-driven effects could lead to better-tailored interventions and improved outcomes for women with TBI. Integrating gynecologic and neuroendocrine factors into standard concussion care could bridge a long-standing gap in sex-specific rehabilitation and research.
“Studies like this remind us that sex as a biological variable matters and that hormone status and reproductive stage should be studied to determine whether treatment strategies may differ for men vs women,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society. “Traumatic brain injury treatment in midlife women may be complicated by coexisting and potentially overlapping symptoms related to menopause.”
Future research will include factor analysis to validate the proposed symptom domains and to develop a unified, hormone-informed questionnaire for clinical use. The goal, the investigators noted, is to ensure that hormone transitions are recognized as critical elements of individualized TBI management in women.
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