A review presented at The Menopause Society 2025 highlights the links between menopause-related brain changes and cognitive function.
Menopause is linked to measurable structural brain changes, including gray matter loss and increased white matter hyperintensities.
These changes may contribute to cognitive, emotional, and behavioral symptoms commonly reported during the menopausal transition.
Further research is needed to understand the mechanisms underlying these neural alterations and to identify effective therapeutic strategies.
A literature review presented at The Menopause Society’s 2025 Annual Meeting examined the scientific evidence linking menopause-related brain structural changes to cognitive, emotional, and physiological outcomes. The analysis, titled “Menopause and Brain Structural Changes: A Bibliographical Revision,” was conducted by researchers from Ponce Health Sciences University in Puerto Rico.1,2
The review aimed to synthesize findings from recent peer-reviewed studies published between 2020 and 2025 that investigated how menopause influences brain structure. Researchers focused on identifying consistent neuroanatomical changes that may underlie menopausal symptoms such as cognitive decline, mood changes, and vasomotor symptoms.
Investigators performed a qualitative, descriptive bibliographic review using databases including PubMed, Google Scholar, and EBSCOhost. Search terms incorporated “menopause,” “brain structure,” and “menopausal symptoms.” Inclusion criteria required studies to involve human subjects, focus on neuroanatomical changes, and be published in English between 2020 and 2025. Only quantitative research on adult menopausal populations was included, and duplicate entries were excluded.
Across multiple studies, menopause was associated with measurable structural alterations in the brain. Reductions in gray matter volume were consistently observed in the frontal and temporal cortices, as well as in the hippocampus—regions crucial for memory, attention, and executive function. These volumetric changes were correlated with declines in verbal and visuospatial memory performance.
Increased white matter hyperintensities, particularly among women with early menopause or frequent vasomotor symptoms, were also noted. “White matter hyperintensities are bright spots seen on an MRI scan of the brain’s white matter, often indicating damaged tissue, typically due to reduced blood flow,” according to the press release. The presence of these lesions has been associated with cognitive decline, balance difficulties, and mood changes, as well as an elevated risk of stroke and dementia.
Some evidence from recent imaging studies indicated that partial recovery of gray matter volume may occur postmenopause, potentially reflecting compensatory neuroplasticity. Additionally, higher estrogen receptor density during the menopausal transition may represent an adaptive response to hormonal changes, though it has also been linked to poorer memory outcomes. Alterations in cerebrovascular reactivity and brain energy metabolism further underscore menopause’s multifaceted effects on neural integrity.
Rodríguez, the study’s first author, emphasized the importance of continued research to better understand these mechanisms. “This type of work highlights the need to continue exploring the relationship between the brain and menopause, particularly their connection with the cognitive, emotional, and behavioral symptoms women experience during this stage,” said Rodríguez.
Commenting on the presentation, Stephanie Faubion, MD, MBA, medical director for The Menopause Society, noted that the findings contribute to an expanding body of knowledge on the neurological implications of menopause. “This study represents the cumulative body of scientific knowledge relative to structural changes that take place in the brain during menopause,” said Faubion. “These data will hopefully lead to a better understanding of the factors underlying some of the cognitive concerns experienced by women during the menopause transition so that we can ultimately identify effective therapies.”
The authors concluded that menopause is associated with gray matter loss in key brain regions, increased white matter hyperintensities, and changes in cerebrovascular function and metabolism. Although some recovery of gray matter volume may occur, lasting alterations in connectivity and energy utilization suggest persistent effects on brain health.
These findings underscore the need for further longitudinal and mechanistic studies to clarify the extent to which structural brain changes contribute to cognitive and emotional symptoms in menopausal women. Continued research may inform clinical strategies for managing cognitive complaints during and after the menopausal transition.
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