More Menopause Symptoms May Be Worse for Brain Health

Hot flashes, insomnia, and mood swings are an uncomfortable part of menopause for many people. But having more menopause symptoms could also mean worse brain health, new research suggests.

According to a study published last month in PLOS One, people who deal with more menopause symptoms may be more likely to have worse cognitive function and mild behavioral impairments later in life—both of which are markers of dementia.

The findings could suggest that the loss of one type of estrogen hormone during menopause may play a role in the development of Alzheimer’s disease and other dementias.

However, the exact relationship between menopause, hormones, and women’s brain health still isn’t well understood.

The study found that treating the loss of estrogen with hormone therapy reduced women’s dementia-related behavioral impairments. However, hormone therapy didn’t significantly help with cognitive symptoms.

“We can’t say for certain that the menopause transition—and the corresponding changes in hormone levels that women experience—explains why women are at higher risk for Alzheimer’s disease,” Matthew Panizzon, PhD, associate professor of psychiatry at the University of California, San Diego, told Health. “But this is an area of active study.”

Here’s what experts had to say about the new research, why menopause symptoms and dementia may be linked, and how women can keep their brains healthy as they age.

For this study, researchers analyzed data from 896 postmenopausal women living in Canada. The participants were about 64 years old on average, and they were about 49 years old on average when they started menopause.

Using a questionnaire, researchers had participants report their perimenopause symptoms. These included irregular periods, hot flashes, chills, vaginal dryness, weight gain, slowed metabolism, night sweats, sleep problems, mood symptoms, inattention or forgetfulness, and other unnamed symptoms.

Almost 75% of participants reported having at least one of these symptoms, and the average was 3.7 symptoms.

Researchers then had women answer questions about any persistent cognitive and behavioral changes they’d noticed. Memory, language, or organizational issues would fall under the cognitive umbrella, while behavioral issues could include decreased motivation, lack of impulse control, or social inappropriateness.

The data showed that women who reported more menopause symptoms also had greater cognitive and behavioral impairment in mid- to late-life.

“Each additional menopausal symptom was linked to poorer cognitive function and greater severity of mild behavioral impairment symptoms,” said study author Zahinoor Ismail, MD, professor of psychiatry, neurology, epidemiology, and pathology at the Hotchkiss Brain Institute and O’Brien Institute for Public Health at the University of Calgary.

But the study is just a jumping-off point—there are some limitations. For one, it just captures a snapshot in time, so it can only identify associations between menopause symptoms and cognitive and behavioral health. It can’t determine whether a higher menopause burden actually causes brain changes, Ismail told Health.

Further research could investigate that question, as well as whether the intensity or duration of symptoms had any effect (rather than just the number of symptoms), he explained.

“Severity may play a key role in understanding risk, so future studies should explore both symptom count and intensity,” he said.

The link between menopause and dementia risk is still not well understood, according to Panizzon.

“Reproductive hormones like estrogen are believed to be neuroprotective. So when estrogen drops after menopause, it is thought that dementia risk increases,” he explained. “But the data is not conclusive.”

Ismail and his colleagues’ latest study similarly suggests that estrogen levels in the body could be linked to the development of dementia.

“Individuals who used estrogen-based hormone therapy—compared to progesterone or unnamed-based hormone therapy, or no hormone therapy—had lower mild behavioral impairment scores by approximately 26.9%,” Ismail explained.

Participants who used estrogen-based hormone therapy also reported fewer cognitive issues, though not to the extent that it was statistically significant.

Given these findings, it may be tempting to draw the conclusion that hormone therapy can lower dementia risk. However, Panizzon said, “We need more work in this area before we can safely say that treating the symptoms of menopause will protect women’s [brain] health.”

Importantly, multiple factors influence Alzheimer’s disease and other dementias, added G. Peter Gliebus, MD, director of cognitive and behavioral neurology at the Baptist Health Marcus Neuroscience Institute.

“Not all women experience significant cognitive symptoms during menopause, suggesting that hormonal changes alone may not be the primary driver of cognitive decline,” he told Health.

Even the relationship between menopause and dementia itself likely comes down to more than just estrogen levels.

“If [menopause] symptoms are not well managed, they may contribute to long-term effects on thinking, behavior, and overall well-being,” Ismail said. “It’s likely that both direct hormonal effects and broader health changes play a role in the connection between menopause and dementia risk.”

For now, more research needs to be done “to confirm whether hormone therapy meaningfully mitigates long-term dementia risk,” Ismail said.

That doesn’t mean hormone therapy isn’t useful for women going through menopause—rather, “the decision to use hormone therapy should be made based on an individual’s symptoms, health history, and in consultation with a healthcare provider,” Ismail said, not as a stand-alone preventative strategy for cognitive health.

But while scientists are continuing to learn more about the relationship between menopause and dementia, there are a few things middle-aged and older women can do right now to help protect their brain health.

It’s important that women with moderate to severe menopause symptoms proactively manage symptoms and their brain health, Jelena Pavlovic, MD, PhD, assistant professor of neurology at the Albert Einstein College of Medicine, told Health.

This includes prioritizing sleep, managing stress, optimizing metabolic health, and engaging in brain-protective activities, starting in mid-life, she said.

It’s also essential to maintain a heart-healthy lifestyle, as there is a strong connection between cardiovascular health and brain function, Gliebus added.

“Engaging in regular exercise, especially aerobic types, enhances blood circulation to the brain and bolsters cognitive resilience,” he explained. “Following a nutrient-dense diet—like the Mediterranean or MIND diet, which incorporates healthy fats, lean proteins, and antioxidants—can help minimize inflammation and promote brain function.”

But brain health aside, if menopause symptoms are causing issues, it’s best to talk to your healthcare provider, Ismail recommended.

“While menopause is a natural transition, its symptoms can last for years and significantly impact well-being,” he said. “Managing symptoms—whether through hormone therapy, if appropriate, or non-hormonal strategies—may improve overall health and quality of life.”