Beyond Brain Fog - The Overlooked Link in Women's Brain Health
- Lucy Browning
- Jul 3
- 7 min read
This article has been written to advertise the Women in Neuroscience UK virtual event Menopause and the Brain on Monday 6th July 6-7pm. Sign up here!
If I asked you to play word association with the word 'menopause', what would come to mind?
For me, I think of middle age, a natural process, hot flushes and changes in hormones. I think of symptoms that span physical and emotional, all centred around a major point of transition in life. I imagine that this is what many people would think of too, especially those who have not experienced menopause themselves.
If I then turned the tables and asked what came to mind when I said 'dementia', I think most people would immediately associate it with older age. This would be understandable and accurately reflects age as one of the strongest established risk factors for dementia. However, menopause is not usually something that people would connect with dementia; rather, it is often understood as a normal stage in the reproductive journey. Yet, an emerging area of research suggests that this transition may be more complex than first thought. Recent studies are beginning to explore whether the timing of menopause, and the associated hormonal changes, could be linked to later dementia risk.
So, what exactly is menopause?
To understand this connection, it is first important to accurately characterise menopause.
Menopause marks the permanent cessation of menstruation and the end of natural fertility. Although it is most commonly associated with midlife, some people experience menopause much earlier due to a variety of factors; these may include surgery, medical treatment or genetics. For this article, ‘menopause’ refers to the typical menopausal transition, between 45 and 55, unless otherwise stated. The lead-up to menopause is known as the menopausal transition or perimenopause; menopause itself is diagnosed after 12 consecutive months without a period or spotting. During this change, levels of oestrogen and progesterone (two hormones produced by the ovaries and involved in the menstrual cycle) begin to fluctuate and eventually decline (Fig. 1). These hormonal changes are thought to contribute to many of the associated symptoms.
Menopause is highly individual; symptoms vary widely between people, and may be influenced by numerous factors such as genetics, lifestyle, environment, ethnicity and the wider health profile.
As mentioned, physical symptoms can include hot flushes, with a sudden feeling of intense heat, night sweats and urinary changes. Other symptoms may be more general, such as weight gain, changes in body shape, fatigue and muscle/joint pain. Menopause is not only physical; many women also experience changes in mood, sleep and cognition. These can include irritability, increased anxiety and the well-known 'brain fog', where someone may notice memory lapses, difficulty concentrating and overall mental fatigue. While these are some of the most discussed symptoms, menopause can involve a wide range of experiences and signs (Stuenkel, 2024).
[For more information, see the comprehensive A-Z list provided by The Menopause Charity]
The association with dementia:
Despite women making up the majority of Alzheimer’s cases, women-specific brain health is only a recently growing field. Within this, the relationship between menopause and dementia remains relatively underexplored, particularly when compared with more widely recognised, non-sex-specific dementia risk factors. Historically, menopause has often been treated as a broad life stage or an expected biological process, rather than as an area requiring focused medical research. This gap may help explain why the connection between menopause, hormonal changes and dementia risk is only now receiving greater attention. It also reflects a wider pattern in which women’s health research has not been prioritised, and where funding can be difficult to secure.
A recent study by Dobson et al. (2024) examined whether the age and type of menopause were associated with dementia risk. The researchers pooled data from 233,802 women across five long-term studies in four countries. They looked at women who experienced natural menopause, those who experienced premenopausal bilateral oophorectomy (surgical removal of both ovaries before menopause), and premenopausal hysterectomy (surgical removal of the uterus). In this study, women were typically followed from late midlife (around their late 50s) to a median age of 72, with an average follow-up of 13 years. Therefore, the study examined later-life dementia risk, rather than following women from the start of menopause itself.
The study found that, compared with women who experienced menopause between the ages of 50 and 52, those who experienced menopause before the age of 40 had a higher risk of dementia. According to the NHS, menopause occurring before the age of 45 is considered early menopause, while menopause before the age of 40 is classed as premature menopause. The increased risk was observed specifically in the premature menopause group. The adjusted hazard ratio was 1.47, indicating that women who experienced premature menopause had a 47% higher relative risk of dementia after accounting for other variables. The authors noted that this level of risk was comparable to established dementia risk factors, such as smoking or a stroke.
For clarity, an adjusted hazard ratio (or aHR) is a statistical measure used to compare the risk of an event between two groups while controlling for other factors that may influence the result. A value of 1 suggests no difference in risk, whereas a value above or below 1 indicates an increase or decrease in risk, respectively.
Importantly, this study found no evidence that the type of menopause (i.e., surgical or natural) increased dementia risk once age was accounted for (aHR = 0.99). This highlights that the timing of menopause is more important than the type of menopause itself. Overall, this suggests that women who experience menopause before the age of 40 may have a higher risk of dementia in later life, irrespective of the cause of the menopause. However, it is important to clarify that this is an association; it does not mean that early menopause directly causes dementia. Instead, it suggests that women who experience premature menopause may benefit from earlier monitoring, personalised support and targeted dementia risk reduction strategies.
Why does this happen? The underlying protective role of oestrogen:
One possible explanation for this increased risk is oestrogen’s role in the brain. Oestrogen is often considered to be predominantly a reproductive hormone, but its role extends far beyond reproduction. Research suggests that oestrogen may support brain health by influencing neurotransmitters, neuropeptides, neurosteroid synthesis, neuronal growth, synaptic plasticity and cell survival. These are all important processes involved in maintaining normal brain function. For a more detailed look into the neuroprotective role of female hormones, check out our previous blog ‘Hormones are a Girl’s Best Friend’.
There is also evidence that oestrogen may interact with pathways involved in Alzheimer's disease, including the accumulation and clearance of beta-amyloid, a protein associated with the neurodegenerative pathology (Conde et al., 2021). As we discuss in our blog ‘The brain, menstrual cycle and female sex hormones: acknowledging sex bias in neuroimaging research’, these mechanisms are highly complex and under-researched. The exact relationship between menopause, oestrogen, hormone therapy and dementia risk remains an active and vital area of research.
The findings from Dobson et al. (2024) support the hypothesis that longer exposure to naturally produced oestrogen may have neuroprotective effects. In contrast, early menopause may shorten this period of exposure and potentially contribute to the increased risk seen in later life.
Where do we go from here?
It must be emphasised that menopause does not cause dementia; rather, the timing of menopause may be a strong and relevant risk factor that shapes long-term brain health. This is important because women who experience menopause early may represent a group who could benefit from earlier monitoring, personalised support and targeted dementia risk reduction. With current knowledge of the disease, this may include monitoring other modifiable dementia risk factors, such as hearing loss, smoking and physical activity. Additionally, it may act as one explanation for why women are more likely to develop dementia than men, with around two-thirds of people living with Alzheimer's disease being women.
Ultimately, Dobson et al. (2024) emphasise the need for a deeper understanding of women’s brain health and for more focused research into how hormonal transitions interact with brain ageing. Importantly, they also highlight the need for more research that considers differences within women’s health rather than treating menopause as a single, uniform experience; for example, distinguishing between those who experience premature or early menopause and those who experience menopause at a more typical age. This is essential; if we group experiences rather than truly understanding each group, we may obscure important discrepancies in risk. By establishing effects and risks more clearly, researchers may be able to better identify effective ways to mitigate and minimise risk, while developing more tailored approaches to support women who may be most affected.
This is a story told time and time again in women’s health research; menopause is sadly not an exception. Despite affecting half the population, menopause research remains overlooked and chronically underfunded. According to the World Economic Forum, less than 2% of private healthcare funding is allocated to women-specific conditions and only a small subset of this is subsequently invested in menopause. This underinvestment may help to explain why important questions about menopause, brain ageing and dementia risk are only now beginning to receive wider attention. Without better funding and more targeted research, key differences between premature menopause, early menopause and menopause at a more ‘typical’ age, risk being missed. If these experiences are grouped too broadly, important patterns of risk may be obscured, limiting the development of truly personalised prevention, support and treatment.
Interested in learning more? Women in Neuroscience UK are hosting a Menopause and the Brain virtual event on Monday 6th July 6-7pm. Sign up here!
References
Conde, D.M., Verdade, R.C., Valadares, A.L.R., Mella, L.F.B., Pedro, A.O. and Costa-Paiva, L. (2021). Menopause and cognitive impairment: A narrative review of current knowledge. World Journal of Psychiatry, [online] 11(8), pp.412–428. doi:10.5498/wjp.v11.i8.412.
Dobson, A.J., XU, Z., Wilson, L.F., Chung, H.-F., Sandin, S., Van, Y.T., Panayotes Demakakos, Elisabete Weiderpass and Mishra, G. D (2024). Menopause age and type and dementia risk: a pooled analysis of 233 802 women. Age and Ageing, [online] 53(11). doi:10.1093/ageing/afae254.
Stuenkel, C.A. (2024). What is menopause? Menopause, [online] 31(9), pp.837–838. doi:10.1097/gme.0000000000002416.
https://www.weforum.org/stories/2026/05/womens-health-in-numbers/
This article was written by Lucy Browning and edited by Rebecca Pope, with graphics produced by Ginevra Sperandio. If you enjoyed this article, be the first to be notified about new posts by signing up to become a WiNUK member (top right of this page)! Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch.
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