A new review of studies shows that menopause causes measurable changes in brain structure, including shrinkage in areas key to memory and thinking. These alterations may explain symptoms like brain fog, but evidence suggests some recovery after menopause. The findings will be presented at The Menopause Society's 2025 annual meeting in Orlando.
Menopause involves profound hormonal shifts that affect brain structure, according to a bibliographical review conducted by researchers at Ponce Health Sciences University's BRAVE Lab in Puerto Rico. PhD students Angélica Rodríguez and Andrea Pereira, supervised by Dr. Bárbara Barros and Dr. Karla Martínez, analyzed scientific literature on how menopause leads to decreases in gray matter volume in the frontal and temporal cortices and the hippocampus. These regions are crucial for memory and decision-making, and the reductions are associated with declines in verbal and visuospatial memory performance.
The review also highlights increases in white matter hyperintensities—bright spots on MRI scans indicating tissue damage—particularly in women experiencing early menopause or frequent hot flashes. These changes, likely due to reduced blood flow, are linked to cognitive decline, balance problems, mood changes, and higher risks of stroke and dementia.
Despite these effects, the study points to potential recovery. Some evidence indicates partial restoration of gray matter volume postmenopause, possibly through neuroplasticity. Researchers observed higher estrogen receptor density during the transition, which may be an adaptive response to falling hormone levels, though it has been tied to poorer memory outcomes. Additional changes include alterations in blood vessel reactivity and brain energy metabolism, underscoring impacts on neural health.
The work will be presented as a poster titled "Menopause and Brain Structural Changes: A bibliographic revision" at The Menopause Society's 2025 Annual Meeting, held October 21-25 in Orlando. "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, the first author.
Dr. Stephanie Faubion, medical director for The Menopause Society, noted, "This study represents the cumulative body of scientific knowledge relative to structural changes that take place in the brain during menopause. 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 review is detailed in the journal Menopause (October 2025, DOI: 10.1097/GME.0000000000000002541).