Menopause: HRT’s brain-protecting effect may be overstated

Many women expect hot flushes, dry skin and night sweats when they reach the menopause. But the effect the menopause can have on the brain is rarely mentioned. This is something a recent Channel 4 documentary presented by Davina McCall explored.

The documentary, called Sex, Mind and the Menopause, discussed how the menopause can cause a range of brain-related symptoms, including brain fog, mood changes and memory problems. It also suggested that taking hormone replacement therapy (HRT) some years before the menopause may be the solution to these problems – alongside potentially halving a woman’s risk of developing dementia.

With around 4.4 million women of working age going through the menopause in the UK, it’s clear that we need solutions to help those suffering from brain-related and other menopause symptoms. But HRT might not live up to what the documentary suggested it to be.

Brain changes

Around 23% of women experience measurable changes in brain function during menopause – especially to their memory. These changes typically occur in the early stages, during perimenopause (the transitional period before menopause, typically between 40 and 44 years of age when oestrogen levels begin to drop and the frequency and intensity of periods start changing).

This is something the documentary touched on, with one doctor using brain scans of perimenopausal women to show that brain activity was 25% lower compared with premenopausal women (the time before perimenopause). However, the documentary did not show viewers that these brain changes are usually temporary – often reversing a couple of years after reaching the menopause – when a woman no longer has periods. This is typically between 45 and 55 years of age.

These temporary brain changes may be caused by other menopause symptoms that can affect sleep, such as night sweats. Since sleep plays an important role in brain function, not sleeping properly could lead to concentration and memory problems. No evidence to date has conclusively shown whether or not the hormonal changes that happen during this period are the cause of brain changes in humans.

While there is good evidence that HRT can help reduce the severity of some menopause symptoms (including hot flushes and night sweats), it’s less certain whether such treatments have any long-term benefit on memory and brain function.


For the full article co-authored by Professor Eef Hogervorst, Dr Emma O'Donnell and Professor Rebecca Hardy, visit the Conversation.

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