Menopause and brain health: what the latest research is really telling us (and what you can do about it)

If you’ve noticed brain fog, forgetfulness, poorer concentration or a dip in confidence during perimenopause or after your final period, you’re not imagining it. Research is increasingly clear that menopause is a neurological transition as well as a hormonal one and the good news is there are practical ways to support brain health now, while also protecting long-term cognitive resilience.

1) Menopause can coincide with measurable brain changes but that doesn’t equal “damage”

In late January 2026, researchers reported that menopause is associated with reductions in grey matter volume in key brain regions, alongside worse sleep and mental health symptoms (such as anxiety and depression). (University of Cambridge)

Two important takeaways:

• Structural or functional brain changes don’t automatically mean permanent harm — the brain is dynamic, and lifestyle + symptom support can influence how you feel day to day.
• Sleep and mental health looked tightly linked with the brain-health picture, reinforcing that “treating symptoms” is not superficial — it can be brain-supportive.

2) Hot flushes, mood and sleep aren’t “just annoying” — they may connect to cognition

A 2024 study highlighted by The Menopause Society suggested that more severe menopause symptoms (including hot flushes and depression) may be associated with poorer cognitive function in postmenopausal women. (The Menopause Society)

This lines up with what many women experience: when sleep is disrupted, stress is high, and mood is lower, focus and memory suffer. Supporting symptoms isn’t only about comfort — it can help you show up with more mental clarity.

3) HRT and dementia risk: the latest evidence is more nuanced than headlines

This is where the research often gets oversimplified.

• A major 2025 evidence review in The Lancet Healthy Longevity found no significant association between menopausal hormone therapy (MHT) and risk of mild cognitive impairment or dementia overall, including across timing/duration subgroups in their analyses. (The Lancet)
• In late 2025, UCL also summarised findings showing no evidence that MHT affected dementia risk after early menopause (with the usual caveats about study design and what we can/can’t conclude). (University College London)

The bottom line: HRT is highly effective for symptoms for many women, and can be appropriate based on your personal risk profile but it shouldn’t be marketed as a guaranteed dementia-prevention strategy. Decisions should be individualised with a healthcare professional.

4) The biggest “brain levers” you can influence right now

If you want the highest return on effort, focus on the pillars that repeatedly show up in cognitive ageing research and help menopausal symptoms.

Protect your sleep (the brain’s maintenance shift)

• Keep the bedroom cool; consider breathable bedding.
• Reduce alcohol close to bedtime (hot flushes + sleep fragmentation can worsen).
• If night sweats are frequent, speak to a clinician about symptom options (hormonal or non-hormonal).

CBT tailored to menopause symptoms is also recognised in UK guidance for vasomotor symptoms (hot flushes/night sweats) and can support better sleep.

Build strength + get your heart rate up (yes, for your brain)

Regular physical activity supports blood flow, insulin sensitivity, inflammation balance, mood and sleep which are all connected to cognition. Aim for:

• Strength training 2–3x/week (major muscle groups)
• Brisk walking/cycling/swimming most days (even 10-minute bursts count)
• Balance + mobility (especially if you’re feeling less steady)

Want to “double up” the brain benefit? Add dual-tasking: walk while naming animals A–Z, do simple step patterns while counting backwards, or balance practice while doing a word game. This challenges attention, processing speed and coordination at once – skills that matter for confidence and everyday function.

Feed your brain like you mean it

A Mediterranean-style pattern is consistently associated with better cardiovascular and brain outcomes:

• Plenty of colourful veg, beans/lentils, wholegrains
• Oily fish (or algae omega-3 if preferred)
• Nuts, seeds, olive oil
• Protein at each meal (supports muscle and muscle supports metabolic health)

Don’t ignore mood, stress and “mental load”

The new brain-structure findings also linked menopause with anxiety/depression and sleep disturbance. (University of Cambridge)
If you’re struggling:

• Tell your GP (you deserve support, not a shrug)
• Consider menopause-specific CBT or counselling
• Build in downshifts: daylight, movement, breathwork, social connection

5) When to get checked

Brain fog is common in perimenopause, but seek medical advice if you notice:

Quick practical checklist 

• Prioritise sleep support (cool room, routine, symptom treatment)
• Strength train 2–3x/week + move most days
• Add dual-tasking once or twice a week
• Eat Mediterranean-style + prioritise protein
• Get support for mood/stress (menopause-specific CBT can help) (British Menopause Society)
• Talk HRT through based on your symptoms and risk profile (not fear, not hype) (The Lancet)