Menopause linked to reduced grey matter in the brain, finds large UK study

Menopause is linked to reductions in grey matter volume in key brain regions as well as increased levels of anxiety and depression and difficulties with sleep, UK researchers have reported.

The findings from the large study, may partly explain why women are more likely to be diagnosed with dementia than men, they added.

Reporting the findings in Psychological Medicine, the team from the University of Cambridge said hormone replacement therapy (HRT) did not appear to mitigate the effects, although it did appear to slow the decline in reaction times.

Data on experience of menopause, self-reported mental health, sleep patterns and overall health from 125,000 women were analysed alongside a smaller group who did tests of cognition, memory and reaction times and 11,000 brain MRI brain scans.

Post-menopausal women were more likely to have sought help from their GP or a psychiatrist for anxiety, nerves or depression, and to score more highly on questionnaires for symptoms of depression than those who had not yet experienced menopause.

This group was also more likely to have been prescribed antidepressants.

The study also found that women taking HRT had greater anxiety and depression compared with the non-HRT group, but more detailed analysis showed that these differences in symptoms were already present before menopause.

It is possible, they noted, that in some cases, a woman’s GP may have prescribed HRT in anticipation of menopause worsening her symptoms.

After menopause, women were more likely to report insomnia, get less sleep, and feel tired while those on HRT reported feeling the most tired, even though there was no difference in sleep duration between the two.

In post-menopausal women, researchers found significant reductions in volume of grey matter in the hippocampus (responsible for forming and storing memories); entorhinal cortex (the ‘gateway’ for passing information between the hippocampus and the rest of the brain); and the anterior cingulate cortex (involved in managing emotions, making decisions, and attention).

Menopause also appeared to have an impact on cognition with post-menopausal women not on HRT having slower reaction times than those yet to start menopause or who were on HRT.

But there were no significant differences between the three groups when it came to memory tasks, the researchers said.

Study author Dr Christelle Langley from the Department of Psychiatry said: ‘We all need to be more sensitive to not only the physical, but also the mental health of women during menopause, however, and recognise when they are struggling.

‘There should be no embarrassment in letting others know what you’re going through and asking for help.’

Co-author Professor Barbara Sahakian, also from the Department of Psychiatry, added: ‘The brain regions where we saw these differences are ones that tend to be affected by Alzheimer’s disease.

‘Menopause could make these women vulnerable further down the line. While not the whole story, it may help explain why we see almost twice as many cases of dementia in women than in men.’

Professor Channa Jayasena, professor of reproductive endocrinology and andrology at Imperial College London, said it was unsurprising that women who had undergone the menopause were more likely to have problems like depression.

‘They found that menopause was associated with reduction in the development of some brain areas, which highlights the need to investigate whether anything can be done to predict or treat this.

‘Comparisons between the women with menopause with and without HRT have been made, but I think these are difficult to interpret.

‘Women taking HRT may have had more severe symptoms of menopause, so it is unfair to compare whether HRT “does a good job” of lessening the bad effects of menopause which have been studied.’