Brain fog during menopause? Here’s what’s really going on

How Menopause Alters Brain Structure

Research has shown that menopause is accompanied by measurable structural changes in the brain. Several studies have identified decreases in gray matter volume in key regions such as the frontal and temporal cortices and the hippocampus, which play major roles in memory and decision-making. These reductions have been associated with declines in certain types of memory performance, including verbal and visuospatial abilities.

Other research has found that white matter hyperintensities -- bright spots visible on MRI scans that often indicate tissue damage -- are more common during menopause, particularly in women who experience early menopause or frequent hot flashes. These changes may result from reduced blood flow to the brain's white matter. The lesions are linked to a higher risk of neurological symptoms such as cognitive decline, balance problems, mood changes, and an increased likelihood of stroke and dementia.

Evidence of Brain Recovery and Hormonal Adaptation

Interestingly, some findings suggest that gray matter volume may partially recover after menopause, hinting at the brain's ability to adapt through neuroplasticity. Scientists have also observed higher estrogen receptor density during the menopause transition, which may reflect the brain's attempt to compensate for falling hormone levels. However, this increase has also been tied to weaker memory performance in some cases. Changes in blood vessel reactivity and energy metabolism within the brain further illustrate how menopause affects neural health and resilience.

Some evidence suggests a partial recovery of gray matter volume postmenopause, potentially reflecting compensatory neuroplastic processes. Additionally, elevated estrogen receptor density during the menopause transition may represent an adaptive response to declining hormone levels, although it has also been associated with poorer memory outcomes Alterations in cerebrovascular reactivity and brain energy metabolism further underscore the impact of menopause on neural integrity and functional resilience.

As part of a project carried out at the BRAVE Lab of the School of Behavioral and Brain Sciences at Ponce Health Sciences University (Puerto Rico), PhD-PSY students Angélica Rodríguez and Andrea Pereira conducted a bibliographical review under the supervision of Dr. Bárbara Barros and Dr. Karla Martínez. Their work analyzed relevant scientific literature on menopause-related brain structural changes and how these alterations may contribute to menopause symptoms. More detailed results will be discussed at the 2025 Annual Meeting of The Menopause Society as part of the poster presentation entitled "Menopause and Brain Structural Changes: A bibliographic revision." Rodríguez, first author, will be presenting the poster at the meeting.

"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," says Angélica Rodríguez, PhD student in Psychology at Ponce Health Sciences University in Puerto Rico.

Building Toward Better Understanding and Treatment

"This study represents the cumulative body of scientific knowledge relative to structural changes that take place in the brain during menopause," says Dr. Stephanie Faubion, medical director for The Menopause Society. "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."