Menopause is an unavoidable transition in every woman’s life, yet this change may have more serious effects than previously believed, especially when considering the onset of the change. In fact, a recent study suggested that those entering menopause at an earlier age may be associated with an increased risk of accelerated brain decline.
Early menopause and your aging brain
“My grandmother experienced adversity over her lifespan, as well as early surgical menopause,” reveals Riley Bove, a professor of clinical neurology at the UCSF MS and Neuroinflammation Center, to Psyop.
“She developed Alzheimer’s Disease when I was in high school. Watching her brain and self change, I always wondered about the effect of her reproductive experiences on her brain health.”
In conjunction with previously published research, Bove set out to explore whether the age at which a woman undergoes menopause (natural or surgical) affects the physical structure of her brain decades later.
For the study, the researchers turned to data from two aging cohorts: the Religious Orders Study and the Rush Memory and Aging Project.
The data included information from 2603 women, with an average age of 78 when they started the study. They were also followed for about 18 years.
All participants underwent yearly cognitive testing, and 774 women had repeated brain MRIs, which helped researchers track changes in brain structure over time. The team also had brain autopsy data for 1287 women who passed away during the study period, allowing pathologists to check for physical signs of Alzheimer’s disease.
‘Early menopause’
The women shared self-reported information on their reproductive history, including the ages at which they began and stopped menstruating, allowing the researchers to calculate their reproductive lifespans. The women further revealed information about their menopausal journeys, and around two-thirds of the women went through menopause naturally, at an average age of 50, while the remaining women underwent surgical menopause, which happened at an average age of 43.
As opposed to using one age to define ‘early menopause ’, the researchers chose instead to see whether women who went through menopause at a younger age relative to other women in the study underwent any differences in brain health and cognitive aging later in life.
The researchers accounted for several factors that may influence brain health, including age, education, smoking, body mass index, menopausal hormone therapy use, and whether each participant carried the gene associated with Alzheimer’s risk (APOE4).
Does early menopause increase Alzheimer’s risk?
“We could see an association between menopause age and white matter injury in women followed in their seventies and eighties — even decades beyond menopause — showing a lasting trace.” – Riley Bove, MD
According to the findings published in JAMA Network Open, early-onset menopause was associated with an increased risk of early clinical Alzheimer’s disease onset, poor cognitive aging trajectories, and faster late-life brain shrinkage (brain atrophy).
Per the study’s findings, earlier menopause was linked to a faster accumulation of white matter hyperintensities, which are areas of damaged brain tissue that an MRI detects. White matter helps the brain communicate, so damage to this area can affect how the brain processes information, as well as attention and focus. It should be noted that the association was noted in women who experienced natural menopause, but not those who underwent surgical menopause.
That said, the risk of cognitive decline and earlier Alzheimer’s diagnosis was stronger in women who experienced surgical menopause.
What’s more, women who experienced menopause earlier were found to be diagnosed with Alzheimer’s disease at an earlier age, with the model estimating that a woman experiencing menopause ten years earlier than another woman may experience almost two fewer years free of Alzheimer’s disease in her old age.
How might early menopause increase Alzheimer’s risk?
Menopause comes with plenty of hormonal changes, with the most significant being the decline of estrogen, which, beyond being a primary female hormone, also has protective effects on brain function, including enhancing memory and boosting blood flow.
“Estrogen appears to provide some protection against these conditions, or against underlying brain vulnerability to injury, until it declines with menopause,” reveals Dr. Bove.
As mentioned, women who experienced surgical menopause had faster memory decline and an earlier Alzheimer’s disease diagnosis, and this may be linked to the sudden loss of estrogen associated with the surgery.
“Women with earlier menopause have fewer total years of estrogen exposure and therefore may have fewer years in which to experience the neuroprotective effects of the reproductive hormones,” Bove says.
That said, women who experienced menopause naturally, and thus a more gradual loss of estrogen, experienced a slower decline.
Does menopause cause Alzheimer’s?
Despite the study’s findings, it’s important to note that much of the participants’ data was self-reported, and over 90% of them were white and relatively highly educated, which raises the question of how broadly the findings apply.
The researchers were also unable to identify the different types of surgical menopause, including the removal of both ovaries versus a hysterectomy, which leaves the ovaries in place.
The findings have yet to prove whether hormone therapy may work to prevent the brain changes linked with earlier menopause.
“One major unanswered question is whether menopausal hormone therapy is protective against brain aging,” Bove reveals. “The higher quality interventional trials, which can reduce the biases that we see in observational studies, have not shown that it is, but perhaps women have not yet been followed for long enough.”
Navigating early menopause
“Rather than alarming women, we’d like to empower women to consider the perimenopause as a window of opportunity. An opportunity to assess carefully their risk factors for brain aging, and to personalize the care and interventions (such as sleep study, mood management, exercise program, blood pressure treatment) intended to support brain longevity,” says Bove.
With that, there are habits that women can follow to protect their brain health, regardless of their menopausal dates, including:
- Following a plant-based diet
- Getting high-quality sleep
- Regular exercise
- Managing stress levels
- Improving gut health
- Regular brain activities
For those experiencing early menopause, Bove suggests that they stay on MHT until they reach the average age of normal menopause, “In the early fifties, unless there is a contraindication.”
Also, if you experience poor cognitive symptoms like difficulty paying attention and trouble retaining information during perimenopause or menopause, then be sure to bring it up to your doctor.
Want to know more?
When we talk about menopause, the conversation turns to hormonal factors — oestrogen, progesterone, the sliding scale of a hot flush. According to Dr. Levidia Strauss, founder of Revita Health, the gut may be the single most overlooked factor in how women experience the menopause transition. Find out more here.
References
Dolan, E.W. (2026). Earlier menopause is linked to faster memory decline and earlier Alzheimer’s onset. PsyPost – Psychology News. https://www.psypost.org/earlier-menopause-is-linked-to-faster-memory-decline-and-earlier-alzheimers-onset/
Pia, C.M., Schneider, J.A., Barnes, L.L., Arfanakis, K., Galit, L.D., Bennett, D.A. and Bove, R.M. (2026). Age at Menopause and Brain Atrophy Among Older Women. JAMA Netw Open, 9(8), p.e2630973. doi:10.1001/jamanetworkopen.2026.30973
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