Menopause
Menopause linked to loss of grey matter in the brain, study finds

Menopause is linked to grey matter loss in key brain regions, along with increased anxiety, depression and sleep problems, new research suggests.
The study also found that hormone replacement therapy (HRT) does not appear to mitigate these effects, though it can slow the decline in reaction times.
Grey matter is brain tissue that contains nerve cell bodies and helps process information, control movement and manage memory and emotions.
Dr Christelle Langley from the University of Cambridge department of psychiatry said: “Most women will go through menopause, and it can be a life-changing event, whether they take HRT or not.
“A healthy lifestyle – exercising, keeping active and eating a healthy diet, for example – is particularly important during this period to help mitigate some of its effects.
“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.”
Researchers analysed data from UK Biobank of almost 125,000 women, who were classified into three categories: pre-menopause, post-menopause who have never used HRT, or post-menopause who have used HRT.
Participants answered questionnaires about their experience of the transition, self-reported mental health, sleep patterns and overall health.
Some took part in tests of cognition, including tests of memory and reaction times. Around 11,000 participants also underwent MRI scans, allowing the researchers to examine brain structure.
Post-menopausal women were more likely than those pre-menopause 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.
They were also more likely to have been prescribed antidepressants.
Although women in the HRT group had greater anxiety and depression compared with the non-HRT group, further analysis showed these differences were already present before the transition began.
The researchers suggest that in some cases, a woman’s GP may have prescribed HRT in anticipation of symptoms worsening.
Women post-menopause were more likely to report insomnia, get less sleep, and feel tired.
Those on HRT reported feeling the most tired of all three groups, even though there was no difference in sleep duration between these women and those not on the medication.
In both groups of women post-menopause, the researchers found significant reductions in grey matter volume.
These differences occurred particularly in the hippocampus, which is responsible for forming and storing memories; the entorhinal cortex, a gateway for passing information between the hippocampus and the rest of the brain; and the anterior cingulate cortex, which helps manage emotions, make decisions and focus attention.
Post-menopausal women who were not on HRT had slower reaction times than those yet to start the transition or who were on HRT.
However, there were no significant differences between the three groups when it came to memory tasks.
Dr Katharina Zühlsdorff from the department of psychology at the University of Cambridge said: “As we age, our reaction times tend to get slower – it’s just a part of the natural ageing process and it happens to both women and men.
“You can imagine being asked a question at a quiz – while you might still arrive at the correct answer as your younger self, younger people would no doubt get there much faster.
“Menopause seems to accelerate this process, but HRT appears to put the brakes on, slowing the ageing process slightly.”
Professor Barbara Sahakian, the study’s senior author 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.”
News
Cultural stigma is a barrier to menopause help, black women say

Cultural stigma and a lack of education are making it harder to get menopause help, ethnic minority women in Jersey have said.
The women came together to share their stories at an event in St Helier hosted by Eve Studios and Liberty Underwear.
Participants were encouraged to speak openly about the symptoms they had experienced.
Angela Mowanga, from Jersey, told ITV Channel: “I became dismissive about signs and symptoms. From our parents and our grandparents, they just carried on.
“I hardly heard the word menopause spoken about in my household. We never had things like hot flushes, itchy skin and tiredness.
“So for us to start talking about menopause, there is a taboo around it. A taboo that comes from ignorance but also not being willing to educate ourselves.
“We as women of colour, societies of colour, we have a lot of taboo subjects, which now have to be highlighted with the generation today.
“However, with the modern day, society is changing. And we hope programmes like this can actually be well received.”
Daisy Ayebale, from Jersey, added: “I think it’s important we are listened to. We need the right information from the experts, but we have also been overlooked when it comes to the healthcare system.
“We need to know this information before it’s too late, before you’re gambling with your health. We are glad to be changing the narrative, we are glad to be changing things right now. We are very hopeful.”
Research shows that black women are more likely to experience menopausal symptoms earlier, more intensely and for longer.
Insight
Women urged to be wary of menopause misinformation on social media

Women are being urged to seek evidence-based advice and avoid menopause misinformation shared on social media.
A seminar co-hosted by the World Health Organization (WHO) mainly examined what is known about the cognitive effects of menopause and current research in the field worldwide.
Dr Nicole Jaff, a South African academic and certified menopause practitioner, said research into menopause and its effects was now at a peak.
She said: “There’s a lot of information out there.
“But I would say please look for the evidence-based information, not for the influencers and the misinformation, but those who are giving guidelines, who are giving information.”
Jaff highlighted research into cognitive changes during menopause and how some women experience brain fog, a term for difficulties with memory, concentration and clear thinking.
She said: “I’m very excited about the non-hormonal treatments that are now available, especially for women who could never take hormone therapy because of breast cancers and various cancers, who can now take it.
“I’m extremely excited about people who are standing up for evidence-based medicine, for science, who are actually fighting back against a lot of the social media and influencers who are not giving evidence-based information and making life very difficult for women because they think they should be forever young or buying this or buying that.”
Jaff advised women and healthcare workers to read new guidelines recently issued by the International Menopause Society. They are available free to download from its website.
The seminar also heard from Professor Aimee Spector, professor of clinical psychology of ageing at University College London.
She raised similar concerns about misinformation, particularly claims linking hormone replacement therapy, known as HRT, to dementia. Some claims suggest HRT reduces dementia risk, while others suggest it increases the risk.
Spector said: “I think there’s also lots of misinformation.
“And I think that there’s huge variations in how even professionals and doctors interpret this information.”
She was part of an international research team commissioned by the WHO last year to assess published studies on the issue.
The institutions involved also included the Global Brain Health Institute at Trinity College Dublin.
Spector said: “The first thing to say is that the quality of evidence was very low.
“Nine out of the 10 studies we looked at were observational, which means that you’re observing patterns over time. But you don’t necessarily know whether that’s due to the hormone therapy or not.
“Our overall recommendation was that there’s insufficient evidence for menopause hormone therapy in terms of either increasing or reducing the risk of dementia. In other words, we don’t know either way.”
Spector said women should therefore decide whether to use HRT to treat menopause symptoms rather than based on concerns about dementia.
She said: “It’s recommended for menopause symptoms, but it’s not recommended to reduce dementia. And I think a lot of people are saying that.”
The Menopause on the Brain webinar was part of an ongoing series hosted by the WHO and other global health agencies.
News
Premature menopause is a high blood pressure risk, study finds

Premature menopause is linked to a higher risk of developing high blood pressure, according to a study of more than 107,000 women.
The risk was highest among women who reached menopause between the ages of 25 and 35.
Researchers said the findings support earlier cardiovascular screening for women who reach menopause before the age of 40.
Dr Stephanie Faubion, medical director for The Menopause Society, said: “The results of this study highlight the potential adverse long-term health outcomes associated with premature menopause, and in particular, the need to regularly screen for cardiovascular risk factors such as hypertension.
“Use of hormone therapy is also routinely recommended in women with premature menopause at least until the natural age of menopause unless contraindications exist.”
Hormonal changes during menopause are known to affect women’s wider health, while earlier menopause has previously been linked to coronary heart disease and stroke.
Coronary heart disease develops when the blood vessels supplying the heart become narrowed or blocked.
However, previous evidence directly linking the timing of menopause to high blood pressure has been mixed.
High blood pressure, also known as hypertension, puts extra strain on the heart and blood vessels and can increase the risk of heart disease and stroke.
Researchers said it can be difficult to separate the direct effects of hormonal changes from factors that often accompany menopause, including weight gain, metabolic changes and other cardiovascular risks.
Metabolic changes affect how the body processes and uses energy, including sugar and fat.
The study analysed data from 107,836 postmenopausal women who joined the UK Biobank between 2006 and 2010. They were followed for a median of almost 15 years.
Researchers divided the women into three groups based on their age at menopause: after 45, between 40 and 45, or before 40.
They also examined whether menopause occurred naturally or followed surgery.
During the follow-up period, 18,508 women, or 17.2 per cent, were diagnosed with high blood pressure.
The proportion increased as the age at menopause fell. Hypertension developed in 16.6 per cent of women who experienced menopause after 45, compared with 18.8 per cent of those who reached menopause between 40 and 45.
Among women who experienced menopause before 40, 22.6 per cent developed the condition.
After taking account of more than 50 factors, including weight, lifestyle habits, family history and laboratory results, premature menopause remained linked to a 12.3 per cent higher risk of hypertension than menopause after age 45.
Further analysis suggested the risk peaked among women who reached menopause between the ages of 25 and 35.
The researchers said this may mean that the cardiovascular risk associated with premature menopause is concentrated among a younger group than the conventional under-40 definition suggests.
Surgical menopause was initially linked to higher rates of hypertension, but the association was no longer significant after other risk factors were taken into account.
The authors said clinicians should consider age at menopause as a distinct cardiovascular risk factor, particularly for women who experience it before 40.
They also called for earlier detection and management of hypertension, alongside individual discussions about hormone therapy.
Hormone therapy replaces hormones that decline during menopause and may be recommended for some women, depending on their individual health and medical history.
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