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Opinion: Not ‘just stress’ – How hormonal changes affect women’s brain function
By Dr Louise Newson BSc(Hons) MBChB(Hons) MRCGP FRCGP DHealth
Over years of studying the health of women there’s one key thing that I’ve come to realise; clinicians have often been missing a crucial piece of the puzzle in understanding women’s mental health and brain function.
It all comes down to three hormones that deserve far more attention for their powerful influence on the brain — progesterone, estradiol, and testosterone.
As an example, I consulted with a 46-year-old woman last week in my clinic. She’s clever, accomplished, always been on top of things.
But recently she has been forgetting words mid-sentence, she can’t remember where she parked her car and finds herself having to read the same page three times and still nothing sticks.
Terrified that she has early-onset dementia, she visited her GP who told her it’s “just stress” or “normal ageing.”
But here’s the thing – it’s neither. It’s her brain responding to a dramatic hormonal shift, and we need to start talking about it.
Women’s mental health, and especially brain health, is deeply influenced by our hormones – progesterone, estradiol and testosterone – all three having fundamental roles in how our brains function.
However this connection is often overlooked in medicine and public conversations.
When levels of these hormones fluctuate and reduce (as they do during perimenopause and menopause) then this can have negative effects on our brain metabolism and function leading to symptoms such as memory problems, brain fog, poor sleep, low mood, anxiety, irritability and fatigue.
Menopausal women have an increased risk of developing dementia due to these hormone levels being low.
These vital hormones work to improve glucose metabolism, which provides the fuel our neurones (nerve cells) need to function and connect with each other.
They also work to reduce inflammation and improve the function of our mitochondria (the powerhouse of our cells) which all work to keep our brains healthy and working well.
Progesterone, estradiol and testosterone also increase neural growth, strengthen synaptic connections between nerves, and regulate levels of neurotransmitters such as serotonin for mood, acetylcholine for memory, melatonin for sleep and dopamine for motivation.
The presence of these hormones is linked to lower rates of memory loss and can reduce risk of Alzheimer’s disease, which affects women at nearly double the rate of men.
Importantly, “brain fog” and forgetfulness commonly reported during perimenopause and menopause are real and measurable phenomena linked to hormonal fluctuations, not just “normal ageing” or stress.
Testosterone is commonly misconstrued as “just a male hormone,” but women’s brains require it for optimal functioning.
Produced by ovaries and adrenal glands, as well as in the brain, testosterone supports cognitive sharpness, energy, and drive.
Emerging evidence links lower levels of testosterone in women to poorer performance on memory, processing speed, and even greater Alzheimer’s risk, especially among those with certain genetic risk factors.
Like estradiol, testosterone boosts dopamine activity, which is crucial for focus, motivation, and pleasure.
Many women report that restoring testosterone improves concentration, energy, and overall mental clarity.
Women’s mental health is closely associated with these changing hormone levels.
Rates of depression, psychosis and anxiety in women are more common at times of hormonal flux such as puberty, the premenstrual phase, postpartum, perimenopause and menopause.
Therefore, clinicians should certainly be assessing for hormonal factors when cognitive and mental health concerns arise in women.
Women represent nearly two-thirds of all Alzheimer’s patients, and much of this is likely driven by the neurological impact of hormone loss.
Understanding estradiol, progesterone, and testosterone as master regulators of brain metabolism and cognition should then lead to better clinical treatment.
This must take the form of more personalised approaches by clinicians, prescribing the right dose and type of hormone treatment, which when combined with a healthy lifestyle offers the best prospects for safeguarding and improving brain and mental health for women.
One of the reasons I developed the Balance app is to empower women with evidence-based information so they can make the choices that are right for them about their hormonal health.
Using technology to both monitor symptoms and learn more is so important – the response from our users has been so positive and inspiring.
Femtech has the ability to reach a global audience and transcend national borders and cultures which is really exciting for me to witness through our Balance app.
It has also enabled us to provide communities with large scale pools of information and support which are not so readily available in other ways.
Also, Balance is used to support and empower women, privately, who are too scared to communicate in the physical world.
We’ve ignored women’s brain health for too long.
Clinicians have too often dismissed symptoms, failed to account for the profound impact of these hormones on brain function, and have frequently accepted cognitive decline as inevitable.
It’s time for that to change.
Because understanding the hormone-brain connection and replacing the missing hormones isn’t just about preventing disease, it’s about helping women thrive, with their minds sharp, their memories intact, and their full cognitive potential realised.
Image Credit: Andrew Crowley
The Scottish government has launched a national review into whether NHS IVF access should be extended to single women.
The review will also consider whether wider access should be offered to couples who have children from previous relationships.
Health secretary Angela Constance said: “Access to NHS IVF treatment should be fair, timely and reflect the way people’s lives and families look today.”
Most single women are not currently eligible for NHS IVF treatment in Scotland.
Campaigners have welcomed the review.
Katie Rollings of Fertility Action said: “It’s an essential and long-awaited decision that will impact a huge number of people who are struggling to grow their families.
She said there is “no evidence” that having two parents rather than one determines whether a child will thrive.
She added: “What matters is whether a child is loved, safe, supported and has stable, positive relationships around them.”
Figures from the Human Fertilisation and Embryology Authority show Scotland is the only UK nation where NHS-funded IVF cycles outnumber privately funded cycles.
In 2024, more than 6,000 cycles of fertility treatment were carried out among more than 4,000 patients in Scotland. Both figures were slightly lower than the record highs recorded in 2022.
The past 20 years have also seen a rise in the number of same-sex female couples and single women receiving fertility treatment.
In 2024, 625 IVF cycles were carried out for women in same-sex couples in Scotland, with more than one third funded by the NHS.
There were 330 cycles involving single women, of which 50 were NHS-funded.
In England, single women can access IVF through the NHS, although eligibility varies according to the local health trust’s policy.
Current Scottish rules state that couples are eligible if they have been living in a stable relationship for two years and neither partner has been sterilised.
Couples where one partner already has a child can be eligible, but those where both partners have children from previous relationships are not.
Eligibility rules also require a body mass index above 18.5 and below 30, and state that couples must not smoke, drink alcohol or take drugs during treatment. The mother must be under 42.
The Scottish government said the review would also examine consistency of access to fertility preservation, including during cancer treatment, as well as reducing waiting times for donor eggs and sperm.
Same-sex female couples already have access to NHS IVF, but they can face long waits for donor eggs or sperm, as can heterosexual couples who require donor treatment.
The National Fertility Group will lead the review and make “costed, demand-modelled recommendations”, which are due to be published by early summer 2027.
The group will include fertility experts from Scotland’s four NHS-assisted conception units in Glasgow, Edinburgh, Aberdeen and Dundee.
Prof Sarah Martins Da Silva, an NHS consultant and chair of fertility medicine at Dundee University, said there were questions to be answered in a resource-stretched NHS.
“As a fertility specialist I’m never going to be disappointed if the criteria is widened,” she said.
“But with single people, as an NHS clinician looking at the competing demands we have, I’d ask the question about whether being single is a health condition that needs to be funded.”
Da Silva said NHS waiting lists were full of couples who require donated eggs or sperm because of medical conditions including cancer and could face longer waits.
“It’s slightly a disservice to them,” she said.
“There would need to be a real investment and resource without making everybody wait an extraordinary long time.
“With the current financial environment we work in, if you’re talking about new money, where would that come from?”
She said she would welcome changes that encouraged more people to donate eggs or sperm and questioned whether arguments about children needing two parents were necessarily relevant to the debate.
“On the one hand bringing up a child is quite an expensive process, and if you don’t have that support, it can be very difficult.
“But on the other hand, many people start off as a couple and divorce.”
Da Silva also welcomed plans for the review to consider eligibility for couples who already have children, describing the move as “fantastic”.
The FDA has granted accelerated approval to AstraZeneca drug Etcamah for certain adults with advanced breast cancer carrying an ESR1 mutation.
Etcamah, also known as camizestrant, was approved in combination with a CDK4/6 inhibitor, either abemaciclib, palbociclib or ribociclib.
The treatment is for adults with hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer when an estrogen receptor-1 (ESR1) mutation is detected during aromatase inhibitor and CDK4/6 inhibitor therapy using an FDA-authorised test.
ESR1 mutations are acquired resistance mutations that tumours may develop during treatment with aromatase inhibitors, a type of endocrine therapy commonly used as a front-line treatment for locally advanced or metastatic breast cancer.
Fewer than 5 per cent of patients have the mutation when HR-positive metastatic breast cancer is diagnosed, according to the FDA. After disease progression on an aromatase inhibitor, nearly 40 per cent have the mutation.
Acting FDA commissioner Kyle Diamantas said: “Women living with metastatic breast cancer face an uphill battle as their tumors continuously evolve to escape treatment.
“We owe them every weapon in our arsenal.
“Today’s approval delivers a win to these patients by granting them a targeted therapy designed specifically to overcome resistance, giving them more time before their disease progresses.”
The accelerated approval programme allows earlier approval of drugs that treat serious conditions and fill an unmet medical need based on surrogate or intermediate endpoints.
For Etcamah, approval was based on how long patients lived without their disease worsening, measured from when the resistance mutation was first detected in their blood.
The FDA said it has not yet been confirmed whether intervening when the mutation is detected, rather than waiting until disease progression is confirmed, results in a clinically meaningful benefit. Confirmatory studies are therefore required to verify and describe clinical benefit.
Angelo de Claro, director of the FDA’s Oncology Center of Excellence, said: “I commend both the FDA and the sponsor for their commitment to advancing cancer care and securing this accelerated approval.
“This marks the first FDA approval of a cancer therapy guided by the detection of a resistance mutation in circulating tumor DNA (ctDNA) before imaging tests show that the disease is progressing.
“But additional evidence is needed to confirm clinical benefit.”
Circulating tumour DNA, or ctDNA, consists of small pieces of tumour DNA released into the blood and can allow earlier molecular detection of resistance mutations.
The FDA also authorised the Guardant360 CDx assay as a companion diagnostic to identify patients with breast cancer who have ESR1 mutations for treatment with camizestrant.
Efficacy was assessed in a clinical trial comparing a switch to Etcamah plus a CDK4/6 inhibitor with continued treatment using an aromatase inhibitor plus a CDK4/6 inhibitor.
Estimated median progression-free survival was 16 months in the Etcamah group, compared with 9.2 months in the aromatase inhibitor group.
Etcamah’s prescribing information includes a boxed warning about the risk of irregular heart rhythm when taken with certain other medicines. It also includes warnings about an abnormally slow heart rate and potential harm to an unborn baby.
The FDA convened its Oncologic Drugs Advisory Committee for the application on 30 April 2026.
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