Women who reached menopause earlier had faster declines in memory and thinking in later life, a US study of 2,603 older women suggests. Its senior author sees midlife as a window to act on risk factors, and tackling such factors could prevent or delay nearly half of dementia cases across the population.
M. Pia Campagna, a postdoctoral fellow at the University of California San Francisco (UCSF), set out to test whether age at menopause tracks with memory decades later. Her team followed 2,603 women in two long-running US studies of ageing for up to 18 years. They were 78 on average when they enrolled.
Women who reached menopause earlier had faster declines in memory and thinking, the team reported in JAMA Network Open on 25 August 2026. Earlier menopause was also linked to an earlier diagnosis of Alzheimer’s disease. Riley Bove, a neurologist at UCSF, was senior author.
The women came from the Religious Orders Study and the Rush Memory and Aging Project. The team also examined brain scans from 774 women and autopsy findings from 1,287. Because the study is observational, it shows an association and cannot show that earlier menopause causes decline.
Natural and surgical menopause showed different patterns
Each year of earlier menopause was associated with faster decline in overall thinking skills and in episodic memory. Episodic memory is the ability to recall personal events and experiences.
In women whose menopause happened naturally, earlier menopause was linked to faster build-up of white matter hyperintensities. These are areas of damage to the brain’s white matter that show up on MRI scans. This link did not appear in women whose menopause followed surgery to remove the ovaries. The authors suggest the gradual hormone changes of natural menopause may explain the difference.
Links with overall brain shrinkage were present but small. The associations persisted, and in some measures grew, decades after menopause.
Hormone therapy and other open questions
Menopausal hormone therapy did not change brain volume trends in exploratory analyses, though few women in the study used it. “One major unanswered question is whether menopausal hormone therapy is protective against brain aging,” Bove said, in comments reported by PsyPost. She added that higher-quality trials “have not shown that it is, but perhaps women have not yet been followed for long enough.”
Women reported their own age at menopause, so some recall errors are possible. Data were missing on pregnancies, breastfeeding and use of the contraceptive pill. Of the women with cognitive data, 92.2% were White and non-Hispanic, so the results may not apply equally to other populations. The findings describe group averages and can’t predict any one woman’s risk.
Using the menopause years to protect the brain
The authors propose age at menopause as a “midlife-identifiable marker for risk stratification.” In practice, doctors could use it to spot women who may benefit from earlier attention to brain health.
“This study is not intended to alarm women,” Bove said. “A majority of women go through menopause and maintain brain health over their postmenopausal lifespan.” She described perimenopause as “a window of opportunity” to address risk factors such as sleep, mood, exercise and blood pressure.
The 2024 Lancet Commission on dementia estimated that nearly half of dementia cases could be prevented or delayed by tackling 14 risk factors across life. They include high blood pressure, hearing loss, physical inactivity, smoking, depression and social isolation. The Commission added two in 2024: high LDL cholesterol in midlife and untreated vision loss in later life. Its estimate covers the whole population, women and men.
Women carry a heavier share of dementia, the World Health Organization says, both directly and as carers. Dementia affected 57 million people worldwide in 2021, and women provide 70% of care hours for people living with it.
The WHO advises regular physical activity, not smoking, limiting alcohol and keeping blood pressure, cholesterol and blood sugar under control. It also recommends staying socially and mentally active, and using hearing aids when needed.
This article is for information only and does not replace advice from a qualified health professional.
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