A large UK Menopause and Mental Health study finds that menopause is linked to higher anxiety, depression, and sleep problems. At the same time, hormone replacement therapy does not ease those effects and is associated with smaller brain volumes in key regions tied to mood and memory.
Menopause is associated with worse mental health and measurable brain changes, according to an analysis of nearly 125,000 women in the UK Biobank, one of the largest health datasets in the world. Researchers say hormone replacement therapy, often prescribed to relieve menopausal symptoms, does not appear to offset these effects.
The study analyzed self-reported mental health, cognitive tests, and brain imaging data from women aged 40 to 69. About fifteen percent of women in England now use hormone replacement therapy, known as HRT, reflecting a sharp rise in recent years.
“We see a consistent pattern of increased anxiety, depression, and sleep disturbance after menopause,” the authors wrote. “These effects are not reduced in women using HRT.”
Menopause Tied to Mental Health Declines
Post‑menopausal women reported higher levels of anxiety, depression, insomnia, and tiredness compared with pre‑menopausal women, according to the Menopause and Mental Health study. Those using HRT reported the highest burden of symptoms across most measures.
Women on HRT were more likely to say they had seen a general practitioner or psychiatrist for anxiety or depression. They were also more likely to report frequent low mood, restlessness, and lack of energy during the prior two weeks.
“These findings from the Menopause and Mental Health study highlight menopause as a critical period for women’s mental health,” said one of the study authors, noting that mood symptoms are often underrecognized or attributed solely to aging.
Cognitive performance showed smaller differences. Memory tasks, including digit span and prospective memory, were largely similar across groups. Reaction times were slightly slower in post-menopausal women not using HRT, but researchers said the effect was modest.
Brain Scans Show Structural Differences
In a subset of more than ten thousand women who underwent MRI scans, researchers observed reduced gray matter volumes in the hippocampus, entorhinal cortex, and anterior cingulate cortex after menopause.
“These brain regions are central to emotion regulation, memory, and cognitive control,” the authors reported. Reduced volumes were most pronounced in women using HRT, even after adjusting for age, education, income, and prior depression.
The hippocampus and anterior cingulate cortex are often implicated in mood disorders and sleep problems. Smaller volumes in these areas have previously been linked to depression and anxiety.
Researchers cautioned that the study design does not prove HRT causes these changes. “It is equally plausible that women with worse symptoms are more likely to be prescribed HRT,” the authors wrote.
HRT Use May Reflect Pre-Existing Symptoms
To explore that possibility, the researchers examined women who were not using HRT at the initial assessment but began treatment later. Those women already reported higher levels of anxiety and depression before starting HRT.
“That suggests baseline mental health differences may drive who receives HRT,” the Menopause and Mental Health study noted. UK guidelines recommend considering HRT for menopausal symptoms, including low mood, but not as a treatment for anxiety or depression alone.
Experts not involved in the research say the findings underscore the need for broader support. “Hormones are only one piece of the puzzle,” said an independent women’s health specialist. “Mental health screening and tailored care during menopause are essential.”
The authors noted limitations, including reliance on self-reported symptoms and lack of data on specific HRT formulations. They also said UK Biobank participants tend to be healthier than the general population.
The scale of the Menopause and Mental Health study offers rare insight into how this transition affects the brain and overall mental health. Researchers emphasize that future work should focus on personalized treatments and improved mental health care during menopause.
