Menopause is more than just a change in reproductive status. It’s a profound transformation, a period that can last a decade or longer, affecting millions worldwide.

Recent research from Puerto Rico, conducted by the BRAVE Lab at Ponce Health Sciences University, has shone a spotlight on how menopause actively reshapes the brain. The team undertook a comprehensive review of studies published between 2020 and 2025, seeking to clarify the mysterious link between hormonal changes and neurological health.

Their findings reveal that the changes brought on by menopause go far deeper than hot flashes and night sweats—they may alter brain structure in ways that influence thinking, memory, and mood.

The menopause transition is notoriously challenging for many. While symptoms such as hot flashes are well known, less visible are the effects rippling through the brain’s architecture.

The BRAVE Lab researchers combed through peer-reviewed studies in major medical databases, focusing on the most recent evidence. Their goal: to map out observable patterns in neuroanatomical changes as people pass through perimenopause and full menopause.

Among the most consistent findings is a reduction in grey matter volume. Grey matter underpins critical cognitive functions—memory, attention, decision-making. A decrease is generally associated with cognitive decline.

Yet, there’s a twist. Some studies suggest this loss may not be permanent; there is evidence of partial recovery in the postmenopausal period. The brain, it seems, is capable of adaptation and reorganisation even after significant hormonal disruption.

White matter also comes under scrutiny. Researchers noted a marked increase in white matter hyperintensities—bright spots that show up on MRI scans, signalling stress or damage to neural pathways. These hyperintensities are more pronounced in those who experienced early menopause or frequent vasomotor symptoms, including hot flashes and night sweats.

Such changes could explain the everyday difficulties with memory, concentration, and mood that so many report during menopause, as well as hint at an increased vulnerability to neurological conditions in later life.

The literature review’s findings point to measurable shifts in brain structure during menopause. These shifts may have far-reaching implications for memory, thought processes, and emotional stability. It’s not just about feeling “off” now; these changes could be laying foundations for future health outcomes.

Yet, there’s reason for reassurance. Experts caution against interpreting loss of grey matter as inevitably leading to lasting cognitive impairment. The link between menopause-induced structural changes and functional decline remains unclear.

Forgetfulness and poor concentration—often described as “brain fog”—are common complaints during menopause. However, current evidence does not support an association between these symptoms and a higher risk of dementia down the road. That’s comforting news for many navigating this transition.

The question of hormone therapy during menopause continues to generate debate. Some leading neurologists advocate for early treatment with oestrogen, suggesting that responsiveness to hormone therapy diminishes with time.

The loss of neuro-protective oestrogen may contribute to increased susceptibility to Alzheimer’s disease—a condition that disproportionately affects women—but not all menopausal women will develop it.

The possibility of a cause-and-effect relationship between hormone therapy and cognitive protection remains under investigation.

Menopause itself is defined as twelve consecutive months without menstruation, marking the point when ovaries cease producing most oestrogen and progesterone. Perimenopause—the years leading up to menopause—can stretch for a decade or longer and brings fluctuating hormone levels with a host of symptoms: irregular periods, hot flashes, night sweats, mood swings, fatigue.

Some reach menopause earlier due to medical interventions or cancer treatments. Each individual’s experience is unique.

Brain fog is one symptom that often goes overlooked yet causes significant distress. Difficulty remembering names, losing track of thoughts, struggling to concentrate—these experiences are frustrating, sometimes anxiety-inducing. There’s a growing recognition among clinicians that these cognitive symptoms are real, not imaginary, and deserve attention.

Treatment options exist but must be tailored to each person’s needs and risks. Hormone replacement therapy (HRT) can offer relief from hot flashes and night sweats and may help mitigate some cognitive symptoms.

Yet not everyone is suitable for HRT—medical history matters. Consulting with healthcare providers is essential to weigh benefits against potential risks, including cardiovascular disease or certain cancers.

The review from Puerto Rico adds weight to the conversation about menopause and brain health. By cataloguing consistent neuroanatomical changes across recent studies, it provides a valuable reference point for clinicians and researchers alike.

The evidence supports what many have observed anecdotally: menopause can feel like a mental fog rolling in, clouding clarity and focus, but it does not spell inevitable decline.

More research is needed—especially long-term studies following women through perimenopause into later life—to unravel the precise mechanisms at play and identify strategies for support or intervention. Understanding how hormonal shifts interact with neural plasticity could offer new avenues for protecting cognitive health as we age.

The societal impact of these findings should not be underestimated. Menopause affects half the population directly—and nearly everyone indirectly through loved ones, colleagues, friends. The stigma surrounding its symptoms is slowly fading as science illuminates their underlying causes. This shift towards openness and evidence-based support is vital.

It’s time for greater awareness among healthcare professionals and the public alike. Menopause is not merely an end—it’s a transition with tangible effects on brain structure and function. Approaching it as a neurological event as much as a reproductive one opens doors for more effective care and support.

Those experiencing menopause should feel empowered to discuss their cognitive symptoms without shame or fear of being dismissed. Clinicians equipped with current research can offer nuanced advice—reassuring those who worry about dementia, guiding those considering hormone therapy, validating the lived experiences of brain fog.

Incorporating findings like those from the BRAVE Lab review into routine care will help normalise conversations around menopause and mental health. It can also foster research into interventions that bolster brain resilience during this critical period.

The average age of menopause hovers around 51 to 52, but experiences vary widely. Whether entering naturally or due to medical intervention, the process can be disruptive—or barely noticeable—for different individuals. Recognising this diversity is crucial when interpreting research findings or designing treatment plans.

For those struggling with symptoms such as hot flashes, mood swings, or cognitive impairment, practical steps are available beyond medication alone. Lifestyle modifications—regular exercise, balanced nutrition, stress management—may help alleviate some effects of hormonal shifts on both body and mind.

There’s increasing interest in non-hormonal therapies for those who cannot take HRT or prefer not to. Cognitive behavioural strategies, mindfulness practices, sleep hygiene interventions—all have shown promise for managing mood swings and improving concentration during menopause. Consult your doctor for the best interventions.

As scientific understanding deepens, hope grows for targeted therapies that address not just physical symptoms but also support brain health through this transition and into older age.

Menopause marks an important turning point—a moment when neurological health deserves as much attention as physical well-being. Science is catching up with lived experience, offering clarity where once there was confusion.

The new literature review from Puerto Rico sets the stage for further enquiry at the intersection of endocrinology and neuroscience. Its findings underscore the need for holistic care approaches that acknowledge both the visible and invisible effects of menopause on everyday life.

For anyone approaching or navigating menopause today, these insights offer reassurance: cognitive changes are real but rarely catastrophic; adaptation is possible; help is available; more answers are on the horizon.