by Isabella Colonna, Deputy Digital Communications Editor
Menopause is increasingly recognised as a key, yet understudied, phase in women’s brain health. Although research is shedding new light on the biological changes associated with the menopausal transition, important questions remain about its relationship with neurological disorders and the implications for clinical practice. Recent work has highlighted the need to address these knowledge gaps and advance research towards more personalised neurological care (Bove and Dobson, Nature Reviews Neurology, 2026). On the occasion of World Menopause Day, Prof. Gennarina Arabia and Prof. Maria Teresa Ferretti, Co-Chairs of the EAN Coordinating Panel on Diversity, Equity and Inclusion in Neurology, share their perspectives on the current evidence, the challenges facing research, and the priorities for improving women’s brain health.
eanNews: Menopause is increasingly recognised as an important phase in women’s brain health. What do we know about the impact of the menopausal transition on brain health, and why should neurologists be more aware of it in clinical practice?
Gennarina Arabia (GA): Menopause is a systemic, hormonally driven transition which can significantly impact brain health, cognition, and long-term risk for neurodegenerative diseases. Neurologists must be aware of it because about two-thirds of people experience neurological symptoms during menopausal transition, including cognitive concerns, mood disturbances, and sleep problems. These symptoms can be severe and impact quality of life, even though they are often under-recognised by physicians. Several studies have also suggested that women who undergo premature or surgical menopause (e.g., bilateral oophorectomy) before age 45 face a higher risk of developing dementia, alongside heightened risks for Parkinson’s disease and stroke. The menopausal transition and the postmenopausal period can be associated with changes in existing neurological disorders’ courses and treatment responses. However, clinicians may lack sufficient scientific evidence to guide management of neurological conditions during this life stage.
eanNews: Menopause and its impact on brain health have remained relatively understudied for many years. Why do you think this has been the case? What scientific, clinical, and societal factors have contributed to this gap, and what is now driving change in the field?
Maria Teresa Ferretti (MTF): Ten years ago, I remember talking with a leading neurologist about menopause and neurodegenerative diseases. When I asked what they thought about the fluctuations in symptoms that many patients started to report back then, their position was that it could easily be attributed to sleep deprivation – and that was the end of the story. We have come a long way since then. Looking back, I think for very long the medical community has just accepted female hormonal transitions as a fact of life without pausing to understand what really happens biologically and how to tailor treatments accordingly. Clinically, the one-size-fits-all approach has for decades maintained a blind spot to women´s specific needs, which were often seen as noise instead of insights. For sure, there is a strong societal component as well; not just your standard ageism, but something worse, since aging in women is particularly stigmatised and taboo. Even in the field of women´s health, menopause tends to be an afterthought, with priority largely given to reproductive issues. However, menopause should logically be a priority – while not all women will experience a pregnancy, all of them, if they reach the right age, will go through menopause, and many of them will need support, especially if they live with a neurological condition. I think, with the increased interest in healthy aging and brain capital, there is higher societal awareness now of the existing knowledge gaps, as well as the opportunities that a better menopause handling might unlock.
eanNews: What do we know about the effects of menopausal hormone therapy on brain health and on its potential benefits and risks in women with neurological disorders?
GA: The Menopause Society and UK NICE recommend systemic menopausal hormone therapy (MHT) for perimenopausal symptoms, including vasomotor symptoms. As neurologists, we are increasingly called upon to interpret how MHT impacts overall neurological health. Beyond short-term symptom relief, long-term data over 18 years reveals reduced all-cause mortality and lower cardiometabolic morbidity. Many observational studies have suggested that the use of MHT may reduce the risk of neurodegenerative disorders, including Alzheimer disease and dementia. However, large longitudinal interventional cohorts are needed to fully clarify whether MHT is neuroprotective and, if so, in which groups and through which mechanisms. Furthermore, underlying neurological conditions can alter the benefit-to-risk profile of systemic MHT, requiring customised evaluations. As clinicians, we must develop clearer, structured frameworks to effectively communicate the complexity of these therapies to our patients and facilitate creation of expert multidisciplinary teams to adequately manage patients with neurological diseases during the menopausal transition.
eanNews: Despite growing interest in menopause and brain health, major gaps remain in the evidence. What are the most important unanswered questions about the biological mechanisms linking menopause to brain health, and what types of research are needed to address them?
MTF: There is a wealth of new research studies appearing almost daily on the topic. This is timely and highly needed to create an evidence base on which to build future guidelines. It is astonishing to see how little we know yet in terms of biological changes that accompany perimenopause and menopause. While I think we are gathering important insights thanks to proteomics and imaging, I do see big gaps on the clinical implementation of such findings. First, the link between menopause and several neurological conditions (that either start at menopause or worsen in their presentation when women experience perimenopause), is far from being elucidated. At the same time, there is very little understanding on the interaction between menopausal hormonal treatment and most brain diseases – an area much in need of clarification. Being an Alzheimer researcher, the question of MHT in preventing Alzheimer is a very pressing to me, as this might be a safe and cost-effective measure that women could easily take. Finally, I see big opportunities, once the evidence base will be mature, for sex-adjusted clinical guidelines, with possibly menopause-specific adjustments, towards precision medicine.
The perspectives shared by Prof. Arabia and Prof. Ferretti highlight the need for greater awareness, stronger evidence and more personalised approaches to women’s brain health.
Menopause is not just a reproductive milestone; it is a brain health issue that neurology can no longer afford to overlook. Addressing the existing research gaps and translating scientific advances into clinical practice are essential to ensuring that women receive the care they deserve. It is time to put menopause on the neurological agenda.
