Today, women now spend more than a third of their lives post-menopause. Understanding how hormonal changes influence brain health has never been more urgent.
One of the most intriguing areas of research today asks: Can hormone replacement therapy (HRT) reduce the risk of Alzheimer’s disease?
Let’s find out more.
Key Takeaways
- Alzheimer’s risk increases with falling oestrogen after menopause.
- New studies show that timing matters: Starting HRT near menopause, possibly even before the last period, may offer brain-protective benefits.
- Early studies indicate that women on HRT experience improved memory and healthier brain regions associated with memory and emotion.
- HRT isn’t a guarantee, but it may tilt the odds in your favour when started early and used wisely.
- Lifestyle and early screening (such as ReCOGnAIze™) are also key components of prevention.
How Menopause Affects the Brain
Menopause is not simply the end of a woman’s reproductive years; it’s a neuroendocrine transition:
- Oestrogen has far-reaching effects across the brain – sharp declines bring consequences.
- Oestrogen plays a critical role in synaptic plasticity – affecting how our brain cells communicate.
- It also affects other aspects – how the brain fuels itself (glucose metabolism), cerebral blood flow, and how neurons defend against damage (neuroprotection).
- Oestrogen also impacts inflammation and the accumulation of amyloid plaques – the abnormal protein build-ups linked to Alzheimer’s.
When oestrogen levels fall, these protective processes become less robust. It’s no coincidence that women are more likely than men to develop Alzheimer’s disease – and that risk begins to climb in the post-menopausal years.
What the Evidence Tells Us About HRT and Alzheimer’s
A recent study found that women who used HRT, particularly those carrying the APOE4 gene (a known Alzheimer’s risk factor), had improved memory and larger entorhinal and amygdala volumes.
The entorhinal cortex is one of the first brain regions affected by Alzheimer’s, and preserving its size may help maintain memory formation and spatial navigation. On the other hand, the amygdala supports emotional regulation and memory, and protecting it could help slow some of the behavioural and emotional changes seen in Alzheimer’s.
In any medical practice, timing often has a significant influence on outcomes. While research is ongoing, emerging evidence suggests that starting HRT closer to menopausal transition may offer greater potential benefits for brain health than beginning it years later.
Studies have also found that women who began HRT during this window had a significantly reduced risk of developing Alzheimer’s disease compared with those who started it later, as much as by 32%. In contrast, initiating HRT more than a decade after menopause did not show the same protective effect.
With that said, HRT is not a guarantee against Alzheimer’s. And since this is an evolving field, the best time to begin treatment is arguable and depends on individual health, hormone profiles, and risk factors.
HRT Is Not The Sole Answer
Even if HRT offers neuroprotective benefits, it is only part of the story.
Alzheimer’s risk is multifactorial, and lifestyle remains one of the most powerful tools for prevention. The same interventions that protect your heart and metabolic health also protect your brain.
These include:
- Regular physical activity, particularly aerobic and strength training.
- Metabolic health: Blood pressure, cholesterol, and blood sugar levels.
- A nutrient-rich, Mediterranean-style diet high in fibre, antioxidants, and healthy fats.
- Quality sleep and good stress management.
- Ongoing mental stimulation and social connection.
Recognise Alzheimer’s: Why Early Screening Matters
One of the most sobering facts about Alzheimer’s is that pathological changes can begin 10–20 years before symptoms appear. By the time memory loss is obvious, the disease is often well advanced.
This is why early screening and monitoring are so important. At Prologue Clinic, we offer ReCOGnAIze™, an advanced cognitive screening tool designed to detect subtle changes long before they become clinically significant. With early detection, we can intervene earlier, optimising lifestyle, addressing reversible risk factors, and, if appropriate, discussing well-timed HRT therapy.
Knowing where you stand gives you the chance to act while it still matters.
Take the First Step: Screen Early, Think Long-Term
If you’re navigating menopause or perimenopause and wondering how best to protect your cognitive health, don’t wait until symptoms appear. A simple screening can provide you with vital insights into your brain health and help shape the steps you take tomorrow.
At Prologue Clinic, we combine advanced screening tools like ReCOGnAIze™ with evidence-based care, personalised HRT guidance, and holistic support for your long-term wellbeing.
Book your ReCOGnAIze™ screening today and take a decisive step in protecting your future.