HRT and Dementia: What Do We Really Know About Menopause and Brain Health?
If you’re a woman in your 40s, 50s or beyond, chances are you’ve heard some fairly conflicting things about HRT over the years.
It’s good for you. It’s bad for you. It increases certain risks. It might protect against others.
And now there’s another question receiving increasing attention:
Could HRT have an impact on our brain health and our risk of dementia?
This one really caught my attention.
Brain health is something I care deeply about, both professionally and personally. I know that I carry one copy of the APOE4 gene variant, which is associated with an increased risk of developing Alzheimer’s disease. That doesn’t mean I will develop it – genes are not destiny – but it does mean I’m particularly interested in what the evidence tells us about the things we can influence.
So when I recently read an article by Professor Eef Hogervorst, a neuropsychologist and epidemiologist who has spent almost 40 years researching menopause hormones, cognition and dementia, I wanted to dig a little deeper.
And some fascinating new research has just been published.
First, why would oestrogen affect the brain at all?
We tend to think about oestrogen as a reproductive hormone, but its effects extend far beyond our reproductive system.
Oestrogen is involved in processes including brain glucose utilisation, neurotransmitter activity, blood flow, inflammation and the maintenance of connections between brain cells.
So when oestrogen levels change dramatically through the menopausal transition, it isn't unreasonable that women may notice changes in areas such as memory, concentration and mental clarity.
Anyone who has walked into a room during perimenopause and completely forgotten why they went there may be nodding at this point!
But temporary menopausal brain fog and developing dementia are very different things. And this is where we need to be careful with the headlines.
So does HRT protect women against dementia?
The scientifically accurate answer at the moment is:
We don't know.
And I think that's important.
A major study published in August 2026 followed 183,450 postmenopausal women from the UK Biobank for an average of 13.3 years.
Women who had used HRT for at least a year had a 10% lower relative risk of all-cause dementia than non-users. The association was stronger in some groups, including women who had experienced surgical menopause and – particularly interesting to me – women carrying APOE4.
The researchers also found that starting HRT between the ages of 46 and 56 was associated with reduced dementia risk, whereas starting after 56 was not.
That is certainly interesting.
But – and this is a very important but – this was an observational study.
It can tell us that two things are associated. It cannot prove that taking HRT was what caused the lower dementia risk.
That distinction matters enormously.
In fact, a 2025 systematic review and meta-analysis involving more than one million women concluded that the evidence overall did not show that menopausal hormone therapy either increased or decreased dementia risk. The authors specifically concluded that HRT shouldn't currently be prescribed for the purpose of preventing dementia.
So this isn't a blog telling every woman to take HRT to protect her brain.
It is a blog saying: this is an area of women's health research that deserves our attention.
But didn't we used to be told that HRT was dangerous?
This is where some of the confusion originates.
An important early study – the Women's Health Initiative Memory Study – found an increased dementia risk in women receiving a particular form of combined hormone therapy.
But there is a crucial detail that can get lost when those results are discussed today.
The women in that dementia trial were 65 or older when they started hormone therapy. The treatment studied also included conjugated equine oestrogen, with or without medroxyprogesterone acetate – not necessarily the same formulations used by many women today.
Researchers have therefore spent years investigating whether when HRT is started, as well as the type, dose and route of hormones used, might make a difference.
The British Menopause Society currently says women can be reassured that HRT is unlikely to increase dementia risk or adversely affect cognitive function when it is started before 60. However, it also states very clearly that HRT should not be started specifically to prevent dementia.
In other words, the story is far more nuanced than either:
“HRT causes dementia”
or
“HRT prevents dementia.”
Neither statement accurately reflects what we currently know.
HRT is only one tiny piece of a much bigger brain-health picture
This is perhaps the most important part of this entire conversation.
The 2024 Lancet Commission identified 14 potentially modifiable risk factors for dementia, including physical inactivity, high blood pressure, high LDL cholesterol, diabetes, smoking, excessive alcohol consumption, obesity, hearing loss and social isolation.
Its analysis suggests that addressing modifiable risk factors could potentially prevent or delay almost half of dementia cases.
There are no guarantees. We cannot control our age or our genes.
But there is still an enormous amount we can influence.
For me, that means:
Moving my body and strength training regularly.
Protecting my metabolic and cardiovascular health.
Eating a predominantly whole-food, nutrient-rich diet with adequate protein and healthy fats.
Prioritising sleep rather than treating it as an optional extra.
Keeping alcohol low.
Staying socially connected and continuing to learn and challenge my brain.
Keeping an eye on things such as blood pressure, blood glucose, cholesterol, hearing and other health markers as I get older.
None of those things is particularly glamorous.
But collectively, they matter.
This is why midlife health matters so much
One of the messages I desperately want women to understand is that looking after ourselves in our 40s, 50s and 60s isn't simply about fitting into our jeans.
It's about the woman we want to be at 70, 80 and beyond.
Strong enough to get off the floor.
Fit enough to travel.
Healthy enough to play with grandchildren.
Independent.
Sharp.
Engaged with life.
And while none of us can guarantee that future, we can give ourselves the best possible foundations for it.
For some women, appropriately prescribed HRT may be one part of their menopause healthcare. That's a conversation to have with a suitably qualified healthcare professional based on your symptoms, medical history and individual risks and benefits.
But whether we take HRT or not, the fundamentals still matter.
Move. Build muscle. Eat well. Sleep. Look after your heart. Stay connected. Challenge your brain.
We don't need to wait until we're older to start protecting the health we'll depend upon later.
And perhaps that's the most empowering message of all.
Ready to start putting some of those foundations into place?
My next 6-week programme will be my FINAL Challenge of 2026.
So if you've been watching from the sidelines and telling yourself, “I'll do the next one…”, this really is the moment to stop postponing it.
Over six weeks we'll focus on the everyday habits that can transform how you feel – nutrition, movement, strength, consistency and taking proper care of yourself.
Because this has never just been about losing weight.
It's about building a stronger, healthier body for the life you want to keep living.
Jen x
This article is for education and information only and is not individual medical advice. HRT is a prescription treatment and decisions about starting, stopping or changing it should be discussed with an appropriately qualified healthcare professional.
Comments