Menopause and Brain Health in Scotland
In this blog, Rachel Tulloch, post-diagnostic support link worker and PhD student at King’s College London, shares findings from the early stages of her research project on Women’s Brain Health and the Menopause.
Recently, menopause has received more attention, especially after the NICE guidelines (1) were updated in 2026. Public figures like Davina McCall have also helped raise awareness about women’s health and menopause (2). Even with better guidance for healthcare providers and more open discussions, many women in the UK still struggle to find the right care and support during this important phase of their lives (3). This topic became of interest to me because, as an Alzheimer Scotland Post Diagnostic Support Dementia Link Worker, I see those living with dementia in their first year of diagnosis, and many of the individuals I see are women. This got me thinking…what happens to women that doesn’t happen to men, to the same extent? Could the menopause be a risk factor for dementia?
During the menopausal transition, levels of oestrogen, progesterone, and testosterone fluctuate, which can lead to a variety of symptoms. Some are more familiar, like changes in the menstrual cycle. Others are rooted in cognitive processes such as night sweats, hot flushes, low mood, anxiety, and brain fog. However, because the body contains many oestrogen receptors, other less well-known cognitive symptoms can also emerge as hormone levels decline. These can include migraines, insomnia, difficulty concentrating and increased forgetfulness1. Interestingly, some symptoms of menopause can overlap with symptoms experienced by individuals with cognitive decline. This occurs because oestrogen plays a key role in supporting various cognitive functions, including memory, emotion, and overall cognition. When natural hormone levels drop, these cognitive-related symptoms may become more noticeable.
There is a growing body of research exploring the connection between menopause and Alzheimer’s disease, particularly focusing on how the protective effects of oestrogen might influence brain health as we age (4, 5, 6). While this research continues to unfold, it’s equally important to raise awareness and promote education about menopause for women of all ages, ensuring they can access support promptly when they need it. This education is needed because it can sometimes be tricky for women to recognise whether their experiences are due to lifestyle factors, like caring for children or aging parents, work pressures, or general stress, or related to menopause. Since the average age of menopause onset coincides with midlife stress (typically between 45 and 55 in the UK (7)), it’s helpful for women to become aware of possible menopause symptoms early on. This awareness encourages seeking support, which can alleviate current symptoms and also help protect long-term brain, bone, and heart health.
Unfortunately, research shows that there are gaps in awareness about menopause among women and their healthcare providers (8, 9, 10, 11, 12). This can be frustrating, especially when women seeking help are told they’re too young or are advised to have blood tests that often don’t provide clear answers (3). Some women are prescribed antidepressants or asked to reduce their work hours to manage stress, which can leave them feeling unheard or unsupported, despite their efforts to seek help (13). According to current NICE guidelines1, blood tests before age 45 are generally unreliable for confirming menopause, and antidepressants can sometimes worsen symptoms if they are linked to hormonal changes
rather than anxiety or depression. Still, inconsistent support remains a challenge for women navigating the menopausal transition (12). If women aren’t aware that their symptoms could be related to menopause, they might delay seeking help and miss the crucial opportunity to consider hormone replacement therapy, which could make a meaningful difference.
My research is looking into the current understanding and awareness of menopause in Scottish women. The research shows that the sooner symptoms are recognised and supported, the better for our overall health. However, because knowledge about menopause varies a lot among women and healthcare providers, figuring out when support is needed can be difficult. I aim to fill this knowledge gap in with the studies in my PhD. I recently completed an in-depth systematic review exploring the barriers to seeking help for psychological and neurological menopausal symptoms in the UK. I found several barriers to getting support, including (i) limited awareness and understanding of menopause among women and their healthcare providers; (ii) beliefs that menopause is a natural part of aging, leading women to think they should just accept it; (iii) cultural factors like stigma and feelings of losing their womanhood; (iv) healthcare provider challenges, such as working with outdated medical models or lacking confidence in prescribing; (v) systemic issues like high workload pressures and missing referral options; and (vi) workplace obstacles, including lack of support or policies to assist menopausal staff. These obstacles can cause delays in women seeking the help they need, which could increase health risks for their bones, heart, and brain later on.
During my research process, I found a lack of Scottish-specific research, with studies either not reporting where in the world their participants lived or including participants mainly from England (12). This means that the Scottish voice is not heard and may be underrepresented. As the devolved nations have their own Women’s Health Plans/Strategies, and NHS Scotland offers free prescriptions, research and recommendations for Scotland must be created by the people these strategies most affect. Therefore, the participant-facing sections of my project will focus purely on a Scottish perspective, with results being used to support the Scottish Government’s aim of improving support and understanding of women’s brain health in the context of menopause.
The current stage of the project involves gathering information about symptom knowledge and understanding from premenopausal women in Scotland to understand where the gaps in knowledge are, with a view to filling those with training and education programmes. I have nearly reached my participant target number, and I am really looking forward to analysing the results in a few months’ time. Next, I plan to interview women who have been to their doctor to discuss the menopause. I want to know what happened in those consultations, what went well and what could have been better. This will help me to make recommendations in relation to consultations to try to improve them and make them more patient-focused. Finally, I hope to speak with the doctors who are having these consultations, explore where the training gaps are, look at how these consultations could better serve the women who need them and the doctors providing support.
I am always keen to explore this topic further and welcome opportunities to collaborate, engage in discussion, receive feedback, and connect with others who share an interest in this area. If you are interested in taking part in any stage of my project, please get in touch. You can reach me via: rachel.tulloch@kcl.ac.uk
References
1. National Institute for Health and Care Excellence (2026). Menopause. Available via: https://cks.nice.org.uk/topics/menopause/#:~:text=Menopause%20is%20when%20menstruation%20stops [Accessed on: 22/08/2026].
2. Jermyn, D. (2025). Whose menopause revolution? Investigating the UK’s ‘Davina effect’ and the contemporary menopause market. European Journal of Cultural Studies, 28(4), 1039- 1057. https://doi.org/10.1177/13675494241287931
3. Barber, K., & Charles, A. (2023). Barriers to accessing effective treatment and support for menopausal symptoms: a qualitative study capturing the behaviours, beliefs and experiences of key stakeholders. Patient preference and adherence, 17, 2971–2980. https://doi.org/10.2147/PPA.S430203
4. Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood. K., Samus, Q., Shirai, K., Singh-Manoux, A., Schneider, L. S., Walsh, S., Yao Yao, M., Sommerlad, A & Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the lancet standing Commission. Lancet, 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0
5. Mosconi, L., Berti, V., Dyke, J., Schelbaum, E., Jett, S., Loughlni, L., Jang, G., Rahman, A., Hristov, H., Pahlajani, S., Andrews, R., Matthews, D., Etingin, O., Ganzer, C., de Leon, M., Isaacson, R & Brinton, D. R.. (2021). Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports 11(10867) https://doi.org/10.1038/s41598-021-90084-y
6. Mosconi, L., Rahman, Diaz, I., Wu, X., Scheyer, O., Webb Hristov, H., V., S., I., R. S., de Leon, M & Brinton, R. D. (2018). Increased Alzheimer’s risk during the menopause transition: A 3-year longitudinal brain imaging study. PLOS One 13(12), e0207885. https://doi.org/10.1371/journal.pone.0207885
7. National Institute on Ageing (2024). What is Menopause? Accessed via: https://www.nia.nih.gov/health/menopause/what-menopause#:~:text=Menopause%20is%20a%20point%20in [Accessed on: 22/08/2026].
8. Aljumah, R., Phillips, S., & Harper, J. C. (2023). An online survey of postmenopausal women to determine their attitudes and knowledge of the menopause. Post Reproductive Health, 29(2), 67–84. https://doi.org/10.1177/20533691231166543
9. Anto, A., Basu, A., Selim, R., & Eisingerich, A. B. (2025). Women’s Menopausal Experiences in the UK: A Systematic Literature Review of Qualitative Studies. Health Expectations, 28(1), e70167. https://doi.org/10.1111/hex.70167
10. Harper, J. C., Phillips, S., Biswakarma, R., Yasmin, E., Saridogan, E., Radhakrishnan, S., Davies, M., Talaulikar, V., & Talaulikar, V. (2022). An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Women’s Health, 18, 17455057221106890. https://doi.org/10.1177/17455057221106890
11. Munn, C., Vaughan, L., Talaulikar, V., Davies, M. C., & Harper, J. C. (2022). Menopause knowledge and education in women under 40: Results from an online survey. Women’s Health, 18, 17455057221139660. https://doi.org/10.1177/17455057221139660
12. Tulloch, R. & Gaffiero, D. (2026). Menopause, Brain Health and Hormone Replacement Therapy: Gaps in Knowledge and Policy Solutions from a Scottish Perspective, Post Reproductive Health, 32(1), 77–81. https://doi.org/10.1080/20533691.2026.2631221
13. Hendriks, O., McIntyre, J. C., Rose, A. K., Crockett, C., Newson, L., & Saini, P. (2025). The mental health challenges, especially suicidality, experienced by women during perimenopause and menopause: A qualitative study. Women’s Health, 21, 17455057251338941. https://doi.org/10.1177/17455057251338941