The Menopausal Transition and Brain Health*
Date: October 20, 2026
Time: 9:15 am to 10:45 am
Room: Pacific Jewel Ballroom
Track: Plenary
Session Description
The menopausal transition represents a critical period of neuroendocrine change with important implications for brain health and neurological disease. Declines in estrogen during perimenopause and menopause are associated with changes in cognition, mood, and disease risk, yet the role of menopausal hormone therapy (MHT) in preserving brain health remains controversial.
Use of MHT declined following the Women’s Health Initiative (WHI), which reported an association between postmenopausal hormone therapy and increased dementia risk. However, subsequent analyses and more recent studies suggest that timing of initiation, patient selection, and formulation of therapy significantly influence outcomes. Emerging data support a “critical window” hypothesis, in which initiation closer to the menopausal transition may have neutral or beneficial cognitive effects. Contemporary MHT regimens also differ substantially from those studied in the WHI.
The impact of menopause on brain health can be further examined through biomarkers and disease risk. Alzheimer’s disease is more prevalent in women than in men, and neuropathological changes may begin during the menopausal transition. On PET imaging, historical hormone therapy use is associated with increased tau deposition in women older than 70, but not in younger women, suggesting an age-dependent effect.
Beyond neurodegeneration, menopause and MHT influence a range of neurological conditions, including migraine, stroke, epilepsy, and multiple sclerosis. Despite this, there remains limited guidance for neurologists on how to incorporate hormonal status and therapy into clinical care.
This plenary session will provide a multidisciplinary review of the menopausal transition and its impact on brain health, address ongoing controversies surrounding MHT, and highlight opportunities for future research and clinical consensus.
Learning Objectives
At the conclusion of this session, attendees will be able to:
- Describe the historical controversy surrounding menopausal hormone therapy, including interpretations of the Women’s Health Initiative and more recent evidence guiding patient selection and treatment approaches.
- Discuss changes in brain biomarkers during perimenopause and menopause, and evaluate current evidence on the impact of MHT on brain aging.
- Outline the effects of menopause and MHT on neurological disorders, including migraine, stroke, multiple sclerosis, and epilepsy, and their implications for clinical care.
Speakers
Menopausal Hormone Therapy and Brain Health: From Controversy to Consensus
Description
As the use of menopausal hormone therapy (MHT) continues to receive increasing attention, controversy persists in social media and some research circles regarding its potential benefits and risks for cognitive health. Medical societies have reached consensus that MHT should not be used to treat or prevent cognitive decline or dementia, except in women with early or premature menopause. However, important gaps remain in our understanding of the relationship between MHT, menopause, and cognitive health.
This presentation will examine the evidence underlying current medical society recommendations regarding MHT and cognition. Participants will review key findings from randomized clinical trials and observational studies, explore evidence regarding the timing of MHT initiation and cognitive outcomes, and discuss important limitations and gaps in the existing literature. Topics will also include the evidence regarding MHT and dementia risk and the distinction between treatment of menopausal symptoms and prevention of cognitive decline.
Attendees will leave with a greater understanding of the evidence supporting current guidelines on MHT and cognition and practical insights into how to communicate the benefits, risks, and uncertainties of MHT with patients.
Menopause, MHT and Alzheimer’s Biomarkers in Women
Description
As women age, the menopausal transition represents a major biological inflection point that may influence brain aging and Alzheimer’s disease (AD) risk. Women account for two thirds of patients living with AD, yet their trajectories of disease progression are complex. Studies suggest that women demonstrate more rapid tau accumulation than men, as well as faster rates of cognitive decline as disease burden increases. There is also a body of evidence that shows greater resilience to cognitive symptoms of AD in women relative to men. Reproductive factors, including the timing of menopause and exposure to menopausal hormone therapy (MHT), may contribute to these relatively counter-intuitive findings.
This presentation will examine the intersection of menopause, MHT, and AD biomarkers through the lens of both risk and resilience. Participants will review evidence for sex differences in cognitive and biomarker trajectories across the AD continuum, including patterns of preserved cognition despite early pathology, and subsequent accelerated tau accumulation and cognitive decline in women relative to men. The presentation will explore how reproductive factors, including age at menopause, and the timing and formulation of MHT may influence these trajectories, while highlighting important limitations of the current observational evidence and areas where prospective data are still needed.
Attendees will leave with a greater understanding of how menopause and hormonal exposures may intersect with AD biology, why women may show distinct patterns of resilience and vulnerability across the disease course, and how emerging biomarker research can help clarify the role of reproductive aging in later-life brain health.
Menopause, MHT and Neurologic Disease
Description
All women who survive to midlife undergo menopause. Managing the menopausal transition goes beyond the purview of gynecologists and requires a collaborative approach in neurological care. Menopause brings profound changes to female physiology as women transition from fertility to post-fertility, which can in turn affect underlying neurological disorders.
Using clinical case vignettes, this session will illustrate how a collaborative, woman-centric preventive neurology approach can be used to help manage the menopausal transition in women with, or at risk for, neurological disease. Participants will review common symptoms of menopause such as sleep disturbances, “brain fog,” bladder dysfunction, hot flashes, and mood changes, and discuss how these symptoms may overlap with, mimic, or exacerbate symptoms from neurological disorders. Additional topics covered will include how timing and symptoms of menopause influence stroke and dementia risk, as well as consideration of how chronic neurological disorders such as migraine, epilepsy, and stroke influence decision-making regarding menopausal hormone therapy.
Attendees will leave the session with improved understanding of how menopausal physiology affects neurological disorders, along with practical management strategies to provide tailored care for female patients navigating the menopausal transition.
Post Anti-CD19 CAR-T cell Therapy Immune Response in Treatment Refractory Multiple Sclerosis
Description
Progressive multiple sclerosis (MS) remains a major therapeutic challenge, with limited treatment options for patients who continue to experience disease progression despite conventional therapies. Anti-CD19 CAR-T cell therapy has emerged as a promising investigational approach that targets pathogenic B cells, offering the potential for durable immune reprogramming in neuroinflammatory disease.
This presentation will examine an in-depth immunologic case analysis of two participants with treatment-refractory progressive MS treated with investigational anti-CD19 CAR-T cell therapy. Participants will review the rationale for targeting central nervous system-resident B cells, explore the trafficking of CAR-T cells into the cerebrospinal fluid, and examine the depth of B-cell depletion, immune reconstitution, and post-treatment immunologic profiling. Topics will also include safety considerations, including cytokine release syndrome and neurotoxicity, alongside changes in oligoclonal bands, IgG index, disability measures, MRI outcomes, and multimodal immune profiling using flow cytometry, single-cell analyses, and proteomics. Additional findings related to Epstein-Barr virus immune responses and autoreactivity will be presented in the context of treatment response and disease mechanisms.
Attendees will leave with a greater understanding of the immunological effects of anti-CD19 CAR-T cell therapy in progressive multiple sclerosis and practical insights into the potential of cellular immunotherapy to reshape the treatment of neuroinflammatory disease, inform future clinical trial design, and guide patient selection.
Speakers
