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
In this presentation, Dr. Maki will discuss how there is considerable controversy in social media and in some research circles about the relative benefits and risks of menopausal hormone therapy (MHT) on cognition. However, medical societies have reached a consensus on that topic, concluding that MHT should not be used to treat or prevent cognitive decline, except in early and premature menopause. Critical gaps in knowledge remain. This presentation will review the data behind medical society guidelines.
Menopause, MHT and Alzheimer’s Biomarkers in Women
Description
In this presentation, Dr. Buckley will examine the intersection of menopause, menopausal hormone therapy (MHT), and AD biomarkers through the lens of both risk and resilience. Highlighting data showing that women often demonstrate preserved cognition despite early pathology yet may experience accelerated tau accumulation and cognitive decline at later stages—patterns that may be modulated by hormonal changes, timing of menopause, and MHT exposure.
Menopause, MHT and Neurologic Disease
Description
In this presentation, Dr. Miller will discuss practical clinical aspects of the menopausal transition, as well as menopausal hormonal therapies, as they relate to common clinical neurological disorders such as migraine, stroke, epilepsy, multiple sclerosis, and cognitive decline.
