Women who reached menopause earlier showed faster cognitive decline in a study of 2,603 women

Women in a long-running Chicago-area aging study who went through menopause at younger ages lost thinking ability faster in later life, according to an analysis of 2,603 women followed for up to 18 years. The work, led by Riley Bove of the University of California, San Francisco, drew on the Religious Orders Study and the Rush Memory and Aging Project, two linked cohorts run out of Rush University Medical Center.

The paper appeared in JAMA Network Open on August 25, 2026, under the name “Age at Menopause and Brain Atrophy Among Older Women.” Press coverage kept circulating into late September, but the findings are about five weeks old, so what follows is an explainer of what the study measured and what it could not show, not a report on a fresh release.

Who was followed, and for how long

Both cohorts enroll older adults who agree to yearly cognitive testing and, eventually, to donate their brains after death, which is why so many participants contribute several kinds of data over so many years. The JAMA Network Open analysis used 2,603 women with cognitive data, tracked for as long as 18 years. A subset of 774 also had repeated MRI scans, which let the team look at physical changes in the brain rather than relying on test scores alone.

Age at menopause was not recorded when it happened. Participants reported it years or decades afterward, and the authors acknowledged that recall of menstrual ages can be inaccurate. Data on pregnancies, breastfeeding and contraceptive use, all of which shape lifetime hormone exposure, were also incomplete. Each gap could blur the true relationship between menopause timing and brain aging, and nothing in the design lets the researchers correct for them after the fact. Surgical menopause, in which the ovaries are removed and hormones drop abruptly, is a separate category that the paper handled apart from natural menopause, and the white matter finding applied only to the natural kind.

Faster decline in global cognition and episodic memory

The lead result is the cognitive one. In the words of the paper’s findings, as relayed by ScienceAlert, “earlier menopause age was associated with faster cognitive decline (global and episodic), earlier Alzheimer’s disease onset, and greater white matter hyperintensity accumulation.” Episodic memory, the recall of specific events and experiences, is the ability that usually slips first in Alzheimer’s disease, which is why the finding drew attention.

The Alzheimer’s result is expressed as time. Menopause occurring 10 years earlier was associated with 1.8 fewer years without an Alzheimer’s diagnosis, and the mean age at diagnosis in the group was 88.4. Both numbers come from comparing many women against one another. No trial assigned anyone an early or late menopause.

Fifteen percent more white matter damage over a decade

The imaging result is the most concrete. Among women who reached natural menopause five years earlier than others, white matter hyperintensity volume grew about 15 percent more over ten years, as Newsweek reported from the paper. White matter hyperintensities are bright patches on MRI that generally reflect damage to the small blood vessels feeding the brain’s wiring, and they are linked to slower thinking and higher dementia risk.

The pattern was specific to spontaneous menopause. Overall brain volume changes were modest. The authors’ own summary says the findings “position menopause age as a midlife-identifiable marker for risk stratification, offering a window for targeted prevention before structural or cognitive changes become apparent.”

Questions the study leaves open

Bove was direct about the limits. “This study is not intended to alarm women,” she said, according to PsyPost, and the observational design cannot show that menopause itself damages the brain. One plausible reading is that earlier menopause is a marker of faster biological aging overall, with the ovaries and the brain both affected, rather than a cause of the brain changes.

The cohort narrows what can be generalized as well. Knowridge reported that more than 90 percent of participants were white, and the women were volunteers in a study of aging who agreed to brain donation, a group that is not a random sample of the population. Nikki Ramskill, a women’s health specialist quoted by Newsweek, put the practical message this way: “earlier menopause does not mean that a woman is destined to develop Alzheimer’s disease.”

What the authors recommend is attention rather than treatment. They describe perimenopause as a window for checking sleep, mood, exercise and blood pressure, and coverage of the paper stressed that the results do not justify starting hormone therapy solely to prevent dementia. The open question is whether acting on that window changes outcomes, which only follow-up studies can test. The full paper sits at the journal’s DOI page, which holds the effect sizes and confidence intervals behind the 15 percent and 1.8-year figures.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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