January 27, 2026

expert reaction to study on associations between menopause and HRT use on mental health, cognition, and brain morphology

A study published in Psychological Medicine looks at associations between menopause and HRT use and mental health. 

Prof Ciara McCabe, Professor of Neuroscience, Psychopharmacology and Mental Health, University of Reading, said:

“There have been previous studies suggesting an association between HRT use and increased depression, however this study shows that those who have higher problems with depression and anxiety in the first place are more likely to be prescribed HRT arguing against the notion that HRT “causes” depression.

“Longitudinal studies are still needed that track mood and brain changes over time to properly assess if HRT can improve anxiety and depression.”

Prof Channa Jayasena, Professor of Reproductive Endocrinology & Andrology, Imperial College London,said:

“Menopause is a time when women are more likely to experience problems with mood and cognition (often called brain fog). This study looked at a resource called the UK BioBank which has helped many research teams around the world look at different health problems. They looked at the relationship between mood, cognition, brain scan results, and whether women had menopause or were on HRT.

“Unsurprisingly, they found that women who had undergone the menopause were more likely to have problems like depression. They found that menopause was associated with reduction in the development of some brain areas, which highlights the need to investigate whether anything can be done to predict or treat this. Comparisons between the women with menopause with and without HRT have been made, but I think these are difficult to interpret. Women taking HRT may have had more severe symptoms of menopause, so it is unfair to compare whether HRT ‘does a good job’ of lessening the bad effects of menopause which have been studied.

“The effect of HRT on brain health in menopause continues to be a topic of debate, and old clinical trials like the Women’s Health Initiative have failed to answer this question. Either way, this is an important complication that millions of women experience in the UK, so deserves close attention in the future.”

‘Emotional and cognitive effects of menopause and hormone replacement therapy’ by Katharina Zühlsdorff et al. was published in Psychological Medicine at 00.01 UK Time Tuesday 27 January 2026. 

DOI: 10.1017/S0033291725102845

Declared interests

Prof Channa Jayasena: Member of the European Society of Endocrinology menopause guideline committee

For all other experts, no reply to our request for DOIs was received.