Menopause, mental health and the resilience of the brain
A conversation with Dr Katharina Zühlsdorff
New research from Downing Bye-Fellow, Dr Katharina Zühlsdorff, caught national attention earlier this month, challenging what we thought we knew about menopause and mental health.
Analysing data from 125,000 women, Katharina along with her research group which includes Professor Barbara Sahakian, found that while HRT is useful for physical symptoms, it may not be the solution for the psychological shifts or grey matter changes that occur during this transition.
Katharina, who was also the beneficiary of a Downing Angharad Dodds John Bursary for postdoctoral support, talked us through her headline grabbing research and what this means for future studies.
What drew you to this research question, and how did your time at Cambridge shape your approach?
We were interested to study the effects of menopause and HRT on mental health and the brain as little was known on the subject. The beneficial effects of HRT on physical symptoms have been shown but its efficacy for mental well-being is far less clear.
We were able to study this using the rich dataset of the UK Biobank, where we looked at records of almost 125,000 women.
My time at the Cambridge Department of Psychology, collaborating with the Department of Psychiatry, was transformative. Being immersed in a community of world-class researchers specialising in the UK Biobank, a massive dataset of nearly 125,000 women, provided the perfect environment to work on this large-scale study.
If you had to explain the key takeaway of this study in just a sentence or two, what would you say?
Our research found that post-menopausal women have higher levels of mental health symptoms compared to pre-menopausal women, yet these symptoms do not appear to be alleviated by HRT. Crucially, we also observed a reduction in grey matter volume in brain regions tied to memory and emotion - a change that HRT did not mitigate.
Your study links menopause to changes in "grey matter." What is grey matter and why does it matter for daily life?
Think of grey matter as the brain’s ‘processing centres.’ It’s primarily made up of neurons and is where information is processed and is therefore important for thinking, decision-making, forming memories and emotional processing - processes we use every day.
Were any of the results particularly surprising to you?
The most striking finding was the lack of impact from HRT on mental health. Given how effectively HRT manages physical symptoms, I expected to see some effect for the psychological challenges many women face during this transition.
What does this mean for women currently navigating menopause?
The most important message is that menopause is not a destiny for dementia. While we saw structural changes, the brain is resilient. We know that ‘lifestyle medicine’ - regular exercise, a healthy diet and moderate alcohol intake - can significantly bolster brain health and mitigate the effects of aging.
The brain regions affected in your study are also linked to dementia. What questions does this raise for future research?
It’s a persistent medical mystery: women are twice as likely as men to develop dementia, and we still don't fully understand why. I hope this study highlights the need for more research into women’s health so we can try and understand the mechanisms driving this disparity.
If you could change one thing about the public conversation around menopause, what would it be?
I want to strip away the stigma. Menopause will affect half the global population, yet it remains a hushed topic. I hope this study empowers women to speak openly and encourages society to treat menopause as a health priority rather than a private struggle.
What is the next step for your research team?
We’re diving deeper into the nuances of HRT. We want to know if the delivery method or the specific dosage makes a difference in mental health outcomes. Additionally, we are eager to quantify exactly how much lifestyle interventions, like exercise, can offset the neurological changes we observed during menopause.
How does your time at Downing College influence this journey?
The intellectual ecosystem at Downing is essential. Many of the core questions in this study were sparked during discussions with colleagues in College. That kind of cross-pollination is what makes Cambridge and Downing such a vibrant and special place.
Published 13 February 2026