MRI Study Reveals Increased Brain Changes in Postmenopausal Women

In a new study involving over 3,400 participants, researchers found that postmenopausal women had a higher load of white matter hyperintensities on brain magnetic resonance imaging (MRI) in comparison to men and premenopausal women of a similar age.

For the study, which was recently published in Neurology, researchers reviewed T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) MRI images for 3,410 participants. The study population included 1,167 postmenopausal women, 806 premenopausal women and 1,437 men with a mean age of 54.3 years, according to the study.

After adjustments for age and risk factors such as diabetes and high blood pressure, the study authors found that for people 45 years of age and older, postmenopausal women had an average 0.94 ml volume of white matter hyperintensities in comparison to an average of 0.72 ml in men. In a subgroup analysis of women between 45 and 59 years of age, researchers found that postmenopausal women had an average 0.51 ml volume of white matter hyperintensities in comparison to 0.33 ml in premenopausal women.

Acknowledging previous research that has noted potential neurological and cardiovascular issues associated with white matter hyperintensities, study co-author Monique M.B. Bretelet, M.D., Ph.D. suggests that postmenopausal women may have elevated risks.

“White matter hyperintensities increase as the brain ages, and while having them does not mean that a person will develop dementia or have a stroke, larger amounts may increase a person’s risk,” noted Dr. Breteler, who is affiliated with the German Center of Neurodegenerative Diseases (DZNE) in Bonn, Germany. “ … Our results imply that white matter hyperintensities evolve differently for men and women, where menopause or factors that determine where menopause starts, such as variations in the aging process, are defining factors.”

The study authors also found that controlled and uncontrolled hypertension led to higher white matter hyperintensities in men and postmenopausal women 45 years of age and older. However, researchers noted a stronger association in postmenopausal women, particularly when it came to uncontrolled hypertension (b = 0.31 [95% CI: 0.20-0.43]), in comparison to men (b = 0.12 [95% CI: 0.01-0.24]). There were no differences between premenopausal and postmenopausal women in regard to the association between uncontrolled hypertension and white matter hyperintensities.

“The results of our study not only show more research is needed to investigate how menopause may be related to the vascular health of the brain. They also demonstrate the necessity to account for different health trajectories for men, women, and menopausal status,” maintained Dr. Breteler.

The authors noted that study limitations included a lack of information on the onset of menopause, the duration, type, or dosing of hormone therapy, and whether study participants were perimenopausal. They also acknowledged that the study findings cannot be extrapolated to a gender diverse population as the baseline questionnaire for the study did not allow for sufficient detail in regard to sex and gender identity.