Reacción a "Menopause is the only hormonal transition in a woman’s life that is not associated with a reduction in grey matter or brain volume"

This is a high-quality study and is particularly interesting because it analyses, over time, how brain structure changes during three major transitions in a woman’s reproductive life: puberty, pregnancy and the menopause. One of its main strengths is that it does not study these stages in isolation, but instead uses a common analytical methodology and includes stable comparison groups. This allows for a clearer distinction between changes associated with each transition and those that occur simply as a result of development or ageing.

Perhaps the most striking finding is that puberty and pregnancy share certain patterns of brain remodelling, with reductions in cortical grey matter volume across numerous regions, although there are also differences between the two stages. Menopause, on the other hand, shows a different pattern: during the menopausal transition, the significant reduction in cortical grey matter observed in women who remain in stable pre- or post-menopausal stages is not seen. It is important not to interpret the reduction in grey matter observed during puberty and pregnancy as necessarily negative or as ‘brain loss’; these are structural changes that may form part of processes of brain reorganisation and adaptation.

There are, however, some limitations that call for caution. The study lacks comparable hormonal measurements across the three cohorts, so it cannot demonstrate that hormones are directly responsible for the changes observed. Furthermore, puberty and the menopause were defined on the basis of self-reported information regarding menarche and the last menstrual period, and the participants were drawn from independent studies carried out using different MRI teams. This is particularly relevant when interpreting the results relating to the menopause: the fact that no significant reduction in cortical volume is detected during this transition does not mean that the brain ‘does not change’. The authors themselves regard this interpretation as preliminary.

The study opens up a very interesting avenue for understanding the female brain from a life-course perspective, but we still need studies that directly measure hormonal changes and enable us to determine the functional significance of these brain changes and how they may relate to women’s health.