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As women go through menopause, they often sense that it's not just their bodies changing, but also their minds. They report hot flashes, anxiety, brain fog and trouble sleeping—all symptoms that can be traced back to the brain.

Now, researchers at UC San Francisco have found biological evidence to back them up. In a new study published in Nature Medicine, they've discovered that levels of 16 molecules in the blood, all linked to brain aging, rise during the menopause transition in midlife. In older women, higher levels of the same molecules were associated with worse memory and thinking skills, as well as Alzheimer's disease risk. This suggests the biology of menopause may set the stage for brain health decades later.

"We don't think that menopause is directly causing dementia," said Kaitlin Casaletto, Ph.D., an associate professor at the UCSF Fein Memory and Aging Center and co-senior author of the study. "But it's possible that we may be able to predict a woman's risk for dementia decades later by the levels of these molecules around menopause."

Two-thirds of people with Alzheimer's disease are women, and the disparity can't be explained solely by women's longer average life expectancy compared with men. Yet studies have not pinned down exactly what it is about women's biology, or how they age, that makes them more prone to dementia.

What is known is that the earliest brain changes associated with Alzheimer's disease begin decades before symptoms appear.

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