Menopause is associated with adverse mental health outcomes and reductions in gray matter volume, according to a study published online Jan. 26 in Psychological Medicine.

Katharina Zühlsdorff, Ph.D., from the University of Cambridge in the United Kingdom, and colleagues analyzed data from nearly 125,000 participants in the U.K. Biobank to examine associations for menopause and hormone replacement therapy (HRT) use with outcomes related to mental health, cognition, and brain morphology, focusing specifically on gray matter volumes in the medial temporal lobe (MTL) and anterior cingulate cortex (ACC).

The researchers observed an association between menopause and increased levels of anxiety, depression, and sleep difficulties. Greater mental health challenges were reported by women using HRT versus postmenopausal women not using HRT. Women prescribed HRT had higher levels of preexisting mental health symptoms in a post-hoc analysis. MTL and ACC volumes were smaller in postmenopausal versus premenopausal women; the HRT group had the lowest volumes.

“We all need to be more sensitive to not only the physical, but also the mental health of women during menopause, however, and recognize when they are struggling,” coauthor Christelle Langley, Ph.D., also from the University of Cambridge, said in a statement. “There should be no embarrassment in letting others know what you’re going through and asking for help.”