---
title: "Menopause and Neurology: Clinical essentials for cognitive, seizure, migraine, MS, and stroke care"
id: "pubmed-42913453"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42913453"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42913453/"
doi: "10.1212/CPJ.0000000000200678"
published_at: "2026-10-23T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Menopause and Neurology: Clinical essentials for cognitive, seizure, migraine, MS, and stroke care
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42913453
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42913453/)
- **DOI:** [10.1212/CPJ.0000000000200678](https://doi.org/10.1212%2FCPJ.0000000000200678)
- **Published At:** 2026-10-23T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The review frames **menopause** as a neurobiological transition with wide neurologic relevance; investigators reported physiologic estrogen decline and shifting estrogen:progesterone ratios as core mechanisms. - Perimenopause commonly produces subjective cognitive complaints—often linked to hypoestrogenism, sleep disruption, vasomotor symptoms, and mood changes—while objective neuropsychological impairment or progressive decline is uncommon. - Data indicated that endogenous and exogenous hormones across the menopausal transition can modify seizure susceptibility and influence antiseizure medication metabolism; the study team observed altered clinical expression in some patients with epilepsy. - Migraine often worsens during perimenopause in estrogen-sensitive phenotypes, then typically stabilizes in postmenopause once hormone levels plateau. - For **multiple sclerosis (MS)**, perimenopause and postmenopause introduce overlapping age- and disease-related symptoms; the cohort described the period as high clinical need with potential acceleration in disability despite falling relapse rates. - Ischemic stroke risk rises sharply after menopause, driven by aging, cardiometabolic risk accumulation, and loss of estrogen’s vascular effects, investigators reported. - The authors reviewed menopause hormone therapy (**MHT**) safety signals: oral estrogen-containing systemic MHT associates with higher thromboembolic events and stroke risk, while transdermal regimens appeared safer at low or standard doses; the review cited specific transdermal dosing ranges. - Timing of MHT initiation matters: data indicated a more favorable risk:benefit when started in women younger than 60 years or within 10 years of menopause onset. - The source did not provide detailed randomized trial data, exact sample sizes, or comprehensive dosing regimens beyond the listed transdermal ranges; the review is meant as a clinical resource rather than a primary trial report.
## Clinical Analysis & Structured Key Points
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Epub 2026 Oct 23. # Menopause and Neurology: Clinical Essentials [Hayley Faye Thornton](https://pubmed.ncbi.nlm.nih.gov/?term=Thornton+HF&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada."), [Riley Bove](https://pubmed.ncbi.nlm.nih.gov/?term=Bove+R&cauthor_id=42913453)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-2 "UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list."), [Ginette Moores](https://pubmed.ncbi.nlm.nih.gov/?term=Moores+G&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list."), [Addie Peretz](https://pubmed.ncbi.nlm.nih.gov/?term=Peretz+A&cauthor_id=42913453)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-4 "Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA."), [Maria Carmela Tartaglia](https://pubmed.ncbi.nlm.nih.gov/?term=Tartaglia+MC&cauthor_id=42913453)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-5 "Division of Neurology, Toronto Western Hospital, University Health Network, Ontario, Canada.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-6 "Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada."), [Michelle Jacobson](https://pubmed.ncbi.nlm.nih.gov/?term=Jacobson+M&cauthor_id=42913453)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-7 "Department of Obstetrics and Gynecology, William Osler Health System, Toronto, Ontario, Canada."), [Barbara Mostacci](https://pubmed.ncbi.nlm.nih.gov/?term=Mostacci+B&cauthor_id=42913453)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-8 "Istituto delle Scienze Neurologiche di Bologna, Italy, Full member of the ERN EpiCARE."), [Aleksandra Pikula](https://pubmed.ncbi.nlm.nih.gov/?term=Pikula+A&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-5 "Division of Neurology, Toronto Western Hospital, University Health Network, Ontario, Canada.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-9 "Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; and.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-10 "Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Toronto, Ontario, Canada."), [Esther Bui](https://pubmed.ncbi.nlm.nih.gov/?term=Bui+E&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#full-view-affiliation-9 "Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; and.") Affiliations Expand ### Affiliations * 1 Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada. * 2 UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA. * 3 Integrating Neurological Sex and Gender Issues in Global Health Training (INSIGHT) Network, see eAppendix A for full member list. * 4 Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA. * 5 Division of Neurology, Toronto Western Hospital, University Health Network, Ontario, Canada. * 6 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada. * 7 Department of Obstetrics and Gynecology, William Osler Health System, Toronto, Ontario, Canada. * 8 Istituto delle Scienze Neurologiche di Bologna, Italy, Full member of the ERN EpiCARE. * 9 Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; and. * 10 Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Toronto, Ontario, Canada. * PMID: **42913453** * DOI: [ 10.1212/CPJ.0000000000200678 ](https://doi.org/10.1212/cpj.0000000000200678) Item in Clipboard Review # Menopause and Neurology: Clinical Essentials Hayley Faye Thornton et al. Neurol Clin Pract. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Neurol Clin Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurol+Clin+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Neurol+Clin+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42913453/) . 2026 Dec;16(6):e200678. doi: 10.1212/CPJ.0000000000200678. Epub 2026 Oct 23. ### Authors [Hayley Faye Thornton](https://pubmed.ncbi.nlm.nih.gov/?term=Thornton+HF&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada."), [Riley Bove](https://pubmed.ncbi.nlm.nih.gov/?term=Bove+R&cauthor_id=42913453)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-2 "UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list."), [Ginette Moores](https://pubmed.ncbi.nlm.nih.gov/?term=Moores+G&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list."), [Addie Peretz](https://pubmed.ncbi.nlm.nih.gov/?term=Peretz+A&cauthor_id=42913453)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-4 "Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA."), [Maria Carmela Tartaglia](https://pubmed.ncbi.nlm.nih.gov/?term=Tartaglia+MC&cauthor_id=42913453)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-5 "Division of Neurology, Toronto Western Hospital, University Health Network, Ontario, Canada.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-6 "Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada."), [Michelle Jacobson](https://pubmed.ncbi.nlm.nih.gov/?term=Jacobson+M&cauthor_id=42913453)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-7 "Department of Obstetrics and Gynecology, William Osler Health System, Toronto, Ontario, Canada."), [Barbara Mostacci](https://pubmed.ncbi.nlm.nih.gov/?term=Mostacci+B&cauthor_id=42913453)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-8 "Istituto delle Scienze Neurologiche di Bologna, Italy, Full member of the ERN EpiCARE."), [Aleksandra Pikula](https://pubmed.ncbi.nlm.nih.gov/?term=Pikula+A&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-5 "Division of Neurology, Toronto Western Hospital, University Health Network, Ontario, Canada.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-9 "Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; and.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-10 "Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Toronto, Ontario, Canada."), [Esther Bui](https://pubmed.ncbi.nlm.nih.gov/?term=Bui+E&cauthor_id=42913453)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-1 "Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-3 "Integrating Neurological Sex and Gender Issues in Global Health Training \(INSIGHT\) Network, see eAppendix A for full member list.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42913453/#short-view-affiliation-9 "Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; and.") ### Affiliations * 1 Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada. * 2 UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA. * 3 Integrating Neurological Sex and Gender Issues in Global Health Training (INSIGHT) Network, see eAppendix A for full member list. * 4 Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA. * 5 Division of Neurology, Toronto Western Hospital, University Health Network, Ontario, Canada. * 6 Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada. * 7 Department of Obstetrics and Gynecology, William Osler Health System, Toronto, Ontario, Canada. * 8 Istituto delle Scienze Neurologiche di Bologna, Italy, Full member of the ERN EpiCARE. * 9 Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; and. * 10 Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Toronto, Ontario, Canada. * PMID: **42913453** * DOI: [ 10.1212/CPJ.0000000000200678 ](https://doi.org/10.1212/cpj.0000000000200678) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Purpose of review:** Menopause is a neurobiological transition with important implications for neurologic care. This review summarizes the physiology and hormonal changes of spontaneous menopause and its treatment as applied to cognition, epilepsy, migraine, multiple sclerosis (MS), and stroke. It aims to serve as a resource for neurologists when managing patients in this transitional life stage. **Recent findings:** Hormonal shifts associated with menopause, particularly declining estrogen and fluctuating estrogen-to-progesterone ratios, influence symptoms, disease expression, and treatment across multiple neurologic conditions. Perimenopause is often associated with subjective cognitive complaints, in part attributed to hypoestrogenism, along with secondary effects from sleep disturbance, vasomotor symptoms, and mood changes. Cognitive symptoms are often transient and rarely with objective neuropsychological deficits or progression. In epilepsy, menopause-related endogenous and exogenous hormones may influence seizure susceptibility and alter antiseizure medication metabolism. Migraine may worsen during perimenopause, especially in estrogen-sensitive phenotypes, with postmenopause stabilization once hormones plateau. In MS, perimenopause and postmenopause contribute to overlapping age-related and MS-related symptoms and is a period of high clinical need with potential acceleration in disability progression despite reduced relapse rate. Ischemic stroke risk rises sharply in postmenopausal women driven by advancing age, accumulation of cardiometabolic risk, and loss of estrogen's protective effects. Oral estrogen-containing systemic menopause hormone therapy (MHT) is associated with increased thromboembolic events (including stroke), whereas transdermal regimens seem safer and are preferred at low or standard doses (≤50 mcg estradiol patch or ≤1.5 mg [or 2 pumps] per day of 0.06% estradiol gel). Timing of initiation also modulates this risk and plays a critical role with a favorable risk:benefit window when initiated in women younger than 60 years or within 10
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