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SpecialistBrain health

Lisa Mosconi

PhD · Associate professor of neuroscience in neurology and radiology, Weill Cornell Medicine · director of the Women's Brain Initiative · author of The Menopause Brain

Go-to expert for: the women's brain and menopause

Who and why

Lisa Mosconi is a neuroscientist at Weill Cornell Medicine in New York who studies why women make up about two-thirds of people with Alzheimer's disease. Her brain-imaging research focuses on how falling estrogen during menopause changes brain structure and energy use, and her books The XX Brain and The Menopause Brain explain this for a general audience.

Why it matters after 50: Brain fog, poor sleep and mood changes are common in the menopause years, and midlife may be a key window for lowering later Alzheimer's risk. Understanding these changes helps women see them as real and manageable.

What Mosconi recommends

  • Menopause is a brain transition, not just a reproductive one. Her scans show changes in brain structure and energy use during perimenopause, and for most women the brain largely settles into a new balance afterwards.Some evidence
  • Menopause hormone therapy is the first-line treatment for hot flashes and night sweats. For most women under 60, or within 10 years of their last period, she says benefits usually outweigh risks. Discuss with your doctor.Doctor only
  • Timing matters for the brain. Trials that started hormones in older women found higher dementia risk, while observational studies link midlife estrogen-only therapy to lower Alzheimer's risk. No trial has yet tested whether starting hormones in midlife prevents dementia (the KEEPS trial in recently menopausal women found no cognitive benefit or harm), so hormones are not prescribed to prevent dementia.Doctor only
  • Mix your exercise: cardio may help hot flashes and brain fog, strength training may help mood, and yoga, Pilates or tai chi may help sleep and stress.Some evidence
  • Eat a mostly plant-based diet, which she says is so far the eating pattern most linked to fewer menopause symptoms and better brain health.Some evidence
  • Protect sleep, manage stress and keep learning new things through midlife.Personal habit

Signature: Imaging the menopausal brain

Her team uses MRI and PET scans to track women's brains across the menopause transition, including the first in-living-brain maps of estrogen receptors in midlife women.

In your plan

Choose her for brain health (women): menopause-aware brain habits. Hormone therapy is information only, decided with your doctor. For men we show general brain content.

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Research and honest caveats

Menopause reshapes the brain

Brain scans of women aged 40 to 65 showed changes in structure, connections and energy use across menopause stages, with partial recovery after menopause that tracked with preserved memory.

Mosconi et al., Scientific Reports, 2021

Estrogen receptors in the living brain

Estrogen-receptor density in the brain rose progressively through the menopause transition, and higher density was linked to poorer memory and more reported symptoms.

Mosconi et al., Scientific Reports, 2024

  • Her imaging studies are relatively small and mostly compare different women at one point in time, so they show associations rather than cause and effect. Whether hormone therapy started in midlife lowers dementia risk has not yet been tested in randomised trials, which she herself has called for; trials such as KEEPS found no effect on thinking either way.

Career highlights

  1. 2018Published Brain Food
  2. 2020Published The XX Brain
  3. 2021Published a major imaging study showing how menopause affects the brain
  4. 2024Published The Menopause Brain

Sources