New study suggests an excessive accumulation of fat in the abdominal area is a risk factor for domain-specific cognitive decline
CLEVELAND, Ohio (Nov 5, 2025)—Weight gain, especially at the waist, is common during the perimenopause and postmenopause period. Such gain, along with declining estrogen levels that are common after menopause, are linked with decreases in insulin sensitivity and increases in inflammatory processes. A new study suggests that central adiposity is also a risk factor for cognitive decline. Results of the study are published online today in Menopause, the journal of The Menopause Society.
Compared with overall body fat, visceral adipose tissue (the intra-abdominal fat tissue stored around several organs, including the stomach, intestines, and liver) has been associated with major health risks, including metabolic syndrome, diabetes, hypertension, elevated lipid levels, cardiovascular disease, and Alzheimer disease and related dementias. The increase in inflammatory markers because of visceral adiposity and decline in estrogen with menopause seems to be a major factor in these disease processes, leading researchers to believe that measures of central adiposity, such as the waist-to-hip ratio, may serve as early and easily recognizable markers of risk for both metabolic and cognitive dysfunction because estrogen receptors in the brain are concentrated in regions serving executive function and memory.
Previous clinical trials that attempted to link hormone therapy with cognition provided mixed results, depending on the age of the participants. That led researchers in this latest study to further investigate the relationship between central adiposity, cognitive function, and hormone therapy exposure in early postmenopausal women. Their research involved more than 700 women aged 42 to 58 years who were less than 36 months post natural menopause.
These participants were then divided into three categories—those who received oral conjugated equine estrogen, those who received transdermal estradiol, and those who received a placebo. Central adiposity was estimated by a measure of waist-to-hip ratio.
The researchers concluded that women with a higher baseline waist-to-hip-ratio had poorer performance on all domain-specific cognitive outcomes at baseline, with only changes in visual attention and executive function over the 4-year study time frame. However, central adiposity was not found to moderate hormone therapy when compared with placebo cognitive domain-specific outcomes. Based on these results, the researchers suggest that cognitive health effects should be investigated in early postmenopausal women, even in women with low cardiovascular risk statuses.
Study results are published in the article “Association between central adiposity and cognitive domain function in recently postmenopausal women: an analysis from the KEEPS-Cog sub-study of the Kronos Early Estrogen Preventive Study.”
“Addressing modifiable risk factors early and often is critical to maintaining optimal health and independence as women age. The metabolic and cognitive changes that commonly occur during and after the menopause transition often catch women off-guard and are more difficult to address after the diagnosis has been made. Instituting preventive lifestyle strategies before the menopause transition will result in longitudinal health gains and reduced morbidity and mortality,” says Dr. Monica Christmas, associate medical director for The Menopause Society.
For more information about menopause and healthy aging, visit www.menopause.org.
The Menopause Society is dedicated to empowering healthcare professionals and providing them with the tools and resources to improve the health of women during the menopause transition and beyond. As the leading authority on menopause since 1989, the nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for healthcare professionals, researchers, the media, and the public and leads the conversation about improving women’s health and healthcare experiences. To learn more, visit menopause.org.