November 4, 2026
*Reviewed by Sarah Song, MD, MPH, FAAN
A study published November 4, 2026, in Neurology® suggests that longer exposure to estrogen throughout life may be linked to better blood vessel health in the brain later in life. Researchers looked at reproductive lifespan, birth control pill use, and menopausal hormone therapy.
The study followed about 350 women in Sweden who were about 70 years old and had no cognitive impairment. Researchers collected information about the participants’ reproductive history and whether they had used birth control pills or menopausal hormone therapy.
The researchers used brain MRIs to look for signs of cerebral small vessel disease, which affects tiny blood vessels in the brain and is associated with stroke, cognitive problems, and dementia.
In this study, women with a longer reproductive lifespan had 8% lower odds of having two or more signs of small vessel disease for each additional year of reproductive lifespan. Women who had used menopausal hormone therapy had 59% lower odds of having two or more signs compared to people who had not used it.
The best results were seen in women who had used both birth control pills and menopausal hormone therapy. This group had fewer signs of small vessel disease and healthier white matter compared to women who had used neither type of hormone therapy.
This was an observational study. The results do not prove that hormone use causes better brain health. More research is needed to understand how estrogen exposure throughout life may affect brain health as women age.
