Brain Changes, Weight Management, and Breast Screening: Essential Updates From TMS 2025

Does menopause accelerate brain aging? Should hormone therapy influence weight loss medication decisions? When should women with dense breasts get supplemental screening?

These questions took center stage at The Menopause Society's annual meeting in October, where researchers presented findings that could reshape how primary care physicians approach care for midlife women.

Patient Care sat down with 3 investigators to discuss their research and its clinical implications.

Menopause Does Not Accelerate Brain Volume Loss

Katrina Wugalter, MA, presented findings from a study of 242 women that found no evidence that menopause stage affects brain volumes—contradicting some earlier, smaller studies.

Using data from the Human Connectome Project in Aging, Wugalter and colleagues examined whether the menopause transition accelerates age-related brain changes. Their sample size was twice as large as previous studies, and all participants were staged using gold-standard criteria and were not taking hormone therapy.

"We did not see that there were any differences in cortical volumes or hippocampal volumes by menopause stage," Wugalter said. "We did see that women's brains are getting smaller in certain regions just because they're getting older... We did not see that those age-related declines are accelerated or exacerbated by the menopause transition."

For clinicians, this means the focus should remain on lifestyle factors that optimize healthy aging rather than menopause-specific interventions for brain health.

Hormone Therapy May Enhance Weight Loss With Tirzepatide

Regina Castaneda, MD, reported that postmenopausal women using hormone therapy achieved nearly 20% total body weight loss with tirzepatide after 18 months, compared with 14% to 15% among those not using hormone therapy.

The findings mirror earlier results with semaglutide and suggest hormone therapy may play a role in metabolic outcomes during obesity pharmacotherapy.

However, Castaneda emphasized that hormone therapy is not indicated for weight loss alone.

"We are definitely not promoting the use of hormone therapy for weight loss outcomes," she said. "But what this is telling us is that personalized, individualized medicine, it's very important."

For patients struggling with both vasomotor symptoms and weight gain, clinicians should consider the complete clinical picture when developing treatment plans.

Dense Breast Screening: Start Risk Assessment at 25

Donna Plecha, MD, outlined updated recommendations for breast cancer screening in women with dense breast tissue, emphasizing early risk assessment and the growing role of abbreviated MRI.

Key recommendations include:

• Begin risk assessment at age 25
• Start routine screening at age 40, annually
• Consider supplemental screening with breast MRI for women with dense breasts, particularly those with extremely dense tissue