Iron Deficiency May Contribute to Cognitive Decline in Menopausal Women
A study reveals that women with sufficient iron levels perform better on cognitive tasks during menopause.
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New research from the University of Oklahoma highlights the importance of maintaining adequate iron levels in the blood for women transitioning into menopause. The study, published in Nutrients, found that women with sufficient blood iron performed better on cognitive tasks than those with lower-than-expected levels for their age.
The researchers measured iron in the blood and brain using MRI scans and conducted cognitive assessments. While none of the participants were classified as iron deficient, many had suboptimal iron levels relative to age-based expectations. These women exhibited poorer memory, attention and cognitive performance.
Cognitive performance
Cognitive performance refers to the ability to use brain functions such as memory, attention, reasoning and problem-solving.
Iron deficiency
Iron deficiency occurs when the body lacks enough iron to produce adequate levels of hemoglobin, the protein in red blood cells responsible for carrying oxygen.
Menopausal transition
The menopausal transition, also called perimenopause, is the time period when a woman’s body undergoes hormonal changes leading up to menopause. It typically involves fluctuations in estrogen and progesterone levels, affecting various physical and mental processes.
Blood iron and brain health
Concerns about iron levels must balance cognitive needs with the risk of iron accumulation in the brain, which is linked to neurodegenerative diseases such as Alzheimer’s. Encouragingly, the study found no relationship between blood iron levels and brain iron deposition. This suggests that maintaining healthy blood iron does not necessarily increase brain iron accumulation during the menopausal transition.
Neurodegenerative diseases
Neurodegenerative diseases are conditions characterized by the progressive loss of structure or function of neurons, including diseases such as Alzheimer’s, Parkinson’s and Huntington’s. They often involve cognitive decline and motor dysfunction.
Broader implications for menopause-related symptoms
Low iron levels, distinct from anemia, could contribute to commonly reported symptoms such as brain fog and visual changes during menopause. Iron plays a vital role in dopamine synthesis, a neurotransmitter involved in both cognitive function and retinal signaling.
“When a woman makes the menopausal transition, she’s no longer losing blood on a monthly basis, which means she’s no longer losing iron. We wanted to see if the cost of being low on iron disappears during the menopausal transition. Very few studies have been done in this area,” said Dr. Michael Wenger, a professor of psychology at the OU College of Arts and Sciences and a lead author of the study.
Currently, routine testing for iron deficiency is not standard practice during OB-GYN visits, potentially missing an opportunity to identify and address reversible cognitive issues. Small dietary adjustments to increase iron intake may offer a low-risk approach to improving symptoms without resorting to high-dose supplements, which are often associated with gastrointestinal side effects.
“Our previous research has shown that being iron-deficient extracts some serious costs in terms of cognitive performance,” Wenger said. “If I were to give a woman with iron deficiency a simple task in which she presses a button every time an asterisk appears on a screen, the deficiency would cost her about 150 milliseconds. That doesn’t sound like a lot, but we make simple decisions like that when we choose every word we say in a sentence. Those 150 milliseconds add up.”
Study limitations and future research directions
The study’s sample size was smaller than intended due to disruptions caused by the COVID-19 pandemic. Researchers plan to pursue additional funding to expand this work and explore the findings in larger, more diverse populations. Understanding iron’s role during the menopause transition could eventually inform better clinical guidelines for supporting women through this critical period.
“I feel like we’ve had a pretty good understanding of post-menopause health, such as watching for cardiovascular issues and osteoporosis, but we haven’t known as much about what to do during this in-between phase, and it’s actually way more bothersome to people,” said OB-GYN and study co-author Dr. Pamela Miles, an associate professor in the OU College of Medicine.
Reference: Barnett AL, Wenger MJ, Miles P, et al. Cognitive performance in relation to systemic and brain iron at perimenopause. Nutrients. 2025;17(5):745. doi: 10.3390/nu17050745
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