3.5-minute read

Dementia is no longer a future issue sitting quietly in the background of Australian health. It is here, it is rising, and it is disproportionately affecting women.

According to the Australian Bureau of Statistics, dementia, including Alzheimer’s disease, is now the leading cause of death in Australia. It has also been the leading cause of death for Australian women since 2016. In 2024, more than 62% of people who died from dementia were women.

For me, this conversation is also deeply personal. I have lost three relatives to dementia on my maternal side, so I understand the fear that can sit quietly in the background when memory, cognition and brain health are discussed. It is also why the brain fog; poor concentration and cognitive changes I experienced during perimenopause were so confronting. When you have seen dementia affect people you love, forgetting words, losing focus, or feeling like your brain is no longer working the way it used to can feel frightening.

Not because women need another thing to fear in midlife, but because women deserve to understand the health changes that come with ageing, menopause and declining estrogen. We cannot keep treating menopause as a short-term inconvenience of hot flushes, night sweats and mood changes when the longer-term health picture is so much bigger.

Estrogen has protective roles throughout the body. It influences blood vessels, cholesterol balance, bone density, inflammation, sleep, mood, metabolism and brain function. When estrogen levels decline through perimenopause and menopause, the ripple effect is not just reproductive.

This is why I speak so often about the long-term health conditions that increase after menopause, including cardiovascular disease, osteoporosis, metabolic changes and dementia.

The brain is not separate from the body. Brain health is connected to heart health, blood pressure, cholesterol, blood sugar, sleep, movement, mood, stress and social connection. Dementia is complex and not all dementia is preventable, but there are powerful things we can do to reduce risk, support healthy ageing and improve quality of life.

Neuroscientist Dr Lisa Mosconi has helped bring this conversation into the mainstream through her research on the menopause brain. Her work shows that menopause is not simply happening to the ovaries. It is also a neuroendocrine transition, meaning it affects the brain. Brain fog, poor sleep, mood shifts and memory changes can be part of this transition, and while they do not automatically mean dementia, they should never be dismissed.

This distinction matters. Menopause-related brain fog is not the same as dementia, but that does not mean it is insignificant. For women with a family history, or for anyone who has watched someone they love decline cognitively, those symptoms can be incredibly distressing. We need better conversations that validate women’s concerns while also giving them accurate, evidence-based information.

The 2024 Lancet Commission on dementia prevention identified 14 modifiable risk factors that could prevent or delay a significant proportion of dementia cases globally. These include lower education, hearing loss, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol, traumatic brain injury, air pollution, social isolation, high LDL cholesterol and untreated vision loss.

That list can feel overwhelming, but I have boiled it down into three easy steps with my mantra.

Movement

Movement is one of the most powerful brain health tools we have. Regular physical activity supports cardiovascular health, blood pressure, insulin sensitivity, mood, sleep and cognitive function. It does not need to be extreme. Walking, strength training, dancing, yoga, gardening and small daily movement all matter.

Movement also helps reduce several dementia risk factors at once, including physical inactivity, obesity, diabetes, high blood pressure, depression and cardiovascular risk.

Mindset

Mindset is not about pretending everything is fine. It is about paying attention to your mental health, stress levels, sleep, social connection and sense of purpose.

Depression, social isolation, poor sleep and chronic stress all matter for brain health. So does staying cognitively engaged, connected and supported. Conversations, learning, creativity, friendship, community and asking for help are not luxuries. They are part of healthy ageing.

This is also where we need to normalise women seeking medical support earlier. Brain fog, memory changes, anxiety, low mood and sleep disruption deserve proper investigation, especially in midlife.

Modify

Modify is where we take action. Get your blood pressure checked. Understand your cholesterol, including LDL cholesterol. Review your alcohol intake. Stop smoking and vaping, if you can. Protect your head from injury. Check your hearing and vision. Manage diabetes risk. Talk to your GP about menopause, cardiovascular health, bone health and brain health together, not as separate conversations.

For some women, menopausal hormone therapy may be part of the discussion. It is not suitable for everyone, and it is not a dementia treatment, but women deserve evidence-based, individualised conversations about the benefits and risks, especially when symptoms are affecting sleep, mood, cognition and quality of life.

There is another important modification we often avoid: planning ahead.

The recent SBS Insight episode on dementia was a powerful reminder that this conversation is not only medical. It is deeply human. Dementia affects identity, relationships, families, care decisions and the people left trying to honour someone’s wishes. It is also why having an Advance Care Directive in place is not pessimistic. It is practical, loving and empowering.

Having an Advance Care Directive allows your values, wishes and preferences to be known if there comes a time when you cannot speak for yourself. It gives your family clarity. It gives your medical team guidance. And it gives you a voice, even in circumstances where your voice may no longer be as easily heard.

Healthy ageing is not about fearing the future. It is about being informed enough to influence it.

Dementia is not inevitable. Menopause is not a decline into invisibility. Midlife is a critical window for prevention, preparation and powerful health conversations.

For me, this is not just professional education. It is personal. It is family. It is lived experience. And it is one of the reasons I will keep speaking about menopause as a whole-body, whole-life health transition, not a punchline.  

The more we understand our bodies, the better we can advocate for them.

Movement. Mindset. Modify. Not because we can control everything, but because there is so much more, we can influence than we have been led to believe.