What dementia risk, menopause, and midlife mean for us, and why the silence is making it worse.

There is a conversation happening in the mainstream health world about women and dementia. About how women make up nearly two-thirds of all Alzheimer’s cases. About the role that oestrogen decline at menopause plays in brain health. About the window of midlife, that hormonal transition we are all navigating, as a moment of particular neurological significance.

It is a conversation that South Asian women are largely absent from. Not because dementia doesn’t affect us, or because our risk isn’t real, but because the research has rarely included us in meaningful numbers, the healthcare system rarely reaches us in culturally grounded ways, and within our own communities, the silence around ageing, memory loss, and brain health is profound.

This article is an attempt to change that a little in one small corner of the internet built specifically for South Asian women in midlife.

Because this conversation matters. And it is long overdue.

What we know about women and dementia

Women are disproportionately affected by dementia globally. Nearly two-thirds of individuals with Alzheimer’s disease are women. There are several reasons for this: women tend to live longer, face higher genetic risk factors in some cases, and experience the decline of oestrogen at menopause, which appears to have implications for brain health.

For years, there was significant debate about whether hormone replacement therapy, HRT, could either protect against or increase the risk of dementia. A major UCL review commissioned by the World Health Organisation, published in The Lancet Healthy Longevity and drawing on data from over one million participants, found no evidence that menopause hormone therapy either increases or decreases dementia risk in post-menopausal women. This is important because many South Asian women have been avoiding HRT out of fear that it would raise their dementia risk. That fear appears to be unfounded, and the decision about HRT should be guided by its proven benefits and risks for individual women, not by concerns about dementia.

What remains true, however, is that the risk factors for dementia are not equally distributed, and South Asian women carry a particular burden of many of them.

What South Asian women specifically need to know

Research using UK electronic health records found that South Asian populations face an elevated dementia risk, with risk factors including hypertension, obesity, and diabetes, all of which are more common in minority ethnic groups, contributing significantly.

These are not abstract statistics. They are the conditions that sit at the intersection of genetics, lifestyle, socioeconomic factors, and healthcare access, and they intersect directly with the hormonal changes of midlife. Cardiovascular disease risk rises at menopause. Blood sugar regulation becomes harder. Blood pressure can increase. All three are also established risk factors for vascular dementia and Alzheimer’s disease.

The picture gets more specific and more urgent still. Research by Dr Naaheed Mukadam, an Alzheimer’s Society Clinical Fellow at UCL, found that people of South Asian heritage are diagnosed with and pass away with dementia at a younger age than white British people.

Earlier diagnosis. Younger age of death. And yet, arriving at services later, when they are already in crisis.

In the UK, South Asian communities tend to present to dementia services later and when in crisis, despite dementia-associated risk factors being common among South Asians. The reasons are multiple and interlocking — cultural stigma around memory loss, language barriers, lack of culturally appropriate diagnostic tools, an assumption within healthcare services that South Asian families “look after their own” and don’t need external support, and the deeply held belief, common across South Asian communities, that forgetting things is simply a normal part of growing old.

It is not simply a normal part of growing old. And the gap between when symptoms begin and when help is sought is costing South Asian women, and their families, enormously.

The Brain Health Conversation South Asian Women Aren't Having, But Need To

The midlife window: why now matters

Midlife is not just the time when dementia becomes a concern. It is the time when the foundations for later brain health are being laid, or not.

The risk factors that elevate dementia risk later in life are often established, compounded, or reversed during midlife. Blood pressure. Blood sugar. Cardiovascular health. Sleep. Stress. Social connection. Physical movement. Cognitive engagement. These are the modifiable factors that research shows can meaningfully reduce dementia risk, and they are all things that midlife is uniquely positioned to address.

For South Asian women in midlife, already managing the hormonal shifts of perimenopause, the physical changes in cardiovascular and metabolic health, the emotional weight of caregiving, the disrupted sleep, the elevated cortisol, this intersection of risk factors is not theoretical. It is daily life.

Which means that the support, the education, and the culturally grounded healthcare that South Asian women access in midlife, or fail to access, have consequences that reach far into the decades ahead.

The silence, and what it costs

Many South Asian people view memory loss as a normal part of ageing, and there is a lack of awareness about dementia within the South Asian community generally. Within South Asian families, there is also significant stigma, fear that a diagnosis will bring shame, that a person will be labelled, and that it reflects on the family. Most South Asian older adults with dementia in the UK are cared for at home, influenced by cultural expectations, stigma associated with social care use, and fears over culturally insensitive care, leading to greater help-seeking at the crisis point.

The result is a community absorbing an enormous amount of invisible suffering. Women, almost always women, quietly taking on the full weight of caring for parents and partners with dementia, without external support, without the language to name what they are carrying, without the knowledge that help exists or that they are entitled to it.

And within that same community, women in midlife are making health decisions about HRT, their cardiovascular health, their lifestyle, and whether to speak to a GP about symptoms, without the information they need to make those decisions well.

What you can do, in midlife, right now

None of this is intended to frighten. It is intended to inform. Because information is the only thing that makes action possible.

If you are a South Asian woman in midlife, here is what the evidence supports:

Know your numbers. Blood pressure, blood sugar, and cholesterol are the three metrics most directly linked to vascular dementia risk. If you haven’t had them checked recently, ask your GP for a health check. This is straightforward, free on the NHS, and one of the most meaningful things you can do for your long-term brain health.
Take sleep seriously. Disrupted sleep, one of the most universally experienced symptoms of perimenopause, is not just exhausting. Chronic sleep deprivation is one of the most significant modifiable risk factors for dementia. If your sleep is severely disrupted, speak to your GP.
Move your body in ways that support cardiovascular health. This does not have to mean the gym. It means regular, sustainable movement, walking, dancing, swimming, and yoga that keeps your heart and blood vessels healthy. What is good for the heart is good for the brain.
Stay connected. Social isolation is a significant dementia risk factor. The Sattva Women’s Circle exists precisely because community is not a luxury; it is health. Being in a room with other women who understand your experience is genuinely good for your brain.
Do not dismiss forgetfulness. Brain fog is a recognised and extremely common symptom of perimenopause, and it is almost always hormonal rather than the beginning of dementia. But if you or someone you love is experiencing memory problems that are affecting daily life, speaking to a GP is always the right first step.
If you are concerned about someone you love, the Alzheimer’s Society offers a free Dementia Support Line, 0333 150 3456, available seven days a week. They also provide a Dementia Symptoms Checklist that can help you describe what you are observing to a GP. These resources exist. You are allowed to use them.

A note on brain fog and perimenopause

Before we close, a reassurance that many women reading this need to hear.

The forgetfulness, the difficulty concentrating, the word-finding struggles, the sense that your brain is wrapped in cotton wool, these are perimenopause symptoms. They are hormonal. They are real. They are not the early stages of dementia, and they are not permanent.

They are deeply unsettling, particularly for women who have always relied on their sharpness and their competence. But they are also, in the overwhelming majority of cases, reversible with hormonal support, sleep, stress reduction, and time.

If you are in your forties or fifties and your brain feels different, please speak to your GP about perimenopause before catastrophising about dementia. The two are not the same. And the distinction matters enormously.

The bigger picture

South Asian women deserve to age well. They deserve healthcare that understands their risk profile, their cultural context, and the specific ways that midlife intersects with long-term health outcomes. They deserve dementia services that reach them before a crisis, in languages they understand, with cultural sensitivity built in rather than bolted on.

Higher levels of neighbourhood deprivation, which are more common in some South Asian communities, can create barriers to education, housing, healthcare, and employment, all factors that shape dementia risk over a lifetime. These are systemic issues that require systemic solutions. But within those systemic realities, there are individual choices available in midlife that matter, and South Asian women deserve access to the information that makes those choices possible.

That is what The Sattva Collective exists to provide.

The brain health conversation is not separate from the midlife conversation. It is the same conversation. And South Asian women deserve to be at the centre of it.

The Alzheimer’s Society’s Dementia Support Line: 0333 150 3456 (open 7 days a week)

Dementia Symptoms Checklist: alzheimers.org.uk

Find local dementia support: alzheimers.org.uk/find-support-near-you

Sources or Further Reading

HRT and dementia risk: UCL/Lancet study (the most important one). The landmark 2025 review covering over 1 million participants https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(25)00122-9/fulltext

UCL press release on the same study https://www.ucl.ac.uk/news/2025/dec/menopause-hormone-therapy-does-not-appear-impact-dementia-risk

South Asian women and dementia risk: elevated risk and later diagnosis, Dr Naaheed Mukadam’s research, Alzheimer’s Society https://www.alzheimers.org.uk/for-researchers/dementia-research-desperately-black-south-asian-services-change

Published study: incidence, age at diagnosis, survival across ethnic groups in England https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12774

South Asian communities and late help-seeking Systematic review on dementia help-seeking in UK South Asian communities https://www.lidsen.com/journals/geriatrics/geriatrics-08-02-279

Post-diagnostic support for South Asians with dementia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895770/

Ethnicity and dementia risk: deprivation and structural factors Alzheimer’s Research UK https://www.alzheimersresearchuk.org/dementia-information/dementia-risk/ethnicity-and-dementia-risk/

Dementia risk higher among South Asian populations: Medical News Today summary https://www.medicalnewstoday.com/articles/dementia-risk-higher-among-black-south-asian-ethnicities-study

Estrogen, menopause and Alzheimer’s disease: brain health connection Frontiers in Molecular Biosciences, 2025 https://www.frontiersin.org/journals/molecular-biosciences/articles/10.3389/fmolb.2025.1634302/full