Gender differences in white matter hyperintensities on MRI brain scans |
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Gender differences in white matter hyperintensities on MRI brain scans
Prof. V Nagarajan, Chairman & Head Neurosciences Research & Translational Task Force, ICMR, New Delhi; Chairman, IEC, Govt. Madurai Medical College; Director, VN Neuro Care Centre, Madurai ,  04 July 2022
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Women have higher amounts of white matter hyperintensities (WMH) after menopause compared to premenopausal women or men of similar age, says a new study published in the journal Neurology.1

To resolve the question of gender differences in distribution of white matter hyperintensities in terms of age, researchers selected 3410 individuals, who were participating in the Rhineland Study. Women comprised nearly 58% (n = 1973) of the study population. While the average age of the enrolled participants was 54 years, 59% (n = 1167) among women participants were of postmenopausal age. The effect of menopause and hypertension on white matter hyperintensities was also examined; 35% were hypertensive, which was uncontrolled in half of these. MRI brain scans were used to measure the white matter hyperintensities for each participant.

Results of this cross-sectional study showed that an average total white matter volume of 430 ml for women and 490 ml for men.

Postmenopausal women had greater amounts of white matter hyperintensities compared to their male counterparts after adjusting for age and risk factors such as diabetes and hypertension. The average total white matter hyperintensities volume, among participants aged ≥45 years, was 0.94 ml in women versus 0.72 ml in men. The number increased with age and their progression was also faster in postmenopausal women compared to men of same age.

Among women, postmenopausal women had more of white matter hyperintensities then the premenopausal women of similar age. The average total white matter hyperintensities volume, among participants aged 45-59 years, was 0.51 ml in postmenopausal women versus 0.33 ml in premenopausal women. There was no difference in the amount of white matter hyperintensities between premenopausal women and men of a similar age.

The burden of white matter hyperintensities was higher in women with uncontrolled high blood pressure, but this had no association with menopausal status.

This study has characterized the differences in WMH between men and women. The postmenopausal women had a higher burden of WMH compared to premenopausal women and men of similar age. Their number also increases faster in women after menopause.

WMH are a frequent finding on brain imaging scans, either CT or MRI, in older individuals. However, their presence should not be viewed simply as an inevitable part of aging and thus to be ignored, even though detected incidentally. It has been shown that WMH “triple the risk of stroke and double the risk of dementia” and are associated with cognitive decline.2 It is therefore a potential biomarker for the heightened risk. Individuals with high amounts of WMH, postmenopausal women in particular, should be thoroughly evaluated for the presence of risk factors for stroke and dementia followed by their appropriate management.


  1. Valerie Lohner, et al. The relation between sex, menopause, and white matter hyperintensities: The Rhineland Study. Neurology. Jun 2022, 10.1212/WNL.0000000000200782; DOI: 10.1212/WNL.0000000000200782.
  2. Wardlaw JM, et al. What are white matter hyperintensities made of? Relevance to vascular cognitive impairment. J Am Heart Assoc. 2015 Jun 23;4(6):001140.
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