Suda51, the man behind Lollipop Chainsaw and Shadows Of The Damned, returns with his weirdest and most entertaining game in several years.

With a career spanning more than three decades, Grasshopper Interactive founder Goichi ‘Suda51’ Suda has a reputation for bringing a punk aesthetic to the craft of making video games. He’s best known for earlier titles like killer7 and No More Heroes but after a poor run in recent years, Romeo Is A Dead Man is very much a return to form. It’s quirky, rule-breaking, and feels like it shouldn’t work – yet, somehow, it does.

If nothing else, Romeo Is A Dead Man is utterly distinctive: you’re not likely to mistake the hard-boiled, ultraviolent, cynically humorous games Suda51 churns out for those made by anyone else. The first aspect in which this new game forcibly grabs your attention is by employing a blizzard of vastly differing art styles, instead of just one.

Thus, in Romeo Is A Dead Man’s first hour, you find a diorama style intro; comic book style framed cut scenes (which themselves showcase different styles of comic book art); conventional third person 3D which is also warped into a Tron style, blocky, shiny neon version of itself; a pixel art hub offering homages to games of the 16-bit era; psychedelic, fractal-like transition screens; and further retro homages going all the way back to the days of Pong.

The game is visually arresting but in the hands of anyone other than Suda51, it would surely have ended up as a horrible mishmash. That it manages not to, is attributable to the sheer off-the-wall nature of its storyline, which instantly forces you to suspend disbelief, then carries on further into the outer reaches of preposterousness. Once you surrender yourself to its logic-defying weirdness, the use of different visual styles to convey chunks of that narrative somehow makes sense.

Romeo Is A Dead Man’s plot centres on Romeo Stargazer, deputy sheriff in a small, dead end American town, who stops his squad car to investigate a body in the road and is mauled and killed by a monster. Luckily, his grandad Benjamin is a time-travelling boffin who has invented a life support system which he turns up with and injects into Romeo. Benjamin dies in the process but is reincarnated as a patch on the back of Romeo’s jacket.

As a result of his newfound powers, Romeo is recruited by the FBI’s Space-Time division, who send him off to take down a list of the universe’s most nefarious space-time criminals, lurking in different time periods and causing anomalies that destroy different multiverse versions of Earth. It turns out that among their number is Juliet, Romeo’s ex-girlfriend. Throughout the game, the story of their romance is told in flashback. Romeo, a puppyish character, still pines for her and that leads to disaster whenever he catches up with one of her variants.

Romeo, along with his mother and sister, and a cast of weird alien types, is headquartered on the FBI’s Space-Time spaceship, which provides a tempo-altering oasis from the relentless gore and violence that each chapter brings. There’s loads to do on the spaceship, most obviously upgrading Romeo’s abilities via a Pac-Man pastiche. But you can also grow zombie-like allies for you to summon or sit around listening to shaggy dog stories from the other characters.

When it’s time to go on a mission, you’ll find each chapter sends you to a different time period, where Romeo must use his melee and shooting skills to dismember hordes of enemies. The combat, using both a melee weapon and a gun, is reminiscent of No More Heroes and the only part of the game that feels in any way ordinary. It’s gory and fun, but it’s the set pieces, locations, and enemies that add the most flavour. The fact that you can’t change weapons without switching back to the main menu is a pain though.

The other element to each chapter is subspace, which is accessed via TVs on which a mysterious philosophical Svengali appears, and allows you to reach areas inaccessible in the surface world. There’s no fighting in subspace (at least until the game’s latter stages) but there are puzzles which open up new areas and staircases, and key parts to find, which will allows you to reach the chapter boss.

There are puzzles – some quite decent but never too obscure – in the surface world too, and plenty of gameplay variation between the chapters. One, for example, majors on stealth (and is set in a creepy abandoned hospital, bringing to mind classic horror games of yore). In another chapter, set in the 1970s, Romeo acquires a zombie assistant called Jenny, who ends up being dismembered but still survives. As is customary for a Suda51 game, dark humour abounds.

As the game builds to a crescendo, you’re even treated to an 8-bit style point ‘n’ click interlude, which morphs into a Japanese hip-hop musical number. By then, Romeo seems to exist outside of space and time. Each chapter begins with an Oscar Wilde quote and it’s a fair bet that no other game this year will be so chock full of literary references.

If you’ve recently worried that games are in danger of becoming generic and safe, Romeo Is A Dead Man will more than allay such fears. It’s completely out there, both visually and story-wise, pleasingly experimental, very funny, and pretty satisfying to play – although its combat is probably its most conventional aspect.

What it isn’t, is polished to within an inch of its life, although for some that will be another part of the charm. It isn’t the longest game around – if you explore every nook of subspace for collectibles, you might get 20 hours’ gameplay from it – but it also doesn’t overstay its welcome.

It makes little sense, at least as far as conventional logic is concerned, but in terms of pure escapism it’s off the charts, creating the absolute antithesis of anything corporate or bland. Romeo Is A Dead Man offers glorious proof that Suda51’s punk ethos is still alive and well. It won’t appeal to everyone, but that’s the point.

Formats: PlayStation 5 (reviewed), Xbox Series X/S, and PC
Price: £41.99
Publisher: NatEase Games
Developer: Grasshopper Manufacture
Release Date: 11th February 2026
Age Rating: 18

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Don Lemon, the former CNN host, has secured legal representation from a federal prosecutor who resigned from his post amid a dispute with the Trump administration. A court filing on Tuesday revealed that Lemon, who is among nine individuals indicted for their alleged roles in disrupting a church service in Minnesota, has hired Joe Thompson.

Thompson, who previously served as interim U.S. Attorney, stepped down last month from the Minnesota U.S. Attorney’s Office, where he had been leading major fraud investigations. His departure coincides with a broader exodus of prosecutors from the office, reportedly driven by growing frustration with the administration’s immigration enforcement crackdown and the Justice Department’s response to fatal shootings by federal officers in Minneapolis.

Lemon faces federal civil rights charges concerning his coverage of the church protest, which occurred at a church where an Immigration and Customs Enforcement official was a pastor. He has previously stated, through another attorney, his intention to plead not guilty, asserting he was not affiliated with the group that disrupted the service and was present solely as an independent journalist.

The indictment, however, reportedly details various actions by the group, including comments made by Lemon during his livestream report on the event.

Lemon is scheduled to be arraigned on Feb. 13 in federal court in St. Paul.

The Trump administration has cited the Minnesota fraud cases, in which most defendants have come from the state’s large Somali community, as justification for its immigration crackdown in the state. Thompson estimated in December that the losses to taxpayers from several fraud cases being prosecuted in Minnesota could total $9 billion.

Thompson recently formed his own law firm with Harry Jacobs, another former federal prosecutor who resigned amid the upheaval in the office. Jacobs had been lead prosecutor in the case of Vance Boelter, who has pleaded not guilty in last year’s assassination of former Minnesota House Speaker Melissa Hortman and her husband, and the nonfatal shootings of a state senator and his wife.

The firm’s website describes them as “battle tested and seasoned” trial lawyers.

Thompson did not immediately reply to messages seeking comment Tuesday.

Cardi B was part of Bad Bunny‘s Super Bowl halftime show. What she did exactly, well, that turned into a perplexing question for two major prediction markets.

At least one Kalshi trader filed a complaint with the Commodity Futures Trading Commission over how the prediction market handled Sunday’s appearance by the Grammy-winning rapper. The result of a similar event contract on Polymarket also drew the ire of some users on that platform.

Prediction markets provide an opportunity to trade — or wager — on the result of future events. The markets are comprised of typically yes-or-no questions called event contracts, with the prices connected to what traders are willing to pay, which theoretically indicates the perceived probability of an event occurring.

The buy-in for each contract ranges from $0 to $1 each, reflecting a 0% to 100% chance of what traders think could happen.

More than $47.3 million was wagered on Kalshi’s market for “ Who will perform at the Big Game? ” A Polymarket contract had more than $10 million in volume.

Cardi B joined singers Karol G and Young Miko and actors Jessica Alba and Pedro Pascal on a starry front porch during the halftime spectacle. She danced to the music, but it was unclear whether she was singing along during the show, which included performances by Ricky Martin and Lady Gaga.

Due to “ambiguity over whether or not Cardi B’s attendance at the 2026 Super Bowl halftime show constituted a qualifying ‘performance,’” Kalshi cited one of its rules in settling the market at the last price before trading was paused: $0.74 for No holders and $0.26 for Yes holders. The platform returned all the money to its users.

Polymarket’s contract was resolved as Cardi B had performed, but the yes was disputed. A final decision on the contract is expected to be announced on Wednesday.

In the CFTC complaint — first reported by the Event Horizon newsletter and posted by Front Office Sports — the trader alleges that Kalshi violated the Commodity Exchange Act with how it resolved the Cardi B contract. The trader — a Yes holder — is seeking $3,700.

A message was left Tuesday night seeking more information from the CFTC.

The Super Bowl capped a big NFL season for prediction markets.

Kalshi reported a daily record high of more than $1 billion in total trading volume on the day of the game, an increase of more than 2,700% compared to last year’s Super Bowl. The season-long total for all Super Bowl winner futures was $828.6 million, up more than 2,000% from last year.

The increased activity on Sunday caused some deposit issues. Kalshi co-founder Luana Lopes Lara posted on X on Monday that the “traffic spike was way bigger than our most optimistic forecasts.” She said the platform had reimbursed processing fees on the effected deposits and added credits to users who experienced delays.

___

AP sports: https://apnews.com/sports

The Oceanic Awards took place this week, with finalists from across the UK turning up at the ceremony to celebrate excellence across the curry industry.

Masala Craft in York scooped the Bar Curry Restaurant of the Year Award at the event which recognised and toasted the talents and hard work of individuals and businesses within the industry.

Masala Craft in York is a Nation’s Curry Awards 2026 winner

The Indian tapas restaurant was among the category winners who have distinguished themselves with their exceptional quality, innovation, and consistency in offering memorable dining experiences.

Masala Craft, led by owner and long-standing chef Arving Mamgain, opened at 72 Walmgate in 2023, which was previously home to Penny’s Bespoke Foodhouse, having previously been based in King Street until it closed in late 2022 due to rising costs.

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Yasmin Mahmood, CEO of Oceanic Awards, said: “We’re proud to once again celebrate the finest in the UK’s curry scene, recognising the creativity, innovation, and exceptional service that have become synonymous with this beloved cuisine.

“The UK’s curry industry is a vital part of our culture, and these awards recognised the exceptional talents of the individuals and businesses that make it so special.

“We’d like to congratulate all of our winners on their incredible accomplishments.”

Jaflong Bangladeshi in Ripon was awarded the Outstanding Achievement Award in the Bangladeshi Restaurant of the Year category, while ILLAM Restaurant in Harrogate received the Outstanding Achievement Award in the South Indian Restaurant of the Year category.

The overall winner of the Curry Restaurant of the Year went to Aarti in Leeds while the Best of Yorkshire Award went to Bengal Brasserie in Wetherby.

The awards annually celebrate the UK’s rich and diverse curry culture and encourage the continued growth and evolution of the industry.

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Congressional Democrats on Tuesday accused the Trump administration of trying to hijack plans to celebrate America’s 250th anniversary and using the nonprofit National Park Foundation to solicit money from private donors for some of the president’s pet projects, including the massive arch he wants to build in the nation’s capital.

During a hearing on the 250th anniversary commemoration, U.S. Rep. Jared Huffman said President Donald Trump and his allies are attempting to use the celebration to “promote an alternate reality.”

The California Democrat accused Republican members of the committee of letting the administration “hijack the country’s 250th anniversary and sell access, hide his donors and rewrite history. You let him clean house and put loyalists on the board of the National Park Foundation, open the door to foreign, dark money donors to buy influence with zero oversight.”

Democratic Rep. Maxine Dexter of Oregon voiced concern that a White House-led initiative, called Freedom 250, is using public money earmarked for a separate, congressionally chartered commission, America250, and is co-mingling it with private donations.

Dexter said the structure of the organization created by the White House makes it difficult to tell who is donating to it.

“This leaves us all guessing which one of Donald Trump’s billionaire buddies and which foreign interests are buying access,” she said.

Danielle Alvarez, spokeswoman for Freedom 250, said it has received no funding from foreign donors. The park foundation, which typically raises money to help the national parks, must grant anonymity if a donor asks for it, the foundation’s president and CEO, Jeff Reinbold, said when asked during the hearing.

Davis Ingle, a White House spokesman, responded to the hearing by saying the president wants to ensure that the country gets “the spectacular birthday it deserves.

“The celebration of America’s 250th anniversary is going to display great patriotism in our nation’s capital and throughout the country,” he said in a statement. “President Trump’s bold vision will be imprinted upon the fabric of America and be felt by generations to come.”

Democrats raise concerns about history being erased

The three-hour hearing, before a subcommittee of the House Committee on Natural Resources, was promoted as an explanation of public and private partnerships supporting America’s 250th anniversary on public lands, but it veered into an airing of numerous Democratic concerns.

Democrats raised questions about national park sites where exhibits and displays have been sanitized or removed altogether as part of the administration’s efforts to quash diversity, equity and inclusion, as well as questions over funding and transparency. Rep. James Clyburn of South Carolina gave an impassioned address about seeing the darker parts of U.S. history as part of the nation’s strength.

Alan Spears, senior director at the National Parks Conservation Association, testified that when “you begin picking at words to soften and sanitize, to erase the history, that is a dangerous precipice to be on. Because I think the quickest way that you can disappear people is to disappear their story or to soften it.”

‘We deserve to know where our money is going’

In 2016, Congress formed America250, the U.S. Semiquincentennial Commission, to lead planning for the anniversary that commemorates the signing of the Declaration of Independence in July 1776.

The commission was initially expecting to receive $100 million of the $150 million appropriated for the anniversary in the Republicans’ tax and spending bill, which they called the One Big Beautiful Bill Act. The money went to the U.S. Department of the Interior and was intended for activities surrounding the commemoration.

A source familiar with the funding for America250, who was not authorized to speak publicly about it, said that the anticipated amount dropped to $50 million and that so far the organization has received just $25 million. Federal funding cuts last year already had led some communities to begin scaling back their plans for celebrating the anniversary.

Tim Whitehouse, executive director of Public Employees for Environmental Responsibility, testified that the funding question is tantamount.

“The American people are paying for this commemoration. We deserve to know where our money is going,” he said, adding that he sent a letter to Interior Secretary Doug Burgum seeking answers.

A spokeswoman with the Interior Department said in a recent email that a portion of the funding was being provided to the U.S. Semiquincentennial Commission through an interagency agreement with the National Park Service. The Interior Department did not respond to requests after the hearing for comment on the distribution of federal money to America250.

One celebration, two entities putting it on

Republicans were relatively silent in responding to the Democrats’ lines of questioning, except North Carolina Rep. Addison McDowell, who defended the celebration being planned as a reminder of how far the nation has come.

“As I sat here and listened to the other side’s remarks, what I heard was a deeply misguided and dark vision of America,” he said. “If you didn’t know any better, you might believe from their remarks that the United States is not the greatest experiment in human history, but an ongoing crime scene.”

Rep. Val Hoyle, an Oregon Democrat, countered immediately: “Yes, we need to celebrate how far America has come, but how the hell do we know how far we’ve come if we erase the history? How is that patriotic?”

America250 is focused on commemorations around the country, including a national volunteer effort and creating an audio-visual archive of stories from everyday Americans. One initiative, “America’s Field Trip,” asks students from around the country to share stories on what America means to them, with a chance to get field trips to historic sites and landmarks. One initiative, America Gives, aims to significantly increase the number of Americans who volunteer with nonprofits with support from companies like Walmart and Coca-Cola and nonprofits like Points of Light.

So far, the organization has said it has had enough money, including from donations, to continue with its original programming.

Much of the programming from the White House group has so far appeared to focus on splashy events, including a planned UFC fighting competition at the White House, athletic events involving high school athletes it’s calling The Patriot Games and a “Great American State Fair” on the National Mall. Freedom 250 was responsible for the striking birthday lighting of the Washington Monument coming into the New Year.

___ Murphy reported from Oklahoma City.

___

AP reporter Thalia Beaty contributed to this report.

All 55 people on board a passenger plane were safely evacuated after the aircraft overran the runway and ended up in shallow waters during an emergency landing in Somalia.

No one was injured in the incident which happened near the country’s main airport on Tuesday.

The Starsky Aviation aircraft had taken off from Mogadishu’s Aden Abdulle International Airport and was bound for the northern city of Gaalkacyo when it developed a technical problem about 15 minutes into its flight.

The pilot then turned back and made an emergency landing but he overshot the tarmac, veered off and finished at the shoreline of a beach in the Indian Ocean.

All 50 passengers and five crew members safely left the plane, a Fokker 50.

Everyone on board was accounted for by a rescue team, transportation minister Mohamed Farah Nuh said.

The aircraft was damaged and the cause of the crash will be investigated.

Pictures showed the plane with at least one wing snapped but otherwise intact on the shoreline.

Starsky Aviation chief executive Ahmed Nur said “the aircraft overran on the runway” before coming to a rest on the shore of the Indian Ocean near the airport.

He added: “No injuries, no deaths.”

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The Somali Civil Aviation Authority said in a statement that at 1.17pm local time (10.17am UK time) “an aircraft with registration number 60-YAS, an F50, was involved in a runway overrun at Mogadishu Aden Abdulle International Airport”.

“The aircraft was carrying 55 people on board. All occupants survived the incident and were promptly transported to a nearby hospital for medical evaluation and care.

“No fatalities have been reported.”

There has been a lot of noise around Sandro Tonali this season and increasing speculation about a future away from Newcastle United but the Italy international has not been dropped because of that.

Tonali is not starting against Tottenham because he has looked out of form for months and in need of a rest. Others have attracted more criticism, but the drop off in performance levels from Tonali, compared to last season, has been dramatic.

It is still a brave call from manager Eddie Howe to leave him out, just as it is to pick Anthony Gordon at centre forward rather than either of his expensive summer signings Yoane Wissa and Nick Woltemade. 

Wissa does not look fit and Woltemade looks like a bad fit but Gordon is still a winger not a centre forward.

But Tonali has not been playing well and Newcastle’s midfield has been far too easy to play through recently. It will, of course, lead to more suggestions that the former AC Milan star does not want to be on Tyneside much longer.

Newcastle, though, are surprisingly relaxed about all the transfer talk about the midfielder, who was supposedly offered to Arsenal in January and who has since been linked with a summer move to Manchester City, Manchester United and Juventus.

The player’s agent has publicly cranked up the pressure by hinting the 25-year-old would be interested in a move if Newcastle do not qualify for the Champions League. It has felt like a summer transfer saga has been well signposted.

Yet, the main power brokers at St James’ Park have shrugged it all off, almost dismissively, in private. They have pointed out that the player has not told anyone at Newcastle that he would like a move and, in fact, stressed to both sporting director Ross Wilson and Howe last week that he is extremely happy at the club.

It has also been pointed out that if Tonali wants a big money move in the summer – he is effectively under contract until 2030 – he needs to be playing a lot better than he is at the moment for anyone to be willing to make a bid that could tempt Newcastle to sell a player who cost them £55m in 2023.

Supermarket shelves can look full despite the food systems underneath them being under strain. Fruit may be stacked neatly, chilled meat may be in place. It appears that supply chains are functioning well. But appearances can be deceiving.

Today, food moves through supply chains because it is recognised by databases, platforms and automated approval systems. If a digital system cannot confirm a shipment, the food cannot be released, insured, sold, or legally distributed. In practical terms, food that cannot be “seen” digitally becomes unusable.

This affects the resilience of the UK food system , and is increasingly identified as a critical vulnerability.

Look at the consequences, for example, when recent cyberattacks on grocery and food distribution networks disrupted operations at multiple major US grocery chains. This took online ordering and other digital systems down and delayed deliveries even though physical stocks were available.

Part of the problem here is that key decisions are made by automated or opaque systems that cannot be easily explained or challenged. Manual backups are also being removed in the name of efficiency.

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The UK’s food supply is more fragile than you might think – here’s why it should be a national priority

This digital shift is happening around the world, in supermarkets and in farming, and has delivered efficiency gains, but it has also intensified structural pressures across logistics and transport, particularly in supply chains which are set up to deliver at the last minute.

Using AI

AI and data-driven systems now shape decisions across agriculture and food delivery. They are used to forecast demand, optimise planting, prioritise shipments, and manage inventories. Official reviews of the use of AI across production, processing, and distribution show that these tools are now embedded across most stages of the UK food system. But there are risks.

When decisions about food allocation cannot be explained or reviewed, authority shifts away from human judgment and into software rules. Put simply, businesses are choosing automation over humans to save time and cut costs. As a result, decisions about food movement and access are increasingly made by systems that people cannot easily question or override.

This has already started to happen. During the 2021 ransomware attack on JBS Foods, meat processing facilities halted operations despite animals, staff, and infrastructure being present. Although some Australian farmers were able to override the systems, there were widespread problems. More recently, disruptions affecting large distributors have shown how system failures can interrupt deliveries to shops even if goods are available.

Getting rid of humans

A significant issue is fewer people managing these issues, and staff training. Manual procedures are classified as costly and gradually abandoned. Staff are no longer trained for overrides they are never expected to perform. When failure occurs, the skills required to intervene may no longer exist.

This vulnerability is compounded by persistent workforce and skills shortages, which affect transport, warehousing and public health inspection. Even when digital systems recover, the human ability to restart flows may be limited.

The risk is not only that systems fail, but that when they do, disruption spreads quickly. This can be understood as a stress test rather than a prediction. Authorisation systems may freeze. Trucks are loaded, but release codes fail. Drivers wait. Food is present, but movement is not approved.

Based on previous incidents within days digital records and physical reality can begin to diverge. Inventory systems no longer match what is on shelves. After about 72 hours, manual intervention is required. Yet paper procedures have often been removed, and staff are not trained to use them.

These patterns are consistent with evidence from UK food system vulnerability analyses, which emphasise that resilience failures are often organisational rather than agricultural.

Food security is often framed as a question of supply. But there is also a question of authorisation. If a digital manifest is corrupted, shipments may not be released.

This matters in a country like the UK that relies heavily on imports and complex logistics. Resilience depends not only on trade flows, but on the governance of data and decision-making in food systems, research on food security suggests.

Who is in control?

AI can strengthen food security. Precision agriculture (using data to make decisions about when to plant or water, for instance) and early-warning systems have helped reduce losses and improve yields. The issue is not whether AI is used, but who is watching it, and who manages it.

Food systems need humans to be in the loop, with trained staff and regular drills on how to override systems if they go wrong. Algorithms used in food allocation and logistics must be transparent enough to be audited. Commercial secrecy cannot outweigh public safety. Communities and farmers must retain control over their data and knowledge.

This is not a risk for the future. It already explains why warehouses full of food can become inaccessible or ignored.

The question is not whether digital systems will fail, but whether we will build a system that can survive its failure.

Menopause is a key period in a woman’s life. This transition is often accompanied by wide-ranging physical and psychological symptoms — some of which can be debilitating and affect daily life. Menopause has also been linked to cognitive problems — such as memory, attention and language deficits.

To mitigate the effects of menopause — including hot flashes, depressive symptoms and sleep problems — many women turn to hormone replacement therapy (HRT). In England, an estimated 15% of women are prescribed HRT for menopause symptoms. In Europe, this number is even higher – varying between 18% in Spain to 55% in France.

But there’s limited understanding of the effects of menopause and subsequent HRT use on the brain, cognition and mental health. To address this, we analysed data from nearly 125,000 women from the UK Biobank (a large database containing genetic and health data from about 500,000 people).

We placed participants into three groups: pre-menopausal, post-menopausal and post-menopausal with HRT. The average age of menopause was around 49 years old. Women who used HRT typically began treatment around the same age.

In short, we found that menopause was associated with poorer sleep, increased mental health problems and even changes within the brain itself.

Post-menopausal women were more likely than pre-menopausal women to report symptoms of anxiety and depression. They were also more likely to seek help from a GP or psychiatrist and to be prescribed antidepressants.

Sleep disturbances were more common after menopause, as well. Post-menopausal women reported higher rates of insomnia, shorter sleep duration and increased fatigue.

Brain imaging analyses also revealed significant reductions in grey matter volume following menopause. Grey matter is an important component of the central nervous system which is composed mainly of brain cells. These reductions were most pronounced in regions critical for learning and memory (namely the hippocampus and entorhinal cortex) and areas key in emotional regulation and attention (termed the anterior cingulate cortex).

Notably, the hippocampus and entorhinal cortex are among the earliest affected in Alzheimer’s disease, the most common form of dementia.

The changes we observed in our study could suggest that menopause-related brain changes may contribute to increased vulnerability to Alzheimer’s disease later in life. This could help explain why there’s a higher prevalence of dementia observed in women.

We also investigated whether taking HRT post-menopause had any effect on health outcomes. Notably, HRT did not improve the reduction in brain grey matter.

In addition, we found that women using HRT showed higher levels of anxiety and depression compared to post-menopausal women who had never used HRT. However, further analyses indicated that these differences were already present. This suggested that pre-existing mental health problems may have influenced the decision to begin using HRT rather than these symptoms being caused by the medication itself.

One potential benefit of HRT use was noted in cognitive performance – particularly for psychomotor speed. Psychomotor slowing is a hallmark feature of ageing.

Post-menopausal women who had never used HRT showed slower reaction times compared with both pre-menopausal women and post-menopausal women who had used HRT. This indicates that HRT helps to slow the menopause-related declines in psychomotor speed.

HRT and menopause

There’s still much we don’t know about HRT – and more evidence on its benefits and risks are still needed.

Some studies report that those taking HRT have an increased dementia risk, while others suggest a decreased risk of dementia.

More research is also needed to understand the effects of HRT and how the different routes and dosages affect menopause symptoms. But according to one UK Biobank study of 538 women, the effects don’t appear to differ – regardless of factors such as the formulation, route of administration and duration of use.

Importantly, however, it’s difficult to establish whether women are actually receiving an effective dose. One in four women using the highest licensed dose of HRT still had low levels of estradiol (oestrogen) – around 200 picomoles per litre. Older women and HRT patch users were more likely to have lower levels.

Optimal plasma levels to relieve menopause symptoms are between 220-550 picomoles per litre. This means that for 25% of the women in the study, HRT would not have had optimal benefit for menopause symptoms.

Considering that most women go through the menopause, it’s important to resolve the question of whether HRT is beneficial – including preventing brain grey matter volume reductions and reducing the risk of dementia. It will also be important to know what the best dose and route of administration are.

There is evidence to suggest healthy lifestyle habits may mitigate these menopause-related changes in brain health.

Our work and that of other research groups shows that a number of lifestyle habits can improve brain health, cognition and wellbeing, thereby reducing the risk of cognitive decline associated with ageing and dementia. This includes regular exercise, engaging in cognitively challenging activities (such as learning a new language or playing chess), having a nutritious and balanced diet, getting the right amount of good-quality sleep and having strong social connections.

Research also shows regular physical activity can increase the size of the hippocampus, which may help mitigate some of the menopause-related reductions observed in this region.

Sleep is also critically important as it supports the consolidation of memories and helps clear toxic waste byproducts from the brain – processes that are essential for memory, brain health and immune function.

Having a healthy lifestyle may offer an accessible and effective strategy to promote brain health, cognitive reserve and resilience to stress during and after the menopause transition.