When discussing menopause, the focus often falls on the physical manifestations such as hot flashes, night sweats, vaginal irritation, weight gain, hair thinning, and joint pain. However, some of the most troubling impacts of menopause include cognitive and psychological symptoms. Fortunately, recent attention from scientists and doctors highlights critical brain changes during midlife. This blog provides key insights about women’s brains, the impacts of menopause, and strategies to optimize long-term brain health through this transition.
Estrogen: The Brain’s Master Regulator
The brain is our body’s control center, crucial for everything we do. Despite this, clinical research shows significant gender bias, with only 0.5% of neuroscience research focusing specifically on women’s bodies. This is troubling given that many brain-related conditions disproportionately affect women and are chronically underfunded. For more insights, see this fantastic video from Ann Bowers Brain Health Initiative.
Women’s brains are hormonally, energetically, and chemically distinct from men’s. Dr. Lisa Mosconi, a renowned neuroscientist and author of The Menopause Brain, highlights several statistics. Women are:1
- 2X as likely as men to be diagnosed with an anxiety disorder or depression.
- Twice as likely to develop Alzheimer’s disease.
- 3X more likely to develop an autoimmune disorder, including those affecting the brain.
- 4X more likely to suffer from headaches and migraines.
- More likely to develop brain tumors or die from a stroke.
- 70% of chronic pain sufferers are women, experiencing pain more frequently, for longer periods, in more areas, and more intensely.
- Rapid hormonal changes are linked to increased ADHD symptoms.
Estrogen: The Brain’s Master Regulator
Estrogen is a crucial hormone in brain processes and the “master regulator” of the brain with many functions:
- Neuroprotection: Boosts the immune system, aids in cell repair, and protects against oxidative stress.
- Cell Growth: Helps with cell repair, new cell generation, and connectivity formation.
- Brain Plasticity: Enhances the brain’s ability to adapt and respond to change.
- Communication: Impacts neurotransmitters for signaling and information processing.
- Mood Regulation: Positively affects serotonin, promoting happiness, pleasure, and sleep.
- Cardiovascular Health: Benefits blood pressure and circulation, protecting the brain and heart.
- Energy: Ensures efficient glucose utilization, promoting brain function.
Hormonal Changes During Menopause
The brain undergoes significant structural and functional changes due to hormonal fluctuations during the menstrual cycle and menopause. During perimenopause, estrogen and progesterone levels vary greatly and decline over time, while testosterone drops more gradually, and FSH and LH increase to compensate for falling estrogen levels.
These hormonal changes impact women’s brain energy, structure, regional connectivity, and overall chemistry. Dr. Mosconi’s research shows that estrogen receptor density in the brain may predict menopause. Brain scans reveal a 30% drop in brain energy during menopause, leading to issues with:
- Energy Production: Fatigue from decreased energy levels.
- Temperature Control: Estradiol affects the hypothalamus, causing hot flashes and night sweats. Some research indicates women who experience more hot flashes may have more decreases in gray matter volume, which can have a greater impact on language, memory, and concentration.
- Stress: Chronic stress can elevate cortisol levels, promoting hot flashes, anxiety, depression, memory loss, brain shrinkage, pain, inflammation, and lower quality of life.
- Sleep: Insomnia and sleep apnea can weaken the immune system, increase cardiovascular disease and diabetes risk, and impact mental health. Sleep is critical for short-term cognitive function, mood, and productivity. During menopause, the brain may not properly regulate sleep and wakefulness, so women can experience more insomnia and sleep apnea. This can weaken the immune system, increase the risk of cardiovascular disease and diabetes, and impact mental health.
- Mood Regulation: Estrogen declines affect the amygdala, causing mood swings and irritability.
- Brain Fog: Changes in the prefrontal cortex and hippocampus can cause mental fuzziness, difficulty processing information, forgetfulness, word retrieval issues, and misplacing objects. This impacts about 60% of women during menopause but is not a sign of dementia.1
- Emotional Regulation: Increased vulnerability to anxiety and depression.
- ADHD Symptoms: Hyperactivity-impulsivity driven by estrogen declines, and inattention influenced by both estrogen and progesterone levels.
About 80% of women experience some of these brain symptoms, with many encountering all of them. Before menopause, the prevalence of brain conditions is roughly equal between men and women but shifts to a 2:1 or higher female-to-male ratio after menopause.1 Find out more about all of the potential impacts of menopause in Menowar’s blog, What Symptoms Can Women Experience During Menopause?
These symptoms are not “all in your head.” It’s crucial to talk with a physician about any concerning neurological symptoms to ensure they don’t require medical attention. However, many women find these changes temporary, with brain energy plateauing approximately five years into menopause, correlating with the easing of symptoms like hot flashes. The decline tends to be more persistent for those at genetic risk for Alzheimer’s. The Study of Women’s Health Across the Nation (SWAN) traced the cognitive performance of 2,300 midlife women over several years, finding that “although there are transient memory deficits experienced during the menopause transition, these appear to be reversible.”2
Strategies For Maintaining Brain Health
Menopause Hormone Therapy (MHT)
Our brain is hard-wired to receive estrogen. There are good indicators that MHT might improve cognitive function and memory and increase brain volume. MHT is proven to reduce hot flashes, which are correlated with brain changes, improve sleep, and lessen psychological symptoms like anxiety and depression.
Importantly, estrogen appears to be highly effective in cell growth, supporting brain function, and helping to prevent the formation of Alzheimer’s plaques when given earlier in the menopausal transition. There is growing evidence that MGT may also protect from cognitive decline. In fact, a recent Tulane University study on rats suggests that short-term MHT use in middle age may lead to better brain aging and memory long after treatment stops. Clearly, this is a ripe area for more extensive research.
To read further on MHT, see Menowar’s blog, Important Information About Menopause Hormone Therapy.
Exercise
It has been demonstrated that exercise can help boost brain health. Plus the benefits of exercise are numerous – stronger bones and fewer injuries, cardiovascular health, and increased overall longevity. Regular physical activity can help impact the brain’s health in many ways:
- Neuroprotection: Promoting neuroplasticity and enhancing brain function.3
- Cognitive Function: Improving memory, attention, and executive function. 4 A recent study showed that those with the highest level of cardiovascular fitness in midlife had a 30% lower risk of developing dementia later in life compared to those who remained sedentary.5
- Mood Regulation: Reducing anxiety and depression symptoms.6
- Hormonal Balance: Regulating hormone levels, such as cortisol and estrogen.
- Vascular Health: Increasing blood flow to the brain, supporting cognitive function.
- Sleep Quality: Enhancing sleep, which is crucial for cognitive health.
- Temperature Control: Improving the body’s ability to regulate temperature, reducing hot flashes.
Diet & Nutrition
Our brains rely on specific nutrients to function properly. Eating smart can reduce inflammation, improve sleep, and help counteract inflammation. The Mediterranean diet, rich in fruits, vegetables, lean meats, dairy, and healthy fats, is highly recommended. Reducing processed foods, sugar, refined carbs, alcohol, caffeine, and spicy foods can alleviate menopause symptoms and support overall health. Women should consume adequate fiber (14 grams per 1,000 calories) and protein (70-100 grams daily) for cell repair, bone remodeling, metabolism, and muscle mass regeneration. While you should get the majority of nutrients and vitamins from food, you can add supplements like B vitamins, Omega-3s, calcium, and vitamin D.
Women who follow a healthy diet can not only reduce menopause symptoms, especially hot flashes, but can also help reduce cognitive decline, depression, heart disease, stroke, and cancer risk. Make sure you drink plenty of water, as it’s critical to maintain hydration for brain health, hormonal health, vaginal lubrication, digestion, circulation, healthy joints, and skin and hair health. For a deeper dive into dietary changes during menopause, read Menowar’s blog, Changing Your Diet During Menopause
Stress and Sleep
Calming activities such as meditation, breathwork, walking in nature, aromatherapy, yoga, hypnosis, and cognitive behavior therapy (CBT) can help manage stress and improve sleep. Adequate sleep is crucial for cognitive function, mood, productivity, and overall health. You can also find important sleep tips in Menowar’s blog, How Can I Improve My Sleep During Menopause.
Brain Stimulation
Keeping the brain active through brain-training games, learning new skills, using brain stimulation tools, and social interactions can maintain cognitive health. Writing things down, calendarizing appointments, organizing items in consistent locations, repeating back names when you meet new people, reducing clutter, minimizing distractions, developing new habits, and always looking to learn new information and adopt different hobbies are effective strategies.
Continual Research & Innovation
Women’s health neuroscience is gaining more attention and focus. Dr. Mosconi and others are exploring the impact of PhytoSERMs. These are plant-based selective estrogen-receptor modulators that can selectively supply estrogen to the brain while being largely inactive in reproductive tissue, therefore posing no increased risk of breast or uterine cancer. There is an NIH-sponsored clinical trial to evaluate PhytoSERMs for support of brain energy and cognitive function in perimenopausal and early menopausal women with results expected in 2025. Methods like neuromodulation show great promise in treating depression, dementia, and chronic pain.
Summary
While genetic and environmental factors are beyond your control, you can positively impact your brain health. Lifestyle changes, including proper nutrition, regular exercise, stress management, and continuous learning, can mitigate the negative effects of hormonal changes during menopause and support long-term cognitive function. Midlife can bring renewed focus, energy, wisdom, and empathy. Your desire to please others may diminish in midlife; you might be more likely to have increased confidence, follow your instincts, and not give a f**k about what others think! It’s time to focus on you and your brain and body. Feel empowered to make positive changes in your life to help combat the potential negative impacts of hormonal changes during menopause.
Footnotes
