It’s All in Your Head
Recent research shows that decreasing estrogen levels during menopause affect brain structure, connectivity and metabolism. This contributes to the most common menopause, or rather perimenopause, symptoms such as hot flushes, brain fog, insomnia and mood swings. We’ll dive into what the research says and give tips for managing (peri)menopausal symptoms.
For decades women have either been told that “it’s all in your head” meaning that they are just imagining their symptoms. Or that “it’s just a natural phase of life” meaning that it’s just to man up and pull yourself through this.
Recent research, however, shed new light on the impairing cognitive and physical symptoms around menopause, showing clear and significant changes in a woman’s brain.
Thus, the “menopause brain” is increasingly recognized for its impact on cognitive function. Which is directly linked to decreasing estrogen levels during menopause.
So, yes! It’s really all in our head! Or rather, all in our brains!
The Science Behind the Menopause Brain1
As women approach menopause, they experience a dramatic and swinging decline in estrogen levels. This is a process that may start up to 10 years before the actual menopause. On average that means at the age of 51 years.
Given that estrogen is vital for many brain functions, including memory, attention and cognitive processing, these hormonal shifts don’t just cause physical symptoms. They also lead to significant changes in the brain’s structure and function.
These brain changes and symptoms then result in what Dr Lisa Mosconi, associate professor of neurology and radiology at Weill Cornell Medicine, refers to as the menopausal brain.
Dr Lisa Mosconi is also the author of the book “The Menopause Brain” (highly recommended!). Her imaging research highlights that the drop in estrogen during menopause affects specific brain regions. Consequently, it’s shown as a decrease in gray matter volume in areas critical for our cognitive functions.
These regions include:
the prefrontal cortex, responsible for complex cognitive behavior and decision-making.
the hippocampus, which plays a key role in memory formation and retention.
In addition, these studies not only show structural changes. They also demonstrate changes in:
connectivity, i.e. how efficiently different processes and areas of the brain communicate with each other and
reduced energy metabolism, i.e. how well the brain can utilize the blood glucose it gets from the blood.
Decreasing Estrogen Leads to Menopausal Symptoms
The decrease in estrogen impacts various brain regions. And this can manifest as the cognitive symptoms experienced during menopause:
Hot Flushes: The hypothalamus is responsible for regulating our body temperature. And the hot flushes many women experience through menopause are associated with decreased estrogen levels.
Brain Fog: The hippocampus is crucial for memory formation and information processing. It’s particularly sensitive to estrogen levels.
The reduced estrogen can lead to memory lapses, making it harder to recall names, dates or daily tasks.
The definition of perimenopause brain fog is the constellation of cognitive symptoms experienced by women around menopause. Symptoms that most frequently manifest in memory and attention difficulties. And that involve such symptoms as difficulties 2:
encoding and recalling words, names, stories or numbers
maintaining a train of thoughts
distractibility
forgetting intentions (reason for coming to a specific room)
switching between tasks.
Mood Swings and Anxiety: The amygdala is involved in emotional regulation and response to fear. Reduced estrogen activity here will influence mood, risk for anxiety and overall emotional responses.
Executive Function: The prefrontal cortex, involved in attention, language, multitasking and complex decision-making, also relies on estrogen.
Declines in this hormone can result in difficulty concentrating and staying focused on tasks that require sustained mental effort.
Sensory Processing: The parietal lobes are involved in perception, proprioception, pain processing and our ability to create a mental map of our world.
Declining estrogen levels will affect our spatial coordination. And additionally how we perceive and process sensory input and output, such as our reaction and resilience to pain.
There’s Hope – Most Brains Adapt
Reading about menopause one may ask oneself how one should ever get through this trial. Indeed, there’s not much positive said about this crucial period of transition in the female life.
However, according to Lisa Mosconi and her research group menopause is not all bad news.
For most women, the cognitive challenges experienced during perimenopause and around menopause,
are temporary and will pass just as the hot flushes disappear.
About 95% of all post-menopausal women don’t experience hot flushes 5 years after menopause3.
Thus the brain will, as the brain does, adapt to new circumstances and a life without estrogen and progesterone.
As a modern woman, I’m grateful for nature’s way of accepting and adapting since I plan to live a third of my life (perhaps the best part of it?) as a postmenopausal woman.
I can accept that the brain cells I once needed to handle my periods and pregnancies may be abundant at this stage.
However, I do need my brain to function though. A lot of important and exciting academic and clinical work still needs to be done.
So what are my options during this period of my life?
What can I do when I’m waiting for my brain to catch up and adapt to the next phase beyond my reproductive years?
Coping with a Perimenopause Brain
Understanding that the menopausal brain is a physiological response to hormonal changes is crucial for managing it.
A healthy lifestyle in combination with pharmacological treatment, when needed, can help many women transition well into menopause.
Menopausal Hormone Therapy (MHT)
Estrogen (and progestogen to protect the uterus) may mitigate hot flushes and improve cognitive symptoms caused by decreasing estrogen levels.
There are some medical contraindicators where estrogen treatment during perimenopause should be avoided. But for most women, estrogen replacement therapy can be used safely. Indeed, there are secondary benefits of short-term MHT such as a reduced risk of bone loss, fractures and colon cancer.
When it comes to estrogen’s potential protective role for cognition and dementia, the age of treatment initiation may be a factor.
Research of over 5000 postmenopausal women showed that women using MHT around age 49, had a 26 percent decreased risk of developing dementia. In comparison to women who never used hormone therapy.
Interestingly, women who started MHT later in life, around age 76, had a 48 percent increased risk of dementia compared to non-MHT users4.
Healthy Diet
A balanced diet rich in antioxidants, omega-3 fatty acids and vitamins may support brain health. Helping to counteract some effects of declining estrogen.
There is however no scientific support for, or need to buy expensive supplements.
A balanced diet with lots of healthy vegetable fat and proteins with enough carbs and fiber is enough. That is of course if you are not prescribed any specific diet recommendations from a licensed medical professional.
Regular (Moderate) Exercise
Physical activity increases blood flow to the brain. It potentially offsets some cognitive declines caused by reduced estrogen.
Remember though, that nature probably didn’t expect peri- and postmenopausal women to do triple ironman competitions or exercise heavily for hours and hours every week.
Mind your body balance, only exercise that feels ok for your body. And remember that with age comes increased need and time for recovery.
Sleep Hygiene
Everyone knows that sleep is essential for cognitive health. To establish and maintain a healthy night routine:
Avoid alcohol and coffee.
Exercise moderately to make your body tired but not too late in the evening.
Turn off notifications on your phone and dim the lights in the evening.
A good night’s sleep will alleviate some cognitive issues linked to menopause so; make sure to prioritize sleep over almost everything else.
Stress Management
High stress and a work-life balance out of control will worsen cognitive symptoms.
Practices like mindfulness and meditation can help manage stress, mitigating some effects of the menopausal brain. But remember that stress for an ADHD brain also can come in the form of mental under-stimulation.
So engaging in brain-challenging activities such as social activities, crosswords or playing a musical instrument can help maintain cognitive function, despite hormonal changes.
In conclusion
Acknowledging the reality of menopause is vital for both women and the medical community.
Because it really is all in our heads and the menopause brain is just a natural part of life.
By appreciating and understanding these changes and by adopting healthy lifestyle habits we can soften the blow that decreasing estrogen throws at our brains.
And maintain good cognitive health!!
Want to learn more? Read also this article about ADHD & menopause
References:
Mosconi L, Berti V, Dyke J, Schelbaum E, Jett S, Loughlin L, Jang G, Rahman A, Hristov H, Pahlajani S, Andrews R, Matthews D, Etingin O, Ganzer C, de Leon M, Isaacson R, Brinton RD. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021 Jun 9;11(1):10867. doi: 10.1038/s41598-021-90084-y. PMID: 34108509; PMCID: PMC8190071.
Maki PM, Jaff NG. Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition. Climacteric. 2022 Dec;25(6):570-578.
Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990;592:52-86; discussion 123-33. doi: 10.1111/j.1749-6632.1990.tb30316.x. PMID: 2197954.
Whitmer RA, Quesenberry CP, Zhou J, Yaffe K. Timing of hormone therapy and dementia: the critical window theory revisited. Ann Neurol. 2011 Jan;69(1):163-9. doi: 10.1002/ana.22239. Epub 2010 Nov 12. PMID: 21280086; PMCID: PMC3058824.
Lotta Borg Skoglund
MD PhD & Letterlife Co-founder
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