The Menopause Brain

by Lisa Mosconi

menopause impacts the brain just as much as it impacts the ovaries—directly and powerfully, and in ways we are only beginning to gather real data about.

The real kicker, however, is that they don’t originate in the ovaries at all. They are initiated by another organ entirely: the brain. These are, in fact, neurological symptoms that come from the ways that menopause changes the brain.

Over three-quarters of all women develop brain symptoms during menopause.

menopause is a neurologically active process that impacts the brain in fairly unique ways.

not just brain energy that changes during menopause but that the brain’s structure, regional connectivity, and overall chemistry are also impacted.

Only in the late 1990s did scientists make a powerful breakthrough: our so-called sex hormones were key not just for reproduction but for brain function as well. In other words, the hormones inextricably involved with our fertility, with estrogen leading the charge, turned out to be just as crucial in the overall functioning of our minds.

For some statistics most people aren’t familiar with, women are: Twice as likely as men to be diagnosed with an anxiety disorder or depression. Twice as likely to develop Alzheimer’s disease. Three times more likely to develop an autoimmune disorder, including those that attack the brain, such as multiple sclerosis. Four times more likely to suffer from headaches and migraines. More likely to develop brain tumors such as meningiomas. More likely to be killed by a stroke. Notably, the prevalence of these brain conditions changes from broadly equal between men and women before menopause to a 2:1 or higher female-to-male ratio after menopause.

Additionally, a high FSH level in a woman who is having hot flashes and is missing her period does not eliminate the likelihood that she is still in perimenopause.

Additionally, night sweats have been linked to presence of white-matter lesions in the brain. These lesions result from a wearing away of the brain’s white matter, the connective nerve fibers between neurons. There is some evidence that the more night sweats one experiences, the more white-matter lesions there are in the brain, potentially causing more severe issues down the line. In a nutshell, hot flashes are very real symptoms that need attending to before they become an actual problem. At a minimum, reports of severe and frequent vasomotor symptoms should cue doctors to look more closely at a woman’s cardiac health, as well as her brain health. Fortunately, there are ways to alleviate, reverse, and even prevent vasomotor symptoms,

Some of the most common emotional changes associated with menopause include irritability, anxiety, and a diminished ability to deal with life’s everyday hassles. Feelings of sadness, fatigue, lack of motivation, and difficulty concentrating can also arise, along with emotional flatness, trouble getting motivated, or a sense of overwhelm.

Not to put too fine a point on it, but even during this phase, women outperform men on those very same cognitive tests measuring memory, fluency, and some forms of attention. That’s true both before and after menopause. During the menopause transition, cognitive scores may take a dip, bringing women’s performance effectively within men’s range. In other words, the average menopausal woman performs just as well as the average man of the same age, who is not, of course, in menopause. (Take that, Darwin!)

Menopause brain encompasses a range of changes in body temperature regulation, cognition, mood, sleep, energy, and libido experienced during the menopausal transition.

The most common symptoms that collectively contribute to menopause brain include: Hot flashes: Sudden feelings of intense heat accompanied by sweating, rapid heartbeat, and flushing of the face and upper body. Sleep difficulties: Disrupted sleep patterns, insomnia, or fragmented sleep. Mood changes: Mood swings, irritability, anxiety, or feelings of sadness or depression. Memory lapses: Memory issues, such as forgetfulness or having trouble recalling names, dates, or details. Difficulty concentrating: Reduced focus and attention span, increased distractibility. Slower cognitive processing: Mental fogginess or sluggishness, trouble thinking clearly, more difficulty processing information or making decisions. Word retrieval problems: Trouble finding the right words or expressing thoughts verbally. Decreased multitasking abilities: Difficulty juggling multiple tasks or switching between tasks, leading to feelings of being overwhelmed. Low energy: Fatigue, lack of motivation, and decreased overall energy levels. Low libido: Decreased sexual desire or interest in sexual activity.

estrogen in particular has been shown to boost metabolism, protecting us against weight gain, insulin resistance, and type 2 diabetes. Estrogen is also instrumental in maintaining bone health and in supporting the heart by keeping blood vessels healthy, possibly by keeping tabs on inflammation and cholesterol levels.

the health of the ovaries is linked to the health of the brain, and the health of the brain is linked to the health of the ovaries.

It’s worth mentioning here that while women’s brains are wired to respond to estrogen’s activation, men’s brains are similarly calibrated for testosterone. This is important, as the quantity and longevity of each sex’s activator hormone differ, and testosterone doesn’t generally run out until late in life. This more gradual tapering-off process leads to andropause, the male equivalent of menopause. However, as the tabloids remind us, most men remain fertile until their seventies—which in a nutshell means that the testosterone receptors in men’s brains have more time to adjust. Women’s brains, on the other hand, don’t have that luxury.

Estradiol is so instrumental in a seemingly endless list of brain processes that it has gained the title of master regulator of the female brain. I can’t help but view estradiol as CEO of the Female Brain, Inc. It’s a genius commander in chief who knows all aspects of the business, inside and out.

However, after menopause, estradiol leaves. She announces her retirement, firmly sets a course to wind down, and kicks up her heels. Estrone is then promoted to the task. Unfortunately, estrone can’t do what estradiol did. Without estradiol in town, the brain is driven to distraction. The connections between neurons aren’t powered as efficiently as before and tend to slow down.

studies have shown that even though many expectant women and new moms don’t feel as mentally sharp as they used to, their IQ is unquestionably unaltered.

For those who can’t shake off the worry, there is no evidence these mental blips might be linked to a higher risk of dementia.

When it comes to HRT, according to professional societies, there is a lack of safety data supporting the use of systemic (oral or transdermal) HRT in women who have had breast or ovarian cancer. The risk of breast cancer recurrence with HRT is higher in those with estrogen receptor positive cancer, but patients with estrogen receptor negative breast cancer may also have an increased risk of the cancer regrowing.

Here in the United States, one in every eight women will develop breast cancer in her lifetime. One in every nine will have an oophorectomy, many due to cancer. One in every four will undergo induced menopause.

In fact, one of the many ways exercise benefits you is by stoking your metabolism and stabilizing your weight. This assist is particularly helpful as several studies show that perimenopausal and postmenopausal women who engage in regular physical activity can greatly improve their body composition, achieving a lower body mass index (BMI), less belly fat, and a higher metabolism, which allows them to burn calories more easily no matter their age.

As little as twelve weeks of training can improve weight, decrease waist circumference, and lower triglycerides and total cholesterol in menopausal women.

In a combined analysis of eleven clinical trials totaling almost 2,000 midlife women, regular exercise significantly reduced depressive symptoms, as well as stress and related insomnia, after just twelve weeks. Both moderate and low-intensity exercise regimens worked like a charm. Since not everyone is into (or capable of) high-intensity workouts, this is good news indeed.

For our purposes, a recent study followed about 200 midlife women for as long as forty-four years. The results show that those with the highest level of cardiovascular fitness in midlife had a whopping 30 percent lower risk of developing dementia as they got older compared to those who remained sedentary. As a dementia specialist, I can assure you that a 30 percent reduction in the rates of dementia is nothing short of extraordinary—so far, no drug has achieved such an effect.

More striking evidence comes from the Nurses’ Health Study, which revealed similar findings among younger women, ages thirty-four to fifty-nine. When these women reached their seventies and eighties, those who had been physically active had a 77 percent lower risk of respiratory death, a 31 percent lower risk of dying from heart disease, and a 13 percent lower risk of dying from cancer than those who were mostly sedentary.

For maximum benefit, experts recommend focusing on three types of exercise: aerobic, strengthening, and flexibility and balance.

As a result, women on a Mediterranean-style diet boast a 25 percent lower risk of heart attack and stroke than those following a Western-style diet high in processed foods, meat, sweets, and sugary beverages. Additionally, those who follow the Mediterranean diet in midlife have at least a 40 percent lower risk of developing depression in old age as compared to those on less healthy diets. They also have half the risk of breast cancer. In more good news, women who follow a Mediterranean diet experience a generally milder menopause with far fewer hot flashes.

Additionally, this diet pattern may delay the onset of menopause, too. A large examination of dietary data collected from 14,000 women revealed that consumption of legumes, like peas or beans, and fish is associated with a later onset of menopause by as many as three years.

This healthy-fied Green Mediterranean diet further reduces the amount of meat on the menu and promotes plant-based protein instead, while introducing additional nutrient-dense foods that are not typically found in the Mediterranean region, such as green tea, avocados, and soybeans. This combination seems to amplify the benefits of the diet, leading to more fat loss around the midsection (the apple shape we discussed in the last chapter) and greater metabolic wins, as well as lower blood pressure, lower bad cholesterol, better insulin sensitivity, and less chronic inflammation.

As a result, eating enough fiber is a fantastic first-line defense against menopausal symptoms like hot flashes, which tend to be fewer and milder with fiber-rich diets. The balance fiber achieves in our bodies is essential for women in general, and for breast cancer survivors in particular. In the Women’s Healthy Eating and Living Study, women treated for early stage breast cancer who consumed a high-fiber diet experienced a significant decrease in hot flashes in as little as one year.

Or better yet, try raw dark chocolate. In its purest form, this type of chocolate is a powerful superfood with an impressive health pedigree. It has a low glycemic load, is satisfying without a sugar crash, and it’s rich in theobromine, a kick-ass antioxidant.

For some inspiration, I am going to share one of my all-time favorite recipes: a delicious three-ingredient dark chocolate ganache. Begin by melting ½ cup of unsweetened dark chocolate chips and ¼ cup of unrefined coconut oil. Then stir in 1 heaping tablespoon of raw cacao powder and a tablespoon of maple syrup. Pour the mixture into an airtight container and freeze for about three hours. This dessert not only provides a burst of energy but also a healthy dose of antioxidants, making it a delightful and guilt-free indulgence.

To restore your gut bacteria, focus on foods rich in prebiotics, probiotics, and the lesser-known bitters: Prebiotics are nondigestible carbohydrates, your gut bacteria’s favorite menu. Garlic, onions, asparagus, beets, cabbage, leeks, and artichokes are fantastic sources, as are legumes like beans, peas, and lentils. Probiotics are live bacteria that repopulate the microbiome. Find these in fermented foods like sauerkraut, kimchi, unsweetened yogurt, and brine-fermented pickles. Probiotic supplements can also be helpful, especially those containing at least three different strains: lactobacillus, rhamnosus, and bifidobacterium. Bitters are a group of plants that are defined by exactly what their name implies: their bitterness. Bitter herbs like dandelion greens, endive, radicchio, and arugula are powerful digestive stimulants that love up the microbiome. Toss these veggies with lemon juice or vinegar for maximum benefits.

Also, the type of soy you’re eating matters. The traditional soy products consumed in Asia are clean, unprocessed, and often fermented, which most of our soy is not. In the Western world, most soy products are made of genetically modified soybeans rife with pesticides and preservatives. Worse yet, processed soybean oil, soy lecithin, and isolated soy protein lace everything from packaged foods and breakfast cereals to lattes and infant formulas—and have nothing to do with good health.

you are interested in eating soy to support a healthy menopause, seek organic and fermented soy, such as fresh edamame, miso, and tempeh.

Much women-based research reveals that polyunsaturated fat supports women’s health, showing a reduced risk of heart disease, obesity, diabetes, and dementia. These female-friendly fats come in different varieties, the most common being omega-3 and omega-6 fatty acids.

There are different types of omega-3s: ALA, or alpha-linolenic acid, found exclusively in plant foods. EPA, or eicosapentaenoic acid, and DHA, or docosahexaenoic acid, found mainly in fish and seafood, but also seaweed and algae.

Most dietary guidelines for women recommend getting at least 1,100 mg of omega-3s every day. This dosage is easily achieved, for example, by using flaxseed (linseed) oil.

Just one tablespoon (15 ml) contains an impressive 7,200 mg of omega-3 ALA, so you’re set for the day. Other excellent alternatives include ground flaxseed, hempseed, walnuts, and almonds. Olives, olive oil, avocados, and soybeans are also excellent sources, as are broccoli, sweet peas, and many leafy greens. Algae and seaweed are important sources of omega-3s for people on vegan or vegetarian diets, or anyone who doesn’t eat fish, as they are one of the few plant foods containing preassembled DHA and EPA.

Monounsaturated fat is known for its protective effects on heart health.

Nuts like almonds, pistachios, Brazil nuts, cashews, and hazelnuts are high in monounsaturated fat, as are fatty fruits like avocados and olives, and some seeds like sesame and sunflower.

A handful of nuts or seeds (about an ounce) once a week, with the peel still on, delivers targeted results. Avoid blanched, flavored, salted, sweetened, or seasoned nuts and seeds.

There is increasing evidence that saturated vegetable fat supports women’s health through its beneficial effects on our hormones, while saturated fat from animal sources does not show the same result. A possible explanation is that vegetable fat seems to have a gentler impact on blood lipid levels than animal fat. For example, in randomized clinical trials, dairy butter increased LDL cholesterol significantly, whereas olive oil and coconut oil did not.

Measuring your cholesterol levels is an effective way to determine your risk of heart disease and stroke. There are two ways to do this. One way is to measure your total cholesterol. Typically, you want this number to be below 200. An even better way is to calculate your cholesterol ratio. The latter will give you a breakdown of your good vs. bad cholesterol, delivering a clearer picture of your health. If your total cholesterol is 200 and your HDL cholesterol is 50, your ratio is 4. A ratio lower than 4.5 is considered good, but 2 or 3 is best.

For example, 3 cups of spinach or 1 cup of lentils have more iron than an 8-ounce steak. However, their iron is not as promptly put to good use. One way to increase the absorption of plant iron is to combine these foods with other foods rich in vitamin C. For example, sprinkle some berries on your oats or lemon juice into your salads and, voilà! mission accomplished.

Another way to ensure a dietary supplement is of high, uncontaminated quality is to purchase products indicating testing by either the U.S. Pharmacopeial (USP) Convention Dietary Supplement Verification Program or ConsumerLab.com.

But what’s important to realize is that chronic stress is actually bankrupting your hormones.

When you’re under chronic stress, your cortisol levels remain high for prolonged periods. This puts a longer-term strain on your sex hormone supply in the process, prolonging the so-called pregnenolone steal. This hormonal sleight-of-hand can in turn promote hot flashes, anxiety, and even the potential for depression.