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Far from the spotlight, 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.
Most women spend about 40 percent of their lives in menopause.
Over three-quarters of all women develop brain symptoms during menopause.
In fact, our studies have shown that menopause is a neurologically active process that impacts the brain in fairly unique ways.
Over time, our investigations yielded a treasure trove of data, demonstrating that it’s not just brain energy that changes during menopause but that the brain’s structure, regional connectivity, and overall chemistry are also impacted.
Our research shows that’s exactly when the brain is going through the most profound changes, too. The best way I can explain this phenomenon is that the menopause brain is in a state of adjustment, even remodeling, like a machine that once ran on gas and is now switching to electricity, challenged to find work-arounds.
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.
In the simplest terms, the vast majority of medical research has used the male body as its exclusive prototype, “boobs and tubes” notwithstanding. On top of that, as recently as the 1960s, the FDA made it standard practice to deny women of childbearing potential access to experimental drugs and clinical trials, claiming that doing so avoided any potential adverse effects on the fetuses.
The phrase woman of childbearing potential, however, was taken to mean “any woman capable of becoming pregnant,” not solely those who were. This meant that any woman from the age of puberty through menopause, regardless of sexual activity, use of contraceptives, sexual orientation, or even any desire to have a child in the first place, was excluded from clinical trials.
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.
However, the underlying hormonal changes can put a targeted strain on many organs, including the brain, especially when ignored or left unattended.
For most women, this can lead to various well-known symptoms such as hot flashes and insomnia. For others, menopause can potentially trigger severe depression, anxiety, or even migraines. For others still, it might be a higher risk of developing dementia down the line.
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.
It’s not uncommon for crying or other releases to happen more often, more intensely, or seemingly unexpectedly. While less prevalent, some women may even develop panic attacks, while others report feeling downright rage—all easy fodder for the stereotype of the mad, bad, and dangerous menopausal woman.
Thankfully, a variety of treatments are available, including menopause hormone therapy and/or antidepressants, as well as lifestyle adjustments, such as a specifically tailored diet and exercise plan,
Poor sleep quality and sleep disturbances are lesser-known changes during this phase of life, yet they’re highly prevalent.
Chronic sleep disturbances can trigger not only low mood, anxiety, and potential depression but brain fog and exhaustion, too. Lower estrogen levels further confound your brain, decreasing your capacity to deal with stress in the first place.
More than half of all perimenopausal women sleep less than seven hours a night. For context, over 70 percent of premenopausal women sleep more than that—a significant jump. One in three perimenopausal women have trouble not only falling asleep but also staying asleep, waking up multiple times per night.
To make matters worse, postmenopausal women are two to three times more likely than premenopausal women to develop new sleep problems, such as sleep apnea. While this disorder is typically considered a men’s issue, once menopause kicks off, women are also at increased risk, possibly because of changes in muscle tone.
Along with sweating and poor sleep often comes something many women don’t anticipate: brain fog. Few things are more disconcerting than when your brain feels like mush rather than the sharp and useful tool you’ve been used to, or when your memory takes a turn for the worse.
According to recent statistics, over 60 percent of all perimenopausal and postmenopausal women struggle with brain fog.
Here are some examples of what brain fog may feel like: Problems with short-term memory; forgetting details like names, dates, and sometimes events; forgetting things that you usually have no trouble remembering (memory lapses); confusing dates and appointments. Difficulty concentrating; having a reduced focus or a shorter attention span (easily spacing out). Feeling mentally slower than usual (mental fatigue); taking longer to finish things or feeling disorganized, with slower thinking and processing. Trouble multitasking, like answering the phone while typing, without losing track of one
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In all seriousness, in medicine, brain fog is referred to as mental fatigue, or more technically, as subjective cognitive decline. The key word here is subjective.
Women’s concerns about their cognitive functions are legitimate and valid. If a woman approaching or past menopause feels she is having memory problems, no one should brush it off or attribute it to a jam-packed schedule—or, worse, to “just being a woman.”
Some cognitive slippage is indeed common during the perimenopausal and early postmenopausal years. In most cases, these issues are short-lived and go away over time. While your brain may feel off or muddy for a while, when the transition passes, typically the clouds clear and the fog lifts.
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.
For some, cognitive performance may indeed deteriorate after menopause and become a diagnosis of dementia later on.
For context, dementia isn’t forgetting where you left your keys. Dementia is forgetting what keys are for.
What causes a lessening of libido can be complex, but it is a common concern with menopause, with as many as 30 percent of women experiencing a drop in desire during those years—an effect that generally peaks during perimenopause and early postmenopause.
While it is true that some menopausal women may gladly give up sex for sleep or chocolate, others report quite the opposite, experiencing renewed interest and desire. This tends to happen during the late postmenopausal phase, typically after age sixty to sixty-five.
For example, vaginal dryness or atrophy, which is the thinning, drying, and inflammation of the vaginal walls that may occur during menopause, can render sex painful.
Other symptoms of menopause, such as hot flashes, insomnia, and fatigue, may also undermine sexual motivation and interest, and sometimes negatively impact self-esteem.
Additionally, women who underwent surgical menopause showed a more significant decrease in desire, which may be due to their experiencing more abrupt hormonal shifts.
If you look at your sexual health as another aspect of your menopause that needs attention, now and for the future, it makes sense to address any sources of disruption. Having a healthy sexual life, if you wish, can be another invigorating aspect of your life during and after menopause.
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:
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The postmenopausal stage of a woman’s life is not the “over and out” that society has mistakenly signaled. Instead, it can come with relief and renewed energy, not to mention a broader outlook on life.
Envision this system as a subway map with several stations, the brain at one end and the ovaries at the other, as we spotlight the most important routes and stops. The ovaries (aka gonads) are so strongly wired to the brain, specifically to two structures called the pituitary and hypothalamus, that medical textbooks identify these connections as a single entity: the hypothalamic-pituitary-gonadal axis, or HPG.
By examining the HPG pathways and its crucial components, we can see how this intricate system not only prepares the entire body to potentially host a pregnancy but also supports a range of behaviors leading up to that significant moment, from the sensation of butterflies in your stomach to feeling energized during a romantic courtship. In addition, by acting upon this system, 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
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As a result, 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.
Scientists have found that high-intensity training clearly benefits men, whereas cardio and resistance training at a moderate intensity work better for women.
Moderate intensity is any exercise that ups your heart rate and enables you to break a light sweat. To achieve this, you should move fast enough to get your blood flowing, bringing roses to your cheeks. Although you might have a little breathiness when talking, you shouldn’t struggle to catch your breath. Singing out loud, however, should be a challenge.
For maximum benefit, experts recommend focusing on three types of exercise: aerobic, strengthening, and flexibility and balance.
It raises your heart rate, enhances your blood flow and circulation, and pumps oxygen and nutrients throughout your body. This in turn protects your heart against plaque while clearing your head and sharpening your mind. As if this weren’t enough, aerobic exercise is the best regimen to foil hot flashes, too.
In multiple studies, brisk walking for 30 minutes three times a week was effective at reducing insomnia, irritability, and fatigue in midlife women. It also improved weight and waist circumference and lowered triglycerides and total cholesterol.
Augmenting that target toward 9,000 to 10,000 steps may lower your risk of dementia, too.
Other examples of properly paced exercise are bike riding at 7 to 10 miles per hour, hopping on the elliptical machine at a steady stride, jumping rope, swimming, exercising in the water, playing tennis, attending group fitness classes, dancing, or stair climbing.
For those who don’t have the extra time or resources to hit the gym or take long walks, let’s remember the accumulated effect of everyday activities like gardening, cleaning the house, and running chores, not to mention running after your kids or grandkids.
Training with free weights, weight machines, or resistance bands can help add muscle mass to your body, thereby stimulating bone-building and boosting metabolism. Body-weight exercises like push-ups and pull-ups, as well as knee raises, planks, lunges, and squats, also build muscle, support bone health, and improve your core strength and balance.
These are plentiful and include things like yoga, mat Pilates, tai chi, and stretching. All can improve your coordination, keep you steady on your feet, and ward off falls and arthritis down the line.
Can you balance on one leg for 10 seconds or longer? It turns out that poor balance is linked to frailty in older age, and is also a prime indicator of declining health.
