Your Menopausal Brain

Let’s start with what we know: Estrogen is a powerful and pervasive hormone secreted primarily in our ovaries. Starting around perimenopause, our estrogen levels fluctuate and decline until, several years after menopause, we produce very little, if any, estrogen. This process is natural and sometimes upsetting.

We joke and often lament about changes in our skin, bones and hair, our ability to sleep well. we often experience and suffer from hot flashes and mood swings. we complain of weight gain and “brain fog.” The loss of estrogen during menopause is just as important a transition for women as puberty.

Less obvious are the changes that occur in our brain. New research is slowly revealing how estrogen affects our brains and why menopause is such an important transition.

For most of our lives, there is no difference between male and female brains, according to Dr. Lisa Mosconi, director of the Weill Cornell Women’s Brain Initiative and author The XX Brain: The Breakthrough Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s. “I’ve been looking at brains for twenty years and I can guarantee there is no such thing as gendered brains,” he says.

Men’s and women’s brains look identical – until menopause. This is when our reproductive hormone, estrogen, fluctuates and decreases. Testosterone levels in men, on the other hand, remain fairly stable, declining only slowly with age.

Estrogen, as part of the neuroendocrine system, is closely related to brain activity as well as reproduction. Estrogen fuels the brain by regulating the levels of glycerol, with which the brain produces energy. With fluctuating, declining estrogen levels, neurons in the brain age faster and produce less energy.

“The loss of estrogen means that the brain’s metabolism of glucose, its main fuel, is reduced by about 20 to 25 percent. This is why women feel they are out of the game. They can still play the game, just not as well,” says Roberta Diaz Brinton, director of the Center for Brain Science Innovation at the University of Arizona, who has extensively studied the effect of estrogen on the brains of mice.

Only at this point can a neurologist differentiate between male and female brains: The female brain produces less energy than a male brain of the same age. Additionally, these hot flashes, mood swings, forgetfulness, and insomnia are all neurological symptoms that come from the brain as it adjusts to declining estrogen. All those pesky menopause symptoms are really in your head.

Not all scientists agree with the Brinton/Mosconi theory, and none of it definitively means that cognition is affected beyond this passing perimenopausal haze. Our brains may have less energy, but there is no apparent cognitive difference between men and women in menopause.

However, along the way, women are much more likely to succumb to the most common form of dementia – Alzheimer’s disease. Two out of three Alzheimer’s diagnoses are women. And that, says Dr. Mosconi, is important information for women. “The point here is that we really need to better understand what’s going on in our brains as we go through menopause … and how to protect our brains in the process.”

While ongoing research tries to tease apart the interplay between hormones and the brain, Mosconi strongly recommends that in the meantime, we can protect our brains with some targeted lifestyle adjustments. “Just like you can’t permanently prevent a heart attack or stroke, you can’t permanently prevent Alzheimer’s,” says Dr. Richard Isaacson, founder of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine. “But one in three cases can either be prevented or delayed.”

These lifestyle changes are neither extreme nor easy. It’s the same old advice your doctor always gives you. But what if you could add the option to keep your brain healthy as you age simply with a few lifestyle choices? It seems out of place, so to speak. So, according to Mosconi and others, here are ways you can support brain health:

• They eat well. Specifically the Mediterranean diet, rich in B vitamins and Omega 3. Eat fish, fresh fruits and vegetables, complex carbohydrates. “What’s interesting about this diet is that it’s quite rich in foods that contain estrogen in the form of phytoestrogens, or estrogens from plants that act like mild estrogens in our bodies,” says Mosconi. Cut down on coffee and alcohol. I drink a lot of water.
• Excercise. Not crazy stuff, not necessarily high intensity burnout rounds, but consistent, regular, low to moderate intensity exercise three to five days a week. Both aerobic (brisk walking) and resistance training (free weights) to maintain muscle. Older women (over 70) can do 15 minutes a day.
• Reduce stress. Besides being generally bad for you, stress produces the hormone cortisol, and cortisol lowers estrogen. They work in parallel. So avoiding stress is really important, not only for mental well-being, but also for brain health.
• Sleep. Sleep is refreshing for our brain. Plus, better sleep and less stress go hand in hand, so improving one can double the payoff. Much has been written about sleep hygiene, but you’ll have to figure out what works for you. For many of us, this is another one of those menopausal bun sandwiches that hit a challenging time in life. Talk to your doctor. do some research; get to know your new tolerances and tendencies.

We can’t change our biological fate or the genes we’ve inherited, but we can try to understand what’s going on with our bodies and we can work to keep them in the best possible shape as we navigate a difficult transition and an ultimately rewarding time of life.