I am in perimenopause. What is happening to my brain?!

Aging Reproductive Health

We have so many brain changes during the menopausal transition (MT) that they can make our heads spin.

Changes in mood, memory, energy level, temperature regulation, cognition, executive functioning…The list goes on. We hear you: it can be frustrating and demoralizing. But fear not! Our brains bounce back and adapt to many of these changes, and we emerge from the menopausal transition with stronger (albeit different) brains.

Menopause transition (MT) involves hormonal changes that mark the end of our potential reproductive chapter, but did you know that the menopausal transition also involves profound changes to our brains? It turns out that our sex hormones are remarkable symphony conductors that influence many parts of our bodies. They orchestrate not only the reproductive processes that begin at puberty but also the complex workings of our brains, where estrogen, the primary female sex hormone, receptors abound. We call these “neuro-endocrinological” (brain and hormonal) processes.

What is going on with our sex hormones during menopause transition? As the menopause transition unfolds, the amount of estrogen gradually lowers. Through brain imaging studies, scientists have observed that after the drop in estrogen during the menopause transition, specific brain regions shrink and become less efficient in using sugar for energy.

One study in 2021 examined individuals at various stages of menopausal transition (pre, during [aka peri], and postmenopause) to assess the impact on brain structure, connectivity, energy metabolism, and plaque accumulation. The findings were revealing: menopause transition significantly influences all these aspects of brain health, particularly in regions crucial for higher cognitive functions (aka thinking clearly and memory). These effects were found to be specifically due to the hormonal changes of menopausal transition, not just from the general process of aging.

However, an encouraging discovery of this research was that although cognitive abilities *changed*, the brain remained strong post-menopausal transition and even stronger in some areas. The brain compensates by forming new connections and enhancing cell energy production in different ways.

Here is a list of positive outcomes:

🟢 Our Brain Cell Recovery in the Precuneus: The precuneus region of the brain is key for our sense of self and agency, memory, spatial function, and navigation. For those past menopause, this brain region rebounds and even shows *improvement* over a two-year span past our premenopausal baseline.

🟢 We Have More Efficient Brain Connections: Although some parts of our brain get smaller, they actually start to work more efficiently after menopause. This is seen in higher ‘fractional anisotropy’ (FA) scores, a measure of connectivity in the brain.

🟢 Our Brain Adjusts to New Energy Levels: Post-menopause, our brains adapt to using glucose, a major fuel for the brain, differently. We come out from the menopause transition with increased memory and cognitive performance.

🟢 Our Brains Adapt to Less Estrogen: Our brains adapt to having less estrogen after menopause. This adjustment could be part of why some other typical menopausal symptoms, like hot flashes, ease with time.

These changes are independent of age, hormone therapy usage, and hysterectomy status.

However, a notable difference was when a person had the presence of the APOE-4 gene. Individuals with this genetic factor experienced more pronounced plaque buildup in their brains during and after the menopause transition, indicating an increased vulnerability to Alzheimer’s disease. If you have a family history of Alzheimer’s, it’s a good idea to check with your primary care team during menopause (for brain, heart, bone health, and more). Stay tuned for more posts on that soon!

In summary, during the menopause transition, we experience some really awful symptoms. Still, our dismay and discomfort may be helped by knowing some of the positive adaptations that are happening in our brains. These include improvements in specific brain regions resulting in more efficient use of energy, better connectivity, improved memory, and increased sense of self and agency. How about that for the adaptability and resilience of our brains?!

Stay healthy, safe, and nerdy,

Those Nerdy Girls+&

P.S. It’s important to note that the findings in neuroendocrine (brain-hormone) science are complex and that our understanding of the relationship between menopause, brain changes, and cognitive health is ever-evolving. It’s also important to consider the individual variability among those who go through menopause. Each person’s experience can be very different based on genetics, health status, lifestyle, and social and environmental influences.

(Subsequent posts will discuss how to maximize the health of our brains as we age. Did you know we have a new Aging Squad of kick-a$$ scientists and clinicians?! Stay tuned.)

References and further reading:

What can you do to weather this major midlife shift in the best way possible? Here are the top five tips.

Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition.

Brain scientist Dr. Lisa Mosconi discusses her findings from the above study with Dr. Sanjay Gupta

Brain anatomy

All things Dr. Jen Gunter, but you can start here: Vajenda

Link to Original Substack Post