In our previous blog, we talked about the rollercoaster of hormonal fluctuations that characterize perimenopause, debunking the misconception of a simple linear estrogen decline. These hormonal shifts orchestrate an incredible amount of changes across the entire body and brain, preparing women for the next phase of life. This has been referred to as ‘the menopause brain’. These fluctuations, though often disruptive, are part of a process involving the brain’s neuroendocrine systems.

These hormonal changes can remodel the brain through a phenomenon called neuroplasticity, which is the brain’s innate ability to adapt and reorganize neural connections. Let’s dive in. 

Neuroplasticity 

Something that’s really amazing about our brains is their ability to change and adapt to stimuli. Our brains are constantly monitoring our connections, snipping the ones we don’t use often and strengthening the ones we do. Our brains don’t want to waste energy on connections we don’t need, which makes sense. The brain wants to stay lean. This idea is called neuroplasticity, and is one of the things that allows us to grow and change throughout our lives. 

The brain is affected by learning, hormones, experiences, neurotransmitters (chemical messengers in the brain), relationships, etc. It is constantly changing to effectively reason through any problem we are having or support us through challenges, and this includes perimenopause. 

Life Stages and Brain Changes 

Menopause is very much seen as a unique event in women’s lives, but it’s actually similar to the changes we go through in puberty and pregnancy. The brain is setting us up for each stage in our lives and is purpose-driven. 

In puberty, our brains are preparing us to become contributing members of society. We are developing empathy and greater reasoning skills, but it’s not an easy transition. Different parts of the brain are becoming more interconnected. While your brain is essentially being remodeled, you experience “glitches,” which are really just symptoms of all of the changes going on. As your brain tries to adjust to the new connections, principally in the frontal and prefrontal cortex, which are associated with reasoning, judgment, and empathy, these “glitches” can cause behaviors like recklessness, volatile emotions, and risk-seeking. Ultimately, we do gain control over these impulses after we go through that period of adjustment. 

Our next big “remodel” happens around pregnancy. Our bodies are preparing us to care for and tune into a tiny human who will not be able to effectively communicate for years to come. Most of the changes experienced in this period are in the amygdala (emotional center) and hippocampus (memory center). These areas become LESS controlled by the frontal cortex, allowing impulses to take over in a sense to put you into “mama bear” mode, where you will protect what you are emotionally attached to. You are increasingly reading the room to identify threats to your child. Your body is also upping your resilience, allowing you to function on less sleep and less food, the brain really is so fascinating in this respect. The “glitches” we experience here can include hot flashes, brain fog, and a volatile mood as we adjust. 

The second part of this pregnancy transformation happens after birth and is a huge reason that women experience postpartum depression. All of these brain-altering processes that were upregulated when you were pregnant come crashing down due to changing hormone levels, and the “glitches” you experience here can range from baby blues to full-on postpartum psychosis. Luckily, medicine has been starting to recognize the driving factors behind this change and develop therapies that are specific to the changes in hormone levels women experience postpartum. 

Something interesting is that the way your body reacts to pregnancy will be very similar to how how it reacts to menopause, so consider it a bit of foreshadowing. 

The last big transition is perimenopause. This transition prepares you for a new phase of your life that can be likened to the role of an older woman in ancient society. Often, older women are one of the leaders of society and a source of wisdom as they care for the next generation and their community. With everything they’ve learned in their lives, they’ve gained an incredible and valuable perspective. So, what is physiologically happening in this phase? 

A few things. We experience lower glucose uptake in the brain, and we see a thinning of grey matter. This is driven by your brain adjusting to lower levels of key hormones like progesterone and estrogen. 

How Your Ovaries Control Your Brain

Let’s rewind a bit and talk about how female hormones affect the brain. Your brain is constantly playing catch-up to hormonal changes. Your hormones are turning on and off at different points in your life and cycling related to your period throughout your entire reproductive window. When we are born, this relationship is not yet activated because it doesn’t really “turn on” until puberty. Then comes the phase of microcycling; your brain is experiencing changes in line with your cycle every single month. Isn’t that crazy? Then, this system turns itself off during perimenopause. 

The role of estrogen and estrogen receptors can be misunderstood, in reality, estrogen is the messenger, and the receptors in the brain are what actually create those structural changes. Estrogen levels alone are not what causes “glitches,” it’s the balance of estrogen receptors and the estrogen hormone. 

Starting at the beginning, if you are born female, your brain is loaded with estrogen receptors. Estradiol (a form of estrogen found in the body) is sometimes called the “master regulator” of the brain because it does so much. It has neuroprotective effects, which effectively block the pruning and removal of extra connections in the brain that we need during our reproductive stage of life. 

In perimenopause, the levels of estradiol are all over the place, so the “glitches” happen because our brains keep trying to adjust the amount of receptors that are activated in the brain to adapt to to the new levels of estrogen, which continue to change throughout perimenopause. Once menopause is reached, our brains get the go-ahead to prune away all of the stuff we needed for motherhood and our reproductive life. These connections are super metabolically active, meaning that they use a lot of energy and glucose to keep them functioning. Since we don’t need them anymore, our brains get rid of them, resulting in a small loss of grey matter, and a decrease in glucose uptake in the brain. 

These changes begin happening before perimenopause even starts, often in the “late reproductive” stage in the late 30s, and continue well into your 70s. 

How Other Cultures View Menopause 

All of these changes don’t really have to do with chronological aging; it’s really a process of its own. Aging and brain development in women is not linear, and changes are finally starting to be seen in the perception of menopause in the US.

The US is behind other countries in this respect. In Japanese, the word for menopause is “koneki” which translates more closely to renewal or regeneration rather than the US perception of aging or loss of vitality. Given the significantly lower occurrence of severe menopause symptoms in the country as a whole, it can be extrapolated that the more positive view of menopause contributes to lower symptom occurrence. That may sound like a leap unless we think of it in the context of the placebo effect. 

The placebo effect stipulates that if you believe something is helping you, it’s more likely to help you. In clinical trials, two groups are given different treatments. One gets the therapeutic drug they’re testing, and the other gets a sugar pill that has no real effect on the body. While the group that gets the real drug experiences more symptom relief (ideally), the group that gets the sugar pill sometimes also experiences some level of improvement because they believe that they are being helped. The power of positive thinking, right?

The opposite of this effect is called “nocebo” where you believe something is going to be uncomfortable or painful so it ends up being that way. You may be thinking: well maybe something is different when it comes to menopause in different countries?” But studies done in other areas of the world that view menopause more positively, like Japan, rural Asia, South America, and rural India show that hormone levels before and after menopause are the same, but symptom severity is lower, so the real difference is the perception. 

What needs to change in the US is that we need to start to honor and make space for the range of experiences women have during this time. We’re already starting to do this with the postpartum experience, more resources and support are available for new moms, but the change has been slow-going. 

Menopause is not the end, but the beginning of a new and equally valuable phase of your life. It sounds pretty beautiful when you think about it that way, doesn’t it?

Supporting your Body Through this Transition 

Establishing good habits before you start perimenopause will make this transition easier for you, and help mitigate some of the changes that start to occur with your body as you age. Establish these habits to prepare your body for the changes that are to come:

1. Eat a nutrient-rich diet: Focus on whole foods like colorful fruits and vegetables, lean proteins, whole grains, and healthy fats.
2. Exercise regularly: Incorporate a mix of strength training, cardio, and flexibility exercises like yoga or Pilates. Strength training helps preserve muscle mass and bone density, cardio supports heart health, and flexibility exercises can reduce stress and improve mobility.
3. Find enjoyable ways to manage stress: Whether it’s meditation, deep breathing, gardening, or a creative hobby, finding activities that help you unwind is crucial. Chronic stress can exacerbate hormonal imbalances, so stress management supports both your mental and your physical health.
4. Stay on top of regular health checkups: Work with your healthcare provider to monitor things like bone density, heart health, and hormone levels. Early detection of issues such as low calcium or high cholesterol can help you take proactive steps to prevent more serious health issues.

By establishing these habits now, you can set the foundation for a healthier and more resilient body and mind as you approach and navigate perimenopause.

Heal the Menopause Brain during Perimenopause 

Dr. Lisa Mosconi, a women’s health specialist, stresses how important it is to nourish your body and mind during perimenopause with the right nutrients. Plant-based antioxidants, like those found in colorful fruits and veggies, help fight oxidative stress—a common issue during this time—and protect your brain while reducing the risk of heart disease. Fiber from whole grains, beans, and produce keeps your digestion running smoothly, balances blood sugar, and supports a healthy gut, which is vital for both hormones and mood. 

Omega-3s from sources like salmon, flaxseeds, and walnuts reduce inflammation, protect your brain, and boost heart health. Lean proteins, such as chicken, tofu, and eggs, are essential for maintaining muscle strength (something that tends to decline with lower estrogen) and for keeping your mood steady. Vitamins A, C, and E, along with beta carotene from foods like sweet potatoes, citrus fruits, and nuts, keep your skin healthy, boost collagen, and strengthen your immune system. Selenium, found in Brazil nuts and seafood, supports thyroid health and energy. 

To care for your nervous system specifically, recommendations include magnesium, taurine, and ashwagandha as well as lots of self care. Rosemary and sage can help with maintaining memory and focus. 

Together, these nutrients can help you tackle the ups and downs of perimenopause, keeping your brain sharp, your heart strong, and your overall well-being on track.

After Menopause 

All of the habits we talked about establishing above are going to help with post-menopausal concerns, but here are some additional tips to counteract the effects of low estrogen on the body over time:

To help with lower bone density, prioritize calcium-rich foods like dairy, leafy greens, and fortified plant milks, and pair them with vitamin D (from sunlight or supplements) to enhance absorption. Strength training is also an important part of maintaining high bone density and muscle mass.

For mood swings, regularly eating complex carbohydrates, such as whole grains and legumes helps regulate blood sugar levels, which can be an issue as you age and often affects your mood.

Stay Tuned!

Stay tuned for the last article in our perimenopause series, where we will talk about testing and treating perimenopause and the role of hormone replacement therapy in mitigating brain degeneration as we age. 

References

1. Briden L. “The Real Reason Stress Hits Hard in Your 40s: Adrenal Health.” Lara Briden’s Blog. https://www.larabriden.com/real-reason-stress-hits-hard-in-your-40s-adrenal/
2. Fanibunda SE, Nagele RG, Dhande J, et al.” The Aging Brain: Neuroinflammation, Cognitive Decline, and Emerging Therapeutic Targets.” Frontiers in Aging Neuroscience. 2022;14:948219. https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.948219/full
3. Liu Y, Brown WT, Hoekstra RA, et al. “Exploring the Intersection of Aging and Neurological Disorders: Mechanisms and Management.” Frontiers in Aging Neuroscience. 2023;15. https://pmc.ncbi.nlm.nih.gov/articles/PMC10002830/
4. Mosconi L. The Menopause Brain: Understanding and Mitigating Cognitive Changes. Aviva Romm Blog. 2022. https://avivaromm.com/menopause-brain-lisa-mosconi/
5. Martin J, Jones C, Smith P, et al. “Nutrition and Brain Health: Perspectives on Cognitive Aging.” Frontiers in Nutrition. 2021;8:752500. https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.752500/full