Like many of you, we’re fascinated by the new studies and findings that are coming out (almost daily, it seems!) on the effects of menopause on our health. From libido to heart health, a growing number of researchers and medical professionals are uncovering a greater understanding of what happens to our bodies in the menopause transition. 

And there’s another new area of discovery in perhaps the most important organ of all—our brain. 

Neuroscientist and director of the Women’s Brain Initiative at Weill Cornell Medicine, Dr Lisa Mosconi’s research focuses on how our genetics, hormones, environment, and lifestyle shape the female brain. More recently, Dr Mosconi and her team have been investigating the menopause-brain connection. While there’s a lot more work still to be done, it’s increasingly clear that menopause needs to be reframed not just as a reproductive health event but as a neurological one too.

What happens to our brain during menopause?

Dr Lisa Mosconi’s research via the Women’s Brain Initiative, together with the University of Arizona, found that menopause affects women far more biologically than being fertile.

Through brain imaging technology, they found that when menopausal women experience symptoms like hot flushes and sleep disturbances, they're actually neurological symptoms, originating in the brain rather than the ovaries, as historically believed. Some key brain symptoms include:

• Hot flushes
• Night sweats
• Disturbed sleep
• Insomnia
• Mood swings
• Tearfullness
• Irritability
• Memory lapses
• Brain fog
• Anxiety
• Fatigue
• Low libido
• Stress sensitivity
• Headaches and migraines

And the list goes on....

They also revealed a link between the female brain during menopause and dementia—more specifically, Alzheimer's. As Dr. Mosconi puts it: “In straight talk, menopause causes metabolic changes in the brain that seem to increase the risk of Alzheimer's disease.

The link between menopause and the brain: estrogen

Estrogen, produced in the ovaries, plays a crucial role in safeguarding the brain against ageing and damage, particularly in the areas that control memory, mood, and body temperature regulation. It's the changing estrogen levels during perimenopause and menopause that's responsible for the many symptoms experienced during this phase. Research conducted by Dr. Mosconi's team found that estrogen fluctuations accompanying menopause symptoms reduce neural protection, leading to increased susceptibility to brain aging and Alzheimer's disease.

Through brain imaging, they also found that a decline in estrogen alters the function and, sometimes, the structure of some regions of the brain.  Dr. Mosconi said. “Some of the brain regions that are impacted by menopause are also some of the regions impacted by Alzheimer’s disease, but the link between the two is not yet fully understood."

This imaging also revealed reduced volume in menopausal brains compared to two study groups: male brains of the same age and those of pre-menopausal women.

And we’re seeing more studies that back up this correlation between estrogen decline-related menopause symptoms and the brain. 

A 2022 study found that hot flushes were associated with an increased amount of tiny lesions in the brain, a sign of declining brain health. Another study in 2023 determined that night sweats were associated with an increase in blood-based Alzheimer’s biomarkers, which serve as early signs of the disease.

But don't be alarmed. It’s important to remember that while this research might be concerning, for the majority of women (around 80%), our brains and cognitive function will stabalise after the menopause transition. Plus, you can start to make lifestyle changes to look after your brain function today.

How to protect your brain during menopause

For women going through the stages of menopause, experts agree on three things in particular that can greatly influence both short-term symptom relief and long-term dementia risk management.

1. The importance of diet

Did you know that of all our organs, the brain is most easily damaged by a poor diet? Certain diets, like the MIND and Mediterranean diets, which centre on vegetables, fruits, whole grains, lean proteins, and healthy fats, may have potential benefits for women with a genetic risk for Alzheimer’s. While this study has found that following a Mediterranean diet decreases depression, particularly in older women, by around 60%.

Thinking of cutting back on meat? There may be a specific added benefit of plant-rich diets for women, research suggests that certain gut bacteria, most nourished by a plant-rich diet, might help balance estrogen levels in the body.

2. Regular exercise

Being consistent with our exercise, including strength training, boosts blood flow to the brain, stimulates the growth of new neurones, and improves cognitive function. In a recent study monitoring nearly 200 middle-aged women, researchers found that those with higher fitness levels had a reduced risk of developing dementia as they aged.

3. Explore prescribed medications

Discuss the benefits of prescribed menopause medications with your doctor or menopause specialist. Be educated and informed so you can make the right decision to treat your unique combination of symptoms

Something to remember, and it starts with you

It’s important to note that along with increasing your daily exercise and prioritising sleep, any lifestyle and diet changes take time. While you may feel you don’t have much time to incorporate them, with the stresses of modern life and caregiving responsibilities, it’s important to keep ourselves on the priority list to have the healthy brain ageing we want and need.