Experts suggest that menopause should be redefined as a neurological condition rather than just a gynaecological issue. Here’s the reasoning behind this perspective and the steps we can take in response.
As I approach my 40th birthday, I find myself reflecting on the natural process of ageing not just in terms of my physical appearance, but also regarding my mental well-being.
Honestly, I feel remarkably content with my ageing body. My husband and I will undoubtedly grow more wrinkled and stooped together, and that seems like a fair trade-off in the journey of life.
Yet, emerging research signals a more complex reality as we transition into this new phase of midlife. Studies suggest that while our physical bodies may age together, my brain may experience changes and declines that it will not.
This stark discrepancy in our cognitive ageing serves as a pivotal concern for me, ultimately highlighting the inequalities that can arise during this period.
It’s become the proverbial straw that broke the camel’s back, or, if you prefer, the tipping point that has tested my already limited patience during this peri-menopausal chapter of life.
If my husband and I were to undertake a verbal memory test today, I would likely come out on top.
However, fast forward a decade, and the outcome could be quite different. On average, research indicates that adult women outperform men in memory-related skills.
This insight comes from Jill Goldstein, a professor of psychiatry and medicine at Harvard Medical School, as well as the founder of the Innovation Center on Sex Differences in Medicine at Massachusetts General Hospital.
Interestingly, this advantage appears to diminish during menopause. Prof. Goldstein has explored some of the underlying reasons for this phenomenon.
“Our studies demonstrate that for women in early midlife, reproductive age plays a distinct role in memory performance, unlike men, for whom chronological age is the primary factor influencing memory changes,” she notes.
Changes in the Brain During Menopause
According to Prof. Goldstein, the impact of sex hormones estrogen, progesterone, and testosterone extends beyond the reproductive system.
These hormones have receptors located in essential areas of the brain that govern mood, anxiety, stress response, memory, and appetite.
They can significantly influence the development, connectivity, and even the survival of brain cells.
Professor Goldstein’s research indicates that during menopause, the reduction of estradiol the most powerful and prevalent form of estrogen throughout a woman’s reproductive years leads to a “reorganization of the brain circuitry responsible for memory performance. This shift affects our ability to process information, recall memories, and even influences our physical and emotional well-being.”
Are you misplacing your keys or mistakenly calling your children by your dog’s name? You can attribute these lapses to the decline in estradiol.
Brain fog is more prevalent than hot flashes. For centuries, women have been presented with a limited narrative regarding menopause, often implying that it lasts merely 12 months following the last period and primarily manifests through hot flashes and night sweats.
Dr Louise Newson, a menopause specialist and author of “The Definitive Guide to the Perimenopause & Menopause”, argues that this depiction is far too simplistic and fails to capture the full spectrum of experiences.
In a survey conducted by Dr Newson involving nearly 6,000 women, the most frequently reported symptoms were not the typical hot flushes or night sweats.
Instead, they were predominantly linked to the brain and nervous system.
Symptoms included: “Brain fog, low energy, memory issues, sleep disturbances, low mood, reduced libido, irritability, decreased motivation, tearfulness, feelings of anxiety, poor concentration, mood swings, and headaches…”
Overall, Dr Newson suggests, “I believe menopause should be redefined as a neurological condition rather than a gynaecological one.”
Brain changes initiate well before menopause.
The timeframe for these changes is often much longer than commonly presumed.
Research suggests that declining hormone levels can begin to influence women’s brains as early as their early40s.
A Finnish study involved 43 men and 28 women who underwent MRI brain scans at ages 33 to 35, and again at ages 42 to 44.
The results indicated that women experienced a greater loss of brain volume over this period compared to men.
The researchers proposed that this disparity may be attributed to the neuroprotective effects of testosterone, as well as the significant hormonal changes related to menopause, which begin several years before the final menstrual period.
Dr. Newson elaborates, “Often, testosterone levels decline first. We frequently see women in our clinic presenting symptoms such as low mood, memory issues, and sleep disturbances.
Upon testing, we often discover their testosterone levels are quite low.” After being prescribed testosterone, many of these women report improvements in clarity and focus.
“Menopause induces distinct alterations in the brain’s structure, functionality, and connectivity,” affirms Dr. Lisa Mosconi, a neuroscientist and the director of the Weill Cornell Women’s Brain Initiative, as well as the author of “The Menopause Brain”.
In her research from 2021, she discovered that women may experience a reduction in grey matter the region responsible for processing information during the peri-menopausal and early menopausal stages.
Additionally, the white matter, which comprises the fibres connecting brain cells, also diminishes, alongside a decline in the brain’s glucose consumption, the primary energy source for cellular activity.
Similar to the Finnish study, Dr. Mosconi’s research indicates that women’s brains start responding to hormonal fluctuations several years before what is commonly linked with menopause, and this occurs in some notably significant ways.
Alzheimer’s disease impacts women at a rate twice that of men, a phenomenon that can be partially attributed to their longer average lifespan.
However, Dr Mosconi’s research reveals that women possessing a specific genetic risk factor for Alzheimer’s namely, a variant of the APOE gene start developing amyloid plaques associated with the disease as early as their late40s.
She explains, “Estrogen has neuroprotective properties, and its decline during menopause may increase the brain’s susceptibility to Alzheimer’s disease.”
The positive changes in the brain after menopause:
While the upcoming decade may initially seem daunting, there’s encouraging news to consider.
Many of the declines identified in Dr. Mosconi’s study turned out to be temporary and reversed after menopause.
She explains, “Menopause is essentially a renovation project for the brain. The neurons and connections that support ovulation and pregnancy are no longer necessary and can be pruned away. This presents the brain with an opportunity to become ‘leaner and more efficient.’ While this process may lead to some bumps along the way, it also brings several advantages.”
Research indicates that for some women, the hormonal fluctuations that diminish after menopause can lead to a renewed sense of emotional well-being and fulfilment, according to Dr. Mosconi.
The amygdala, which is the brain’s emotional hub, may become less sensitive to negative or distressing experiences.
Additionally, many women report feeling a newfound sense of liberation, clarity and focus during this phase of life.
Experts agree that there are numerous ways to navigate menopause while maintaining a sharp and powerful mind.
Dr. Mosconi emphasizes that while postmenopausal women may no longer be reproductive, they can still be incredibly productive.
Prof. Goldstein highlights three key activities that contribute to preserving brain health as we age: engaging in deliberate cognitive exercises, participating in purposeful physical activity, and fostering social connections.
Therefore, it’s essential to prioritize both physical and mental exercise, along with quality time spent with friends. That’s a recipe for success I wholeheartedly endorse.
How to Enhance Your Menopausal Brain:
By: Dr. Lisa Mosconi
1. Diet: Adopt a Mediterranean-style diet, rich in omega-3 fatty acids, fruits, vegetables, whole grains, and lean proteins. A 2021 analysis found that high blood sugar levels, diabetes, abdominal fat, and a heart age score that exceeds your actual age during midlife are linked to notable declines in cognitive performance a decade later.
2. Hormone Replacement Therapy (HRT): Research by Dr. Lisa Mosconi indicates that HRT is associated with increased grey matter volume in midlife women. Grey matter, present throughout the nervous system, plays a crucial role in memory, decision-making, and emotional regulation.
3. Exercise: Engaging in regular physical activity, including both aerobic and resistance training, can enhance hormonal function, cognitive abilities, and overall brain health. Notably, aerobic exercise boosts levels of the protein BDNF, which is correlated with reduced cognitive decline during menopause.
4. Cognitive Engagement: Challenge your brain with stimulating activities such as learning a new language, playing a musical instrument, or solving puzzles.
5. Sleep: Aim for seven to nine hours of quality sleep each night, as adequate sleep is essential for cognitive health and memory consolidation.
6. Stress Management: Incorporate techniques such as mindfulness, meditation, or yoga to help mitigate stress and its detrimental effects on the brain.
7. Regular Medical Check-ups: Collaborate with your doctor to effectively manage any medical conditions that may impact brain health, including heart disease, diabetes, and thyroid disorders.
8. Pharmacological Options: Consult a healthcare professional to explore available hormonal and non-hormonal treatment options.
