For many women menopause marks a time of increased stress and discomfort that can also signal significant changes in mood and mental health. It can be frustrating for many to have these challenges met with the “it’s normal” response when it’s used to dismiss instead of validate their experiences. So instead lets talk about what’s actually normal and what’s specifically happening in our BRAIN during menopause that impacts our mental health and our sense of self. Understanding the why’s can help us navigate the what to do’s.

Menopause is often officially defined as the time when a woman has not had a period in twelve months. The impacts of menopause are relevant during the entire time period that hormone levels begin to reduce in our ovaries and their communication in our brain through oestradiol (estrogen), progesterone, and testosterone. These hormones work as neurotransmitters in our brain and affect the way it functions. So when women begin menopause and report feeling like they aren’t always thinking or functioning like themselves, this is a very real and relevant concern. Menopause is not just a hormonal change, but a neurological one as well. Thankfully, many of these symptoms have a time limit and don’t impact women’s actual cognitive performance, but it does significantly add to their stress, physical comfort, experiences of brain fog, mental load, and more. I’ll discuss what that may look like for you or your loved ones.

Menopause- The Basics

The average age of menopause ranges from 45-55, with the average onset at 51. It can begin as young as 40 though and perimenopause (the time initiating hormonal changes related to menopause) can begin as early as 35, but typically begins in the 40’s. In perimenopause, periods can become less frequent or irregular, hormonal shifts can begin, and some menopausal symptoms start.

These changes in oestradiol (estrogen), progesterone, and testosterone affect all the working systems in a woman’s body, in similar ways to how puberty and pregnancy affect the body and brain as a whole all the way down to the cellular level. This means our brain, our gut, our immune system, our skin, our glands, everything!

As I said, these hormones work as neurotransmitters in our brain and affect how our brain functions- so as estrogen, progesterone, and testosterone levels begin to shift and decline, it impacts our brain neurologically. These impacts and changes are the foundation of some of the physical symptoms women experience during menopause. For example, when estrogen reduces it doesn’t activate the hypothalamus as it had before. The hypothalamus is where body temperature is regulated and as these changes occur, errors in its activation (miscues) can lead to hot flashes and night sweats. Hot flashes and night sweats are actually a neurological issue and not an issue with your skin or glands per se.

It is also important to note that estrogen and cortisol (the hormone that assists in regulating our stress response) often work in balance with each other- as one increases the other decreases. Unfortunately, chronic stress can also suppress estrogen, which can further exacerbate the side effects of menopause. Lets look at that impact on women’s mental health.

Mental Health

Estrogen fluctuations can impact Serotonin and GABA levels in the brain which can have an impact on mental health disorders like Anxiety and Depression. This age range for women has the highest risk of suicide as depression rates double. It’s very important to note the risk for these specific symptoms typically occur in women who have already had a history of clinical Depression. It does highlight how seriously we need to take women’s mental health during this time though!

While the hormonal changes of menopause can directly affect previous mental health symptoms, the physical symptoms I’ve just listed can also increase stress and negative thinking, which can impact overall mental health as well. Lets look at that further. Disruptions in sleep during this time can impact our overall functioning and quality of life. It can increase feelings of brain fog, anxiousness, and stress. It can also have functional consequences like causing us to feel too tired for social engagements, completion of personal projects, or unmotivated for self care and meeting our other needs. Symptoms like hot flashes can build anxious thinking patterns and maladaptive anxious behaviors. Women can start feel panicky or irritable when warning signs of an oncoming hot flash begin to start. These can even be mistaken for panic attacks. It can lead to avoiding social settings in favor for more controlled or isolated environments to manage how hot flashes make us feel. Mood fluctuations can impact our relationships and communication with others as well as our desire to keep up with social engagements. It can also impact chronic physical conditions like cardiovascular diseases. Changes in our body, skin, hair, nails, etc., can reduce our confidence and self esteem, leading to negative thinking patterns about ourselves. Also the reduction in progesterone, which can begin in perimenopause, makes us less stress resilient during this time. This means the stress loads that were previously tolerable become increasingly difficult for our body and mind to manage without impact. Keep in mind this is also commonly a time when adults are often taking on the emotional or physical needs of their parents as well as their growing children, which also increases their mental, emotional, physical, and financial stress loads.

Side Note-Alzheimers

Women make up about 2/3rds of Alzheimers cases in the United States. While multiple factors play into that statistic, one predominate theory had always been that because women, on average, tend to live longer than men- at an average rate of 5 years in the US-they would make up a larger portion of older aged disorders like Alzheimers. Lately, though, more focus has been shed on the impact of the neurological changes associated with menopause that can increase some women’s risk for Alzheimers, especially women with early onset menopause for medical reasons. There is a shift from thinking of Alzheimers as a disorder of old age to one whose roots begin in midlife for both men and women. While this information may feel daunting, it is also an opportunity to address lifestyle benefits for reducing menopausal stress and Alzheimers risks during the ages that you are more physically capable of engaging in them.

The Good News!

The big take-away from all of this information should be that women understand that their experiences are real and valid and that they need to be met with compassion from themselves as well as compassion and support from those in their lives. Women’s bodies go through a fundamental change at so many levels during menopause which can leave them feeling unsettled until they are able to adapt to this new version of themselves post menopause. Thankfully in post menopause the intensity (and the existence of some of these symptoms) can significantly subside. While women often report feeling like they have less “brain energy” following menopause, their actual cognitive performance in comparison to men of their age group does not reduce! Dr. Lisa Mosconi, a renowned neuroscientist following the impacts of menopause on the female brain, has stated that “after menopause women have increased resiliency and greater emotional strengths”.

There are also ways to address and minimize your symptoms during this time! Some may seem like a common theme we hear for addressing our mental health and that is because of how significant and impactful these lifestyle changes are- diet, exercise, and sleep are foundational to how our body functions and are vitally important during menopause!

• Diet- eating a variety of healthy nutrients (think a variety of natural colors) and reduce any large consumptions of processed or high sugar foods. Reduce alcohol consumption. Women’s menopause specialists often suggest Mediterranean diets or low inflammation diets can help with estrogen regulation.

• Sleep- sleep is very important for brain functioning, such as repair and reprocessing. As I’ve discussed though, sleep can be impacted by night sweats, restless leg symptoms, anxiety, and body tenderness. Medications do exist to help address night sweats and hot flashes that have been impactful in helping increase good sleep, so talk to your doctor about options- both medically or holistically.

• Exercise- low impact and consistent exercise can help regulate cortisol levels and stress during this time. Boosting your heart rate for at least 30 mins can also help boost estrogen as well as dopamine and serotonin

• CBT Therapy- Cognitive Behavioral Therapy can help address negative thinking patterns or negative self views that can arise during this time. It can also help address clinical levels of Anxiety and Depression.

• Hormonal Therapy- previous research with hormonal therapy had looked at problematic studies introducing a medroxyprogesterone in women in the latter stage or end of menopause (over 60) and had suggested increased risks. Current hormonal therapy often includes the use a different progesterone called micronized progesterone which is given at lower doses to women in earlier age ranges (50-60) and has been shown to be safe for most women. A current meta-analysis study is underway to show the long-term effects of this form of progesterone, with some findings already published that I’ve linked below. As always, talk to your healthcare provider for your individual healthcare plan and options.

• Stress Reduction- overall stress reduction is very important to help temper the side effects of menopause. While this may seem like an impossible task, start with the unnecessary stress you may be taking on for yourself. What are things that you can say no to, can delegate to others, can work on changing how you react to, can reprioritize, or that you can have more compassion with yourself or others with? Working with a therapist can also help with some of these thought patterns and reactions.

• Stop Smoking- smoking not only increases your risk of earlier menopause onset, but it can increase the intensity of symptoms during menopause.

You can learn more about the impact of menopause on the brain with these books by some of the leading neuroscientist in the field of menopausal research. These are amazon affiliated links.

Citations

• Alblooshi S, Taylor M, Gill N. Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australas Psychiatry. 2023 Apr;31(2):165-173. doi: 10.1177/10398562231165439. Epub 2023 Mar 24. PMID: 36961547; PMCID: PMC10088347.

• Bromberger JT, Kravitz HM. Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstet Gynecol Clin North Am. 2011 Sep;38(3):609-25. doi: 10.1016/j.ogc.2011.05.011. PMID: 21961723; PMCID: PMC3197240.

• Harvard. “Menopause and Mental Health”. Harvard Health Publishing. 2020. https://www.health.harvard.edu/womens-health/menopause-and-mental-health

• Hipolito Rodrigues MA, Gompel A. Micronized progesterone, progestins, and menopause hormone therapy. Women Health. 2021 Jan;61(1):3-14. doi: 10.1080/03630242.2020.1824956. Epub 2020 Sep 21. PMID: 32957843.

• Jett, S., Dyke, J.P., Andy, C. et al. Sex and menopause impact 31P-Magnetic Resonance Spectroscopy brain mitochondrial function in association with 11C-PiB PET amyloid-beta load. Sci Rep 12, 22087 (2022). https://doi.org/10.1038/s41598-022-26573-5

• Mishra GD, Chung HF, Pandeya N, Dobson AJ, Jones L, Avis NE, Crawford SL, Gold EB, Brown D, Sievert LL, Brunner E, Cade JE, Burley VJ, Greenwood DC, Giles GG, Bruinsma F, Goodman A, Hayashi K, Lee JS, Mizunuma H, Kuh D, Cooper R, Hardy R, Obermeyer CM, Lee KA, Simonsen MK, Yoshizawa T, Woods NF, Mitchell ES, Hamer M, Demakakos P, Sandin S, Adami HO, Weiderpass E, Anderson D. The InterLACE study: Design, data harmonization and characteristics across 20 studies on women's health. Maturitas. 2016 Oct;92:176-185. doi: 10.1016/j.maturitas.2016.07.021. Epub 2016 Aug 4. PMID: 27621257; PMCID: PMC5378383.

• Mueck AO. Postmenopausal hormone replacement therapy and cardiovascular disease: the value of transdermal estradiol and micronized progesterone. Climacteric. 2012 Apr;15 Suppl 1:11-7. doi: 10.3109/13697137.2012.669624. PMID: 22432811.

• Nerattini Matilde , Jett Steven , Andy Caroline , Carlton Caroline , Zarate Camila , Boneu Camila , Battista Michael , Pahlajani Silky , Loeb-Zeitlin Susan , Havryulik Yelena , Williams Schantel , Christos Paul , Fink Matthew , Brinton Roberta Diaz , Mosconi Lisa .Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer’s disease and dementia (2023). Frontiers in Aging Neuroscience; 15.

• Razzak ZA, Khan AA, Farooqui SI. Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females. Int J Health Sci (Qassim). 2019 Jul-Aug;13(4):10-16. PMID: 31341450; PMCID: PMC6619462.

• Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice. Stute, Petra et al. Maturitas, Volume 174, 8 - 13