Menopause is often discussed in terms of its physical symptoms—hot flashes, night sweats, and hormonal fluctuations. However, the changes that occur in the brain during this transition are equally significant, influencing cognition, mood, and overall mental health. Understanding these shifts, including the physiological, neurochemical, and biochemical alterations, can provide valuable insights into the menopause experience and help in managing its effects more effectively.
The Hormonal Shift: Oestrogen's Role in Brain Function
Oestrogen, which as well as being a major sex hormone, plays a significant role in brain function. It’s not just involved in reproduction—it also helps neurons communicate, keeps brain cells alive, and even regulates brain energy use.
Neuroprotection: Oestrogen helps neurons grow and survive by binding to estrogen receptors (ERα and ERβ) in areas like the hippocampus (important for memory) and prefrontal cortex (involved in decision-making).
Neurotransmitter Regulation: Oestrogen increases serotonin (linked to mood), dopamine (involved in motivation and reward), and acetylcholine (crucial for memory).
Blood Flow and Energy: It also improves blood flow in the brain, ensuring that neurons get the oxygen and nutrients they need. It is also a key regulator of the mitochondria which are organelles within the neurons that produce energy. If the mitochondria are not functioning optimally, neither are the neurons.
As oestrogen levels drop during menopause, all these functions become less efficient, leading to cognitive and emotional changes.
Cognitive Changes: Memory, Focus, and Mental Clarity
Many women report experiencing "brain fog" during the menopause transition, characterized by forgetfulness, difficulty concentrating, mental fatigue and slower thinking. Research indicates that these symptoms are linked to shrinkage in the hippocampus (responsible for memory consolidation) and the prefrontal cortex (critical for executive functions like planning and attention).
Neuroimaging studies have shown alterations in brain connectivity and a decrease in grey matter volume during menopause, which are believed to be reversible post-menopause.
Oestrogen helps regulate acetylcholine, a neurotransmitter essential for memory and learning. When oestrogen declines, acetylcholine activity decreases, making it harder to focus. Additionally, reduced neurotrophic support, such as brain-derived neurotrophic factor (BDNF), can reduce neuronal activity, further contributing to cognitive challenges.
The loss of oestrogen also means that synapses (connections between neurons) become less flexible, making it harder to form new memories.
Mood and Emotional Health: The Neurochemical Impact
The hormonal changes during menopause don’t just affect cognition—they also impact mood, anxiety, and emotional resilience. The decline in oestrogen levels disrupts the balance of key neurotransmitters:
Serotonin: Oestrogen normally boosts serotonin, the neurotransmitter that stabilizes mood. With lower oestrogen, serotonin production and receptor sensitivity decrease, leading to mood swings or even depression.
Dopamine: Less oestrogen means less dopamine activity, which can reduce motivation and make everyday tasks feel less rewarding. Low dopamine is often found in ADHD and this may be a contributing factor to the increase in number of women diagnosed with ADHD in midlife.
GABA: Estrogen interacts with the GABA and glutamate systems, which balance relaxation and excitation in the brain. A drop in oestrogen can lead to increased anxiety and irritability as well as increased reactivity to stress.
· Additionally, sleep disturbances due to night sweats and hot flashes exacerbate mood disorders by impairing the brain's ability to regulate emotions effectively.
Brain Energy Metabolism: A Shift in Fuel Use
Emerging research indicates that the brain undergoes significant metabolic changes during menopause. The brain primarily runs on glucose, but oestrogen helps regulate how efficiently the brain uses glucose for energy.
Glucose Hypometabolism: Studies show that as oestrogen declines, the brain becomes less efficient at using glucose, which can lead to brain fog and fatigue.
Mitochondrial Dysfunction: oestrogen supports mitochondria (the cell's energy producers), so when oestrogen levels drop, mitochondria become less efficient, leading to oxidative stress (cell damage from free radicals). Increased oxidative stress contributes to neurodegenerative processes.
Ketone Shift: When glucose metabolism declines, the brain may start using ketone bodies (from fat breakdown) as an alternative energy source.
This metabolic shift is being studied in relation to neurodegenerative diseases like Alzheimer’s, which disproportionately affect postmenopausal women.
Coping Strategies and Brain Health Support
While these effects are concerning, they are often temporary and can be managed through exercise, diet, cognitive training, and possibly hormone therapy.
Strategies to support brain health include:
Regular Physical Activity: Exercise promotes neuroplasticity, enhances BDNF levels, improves mood, and supports mitochondrial health.
Balanced Nutrition: A diet rich in antioxidants, omega-3 fatty acids, phytoestrogens, and lean proteins supports brain metabolism and reduces inflammation.
Cognitive Training: Engaging in intellectually stimulating activities can enhance cognitive reserve and resilience.
Mindfulness and Stress Management: Techniques such as meditation, yoga, and controlled breathing exercises help regulate mood, reduce cortisol levels, and improve emotional stability.
Hormone Replacement Therapy (HRT): For some women, HRT may alleviate cognitive and mood symptoms by stabilizing oestrogen levels, although it should be considered carefully under medical supervision.
If you have noticed cognitive and mood changes and would like support, please do get in touch and let's chat.
Michaela x
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