Changes in structure and functionality of the female brain.

Menopause is more than just the end of a woman’s reproductive years; it’s a complex and fascinating neurological and hormonal transition that primarily impacts the brain. Under this lens, this article is delivered in two parts. The first part seeks to share insights on how menopause affects and changes brain functionality. The second part dives into the hormonal connections involved, the upside of these changes and a practical short guideline for symptom prevention and brain health focusing on three lifestyle areas: sleep, exercise, and nutrition.

A new take on menopause.

Traditionally, menopause has been understood as the end of fertility for women, a “thing” of the ovaries and the uterus, and a sign of aging. However, research led by Dr. Lisa Mosconi, a neuroscientist specializing in menopause, and Lounne Brizendine, PhD, a neuropsychiatrist specializing in the study of the female brain, have opened a new perspective in our understanding of how this transition affects primarily the brain. Menopause can be viewed as the physiological reconstruction of the brain.

Menopause involves significant brain changes that can lead, on the one hand to temporary, yet underestimated neurological symptoms such as brain fog, memory lapses, and anxiety among others. On the other hand, it opens the space for a much wiser approach to life and a less emotional mindset.

What is menopause?

Women are born with the neuroendocrine system that connects the brain with the ovaries and the rest of the endocrine system. This means that a huge part of your brain is wired to respond to your reproductive organs, so the brain talks to the ovaries and the ovaries report back to the brain every day of a woman’s life. The system is activated during puberty, is over-activated during pregnancy, and once again changes to stop fertility during menopause.

Menopause is a day in your life, but the term is commonly used to refer to a full stage in a woman’s life. It is the day a woman has not had a menstrual cycle for 12 consecutive months. Perimenopause is the stage (it can last 7 to 10 years) preceding menopause where all the changes start to occur. Hormones are not stable, and the brain chemistry is erratic in behaviour. This can trigger many symptoms, from irregular periods, bleeding disorders, and hot flashes, to mental fatigue, brain fog, tinnitus, etc. Post-menopause is what comes after menopause.

Have you ever moved houses, cities or countries? Well, menopause is like the “moving day”. But you cannot move unless you do lots of planning and packing (maybe years) ahead of time. This preparation is perimenopause. Then you move and a new life begins, you must learn about the neighbourhood, look for a school if you have kids, navigate new streets, maybe learn a new language, and settle in a new space. Well, this is what your brain does before, on and after menopause.  

A loud silence.

As a woman in my 50s, and based on open conversations, it’s not the physical symptoms of menopause that affect us most, but the more silent ones that we find hard to tackle and believe are only “in our minds”. So, it is not you who suddenly can’t find the right words when speaking, and randomly feels mental fatigue, but the hormonal and chemical changes leading to a “renovation” in your brain.

The female brain has been studied only in recent years (compared to the male brain which has dominated scientific research). This research has shown that women change their brain architecture and functionality almost in full three times in their lifespan (while the male brain remains quite the same throughout the lifespan). This means, the brain undergoes a complete rewiring of connections and neurological pathways.

P-1. Puberty.

The stages for these milestones are Puberty, Pregnancy and Perimenopause.

During puberty, hormonal changes in females trigger the development of reproductive capabilities, impacting brain structure and function. Regions in the brain responsible for decision-making, planning, emotional regulation, memory and learning, and impulse control, mature and develop during puberty. At this stage, however, we are contained by our family, with little (high-stake) responsibilities. Hence, even though it is a roller-coaster of a stage, we have plenty of support while navigating these waters. This is the first massive change.

P-2. Pregnancy.

Pregnancy, the second “extreme makeover” of the brain brings further hormonal shifts, the volume of grey matter change, often accompanied by mood changes, reduced focus, concentration and brain fog. The amygdala, for example, critical for emotion processing and response, becomes larger and more responsive. We become vigilant, attentive and emotionally sensitive. But, since a baby is on the way, normally everything is beautiful. There are baby showers, people take pictures and if you’re having a hard time, people are usually compassionate. There is maternity leave and other support systems from an extended community.

P-3. Perimenopause.

The last big change in the female brain occurs during perimenopause, this seven-to-10-year transition marking the end of fertility in women, where another wave of hormonal changes leads to alterations in brain architecture, function and structure, mainly led by estrogen and progesterone erratic behaviour and progressive decline.

But this stage comes without parents paying for our bills or cooking our food and without the excitement of a baby (thankfully). It comes with many responsibilities and open fronts: career growth, a spouse, teenage children or young adults, and aging parents. A handful! Plus, the multiple symptoms which are natural to a brain renovation.

Observe your brain, and your mom’s.

Both Dr. Mosconi and Brizendine suggest recalling what your puberty and pregnancy (if you had children) looked like. It is the first predictor of what to expect in the perimenopausal years and what actions to take. Scientific research suggests that this stage is not too different in biological nature from puberty and pregnancy. But, be mindful to fit in the equation that the circumstances are completely different.

The second predictor is to learn about your mother’s experience, which even though may sound obvious, many (or most) women do not talk about their menopause journey with their daughters. Take upon this invitation to have a kind conversation with your mom.

The next delivery.

In Part 2 of this menopause brain series, understand the role of estrogen in the brain, the upside of post-menopause and three practices to improve brain health throughout this unavoidable stage in our life.

With care,