How menopause changes the brain

"For decades, some doctors have told women that the brain fog, insomnia and mood swings they experience in midlife are 'all in their heads,'" Bever writes. However, new research has found that women experience significant physical changes in their brains during menopause, which can lead to different cognitive symptoms.

In brain imaging studies, researchers found that menopause reduced gray matter volume in areas of the brain involved in concentration, attention, language, and memory.

Researchers also observed changes in connectivity, as well as declines in brain energy levels, which suggests that the brain is not burning glucose from the bloodstream as quickly or efficiently as before.

"Menopause does impact the brain," said Lisa Mosconi, an associate professor of neurology and radiology at Weill Cornell Medicine who helped conduct the studies. "We're not crazy. We're not losing our minds."

According to Bever, women's brains "evolve" throughout the course of their lives, including puberty, pregnancy, and menopause. This means that when neurons that were necessary for menstruation and pregnancy are no longer needed, the brain goes through a "renovation," Mosconi said.

Although a definitive cause of these changes is unclear, a decline in estrogen during the transition to menopause may explain some of the symptoms women experience. Estrogen helps regulate behavior, cognitive function, and neuronal health.

Dropping estrogen levels in the hippocampus, which affects learning and memory consolidation, can lead to changes in memory and cognition. Low estrogen levels can also disrupt the amygdala, which influences emotional responses, and the prefrontal cortex, which affects attention, decision-making, language, and multitasking.

"When [estrogen] withdraws after menopause, the brain keeps going, the orchestra keeps singing, but the tune is not quite the same, and many women can feel the changes," Mosconi said.

Currently, it's unclear if there is a way to prevent, stop, or reverse the brain changes women experience during menopause. However, at least some symptoms may be temporary.

When Mosconi and her colleagues followed up with participants in their brain imaging studies two years later, they found that metabolic activity typically stabilized in some areas of the brain. Some women also saw their gray matter volume rebound after menopause. More research is needed to understand which changes are permanent and which are temporary, Mosconi said.

How to ease menopause's cognitive symptoms

According to women's health experts, a combination of a healthy lifestyle and pharmaceutical interventions, when necessary, can help women have an easier transition into menopause.

For example, Sharon Malone, chief medical advisor of Alloy Women's Health, said that doctors may prescribe women birth control during perimenopause, or the years leading up to menopause, to help stabilize erratic periods, prevent unwanted pregnancies, and reduce symptoms.

For women who do not need birth control, menopausal hormone therapy, which uses estrogen or estrogen plus a progestogen, can help. This therapy is used to treat hot flashes, night sweats, and other symptoms caused by lower hormone levels.

"Estrogen is not the danger most women think it is," Malone said. "For the overwhelming majority of women, estrogen can be used safely and effectively. And estrogen is without question the most effective treatment for the symptoms of menopause."

There are also nonhormonal treatments for menopause symptoms, including anti-seizure drugs, antidepressants, and blood pressure medication. Diet and nutrition, exercise, and sleep have also been associated with "a gentler menopause for many women," Mosconi said.

"There's a lot of talk about a window of opportunity — that perimenopause should be viewed as a critical window for improving women's health," said JoAnn Manson, a professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

"Every time we talk about menopause, it's always doom and gloom," Mosconi said. "There's no sense of achievement. There's no sense of status gained. There's no sense of having crossed an important milestone. I think that's absolutely unfair. I'm hoping that we can break the stigma and make menopause an accepted and welcomed part of a woman's life."

Advisory Board women's health resources

To better understand how to support women's health, check out these Advisory Board resources:

Organizations must make an effort to address inequities in women's care and improve their health outcomes. This cheat sheet outlines how organizations can improve care for menopause symptoms.

Similarly, this expert insight explains five practical ways employers can improve women's health and well-being in midlife, as well as foster a supportive work environment.

More broadly, this report outlines six key factors impacting women's health in the United States, including the roles of various healthcare stakeholders and the importance of cross-industry collaboration. We also have resource libraries on both women's health and clinical technology for women's services. (Bever, Washington Post, 5/2)