Our Brain in Menopause

Untitled design - 2021-05-28T223106.652.png

5 minute read

When Charles Darwin wrote his oft-quoted meme: “It’s not the strongest that survive, but those most adaptable to change”, I’m not sure he was talking about menopause it but turns out that this is one of the central things that makes us able to live and thrive beyond our reproductive years.

If the changes that occur during perimenopause and the early part of menopause were to continue in the same trajectory, women would be much less mobile, functional and strong than the majority are in what is often the latter half of our lives. *

But the evidence is showing us that our brilliant bodies are very smart, and learn to adapt to new hormonal levels. You could say that in our late perimenopause and early menopause our body experiences a hypo-oestrogenic state (too little of the hormone). But the good news is it makes adjustments so that this is not the same stressful biochemical experience for the years after. Instead, an equilibrium is found by the adjustment of many of our systems to a new norm.

Interestingly (and unfortunately) it is the reproductive tissues that are least able to stabilise without oestrogen**. Why do I find that interesting and not just unfortunate? Because it’s fascinating on a Darwinian level: we don’t need to reproduce anymore, but we do need to be able to gather fruits and roots, light the fire, mind the tribe’s offspring and remember who and what is safe or not. Arguably, our vaginas don’t serve any function in our post-reproductive years. Luckily, localised oestrogen prescriptions seem to be a really safe way of enhancing the wellbeing of our sexual organs, which is good, because now that we are not hunter-gatherers, we have more leisure time in which to be looking for something pleasurable to do, and longer relationships because of our new longevity.

Of course, some of the experiences of this transitional time, and the years afterwards, are related to our sense of self and our place in the world. These are things that we can’t necessarily trust to the inner adaptations of our cells. These sources of discomfort, maybe even grief, need mindful help towards choices of self-acceptance and maybe even empowerment. We could also do with a whole societal evolution, but that’s an article for another day.

But many of the difficult effects of perimenopause stem from changes in the brain, like hot flushes, memory, concentration, some aspects of libido, disturbed sleep and mood changes. Many of my clients and trainees really struggle with the prospect of having to suffer from these difficulties for the rest of their lives. I have only ever been able to tell them that many women report a return to some sort of balance, but that we don’t know why (it may be to do with a decline of the number of oestrogen receptors on our cells compared with pre-menopause). I have not been able to tell them that we don’t continue on a rotten downward trajectory, even though anecdotally it seems that we regain, or rather find a different balance.

Until now.

In a recent ground-breaking study of the female brain (with comparisons of women in pre, peri and post-menopause, and to male brains of similar ages), the renowned neuroscientist Dr Lisa Mosconi has seen enough evidence to declare:

“The female brain has the remarkable, understudied, and under-celebrated ability to adapt to menopause.”

Just in case you don’t want to read the whole paper, jargon and all, here are a few standout tidbits:

Neuro-imaging results provide new physiological evidence for post-menopause brain adaptations encompassing brain structure, connectivity, and preservation of cognitive function.
In most brain regions, brain biomarkers recovered or stabilised after menopause.
Studies have reported perimenopause decline in cognitive function and a return to the pre-menopause state after menopause.
The brain becomes more capable of using an alternative energy source post-menopause.
Reproductive ageing (i.e. menopause) is not uniformly associated with Alzheimer's risk.
Clinical trials of late post-menopause women over 65 show an increased risk of dementia in those who take oestrogen and progesterone, and no effect either way in women who take oestrogen-only. (This is good news if you can’t take HRT, or are only on oestrogen, and good information to bring to your doctor as you reach your 60s and may want to consider changing treatments. There is some evidence not mentioned in this study that HRT after 60 can negatively affect heart health, so in your late 50s, it’s definitely a good age to be going back to discuss your current choices.**)
Women perform better than men in several cognitive domains across the adult lifespan. Ooh yeah! (the “ooh yeah!” was not in the study!)

And even better, the woman behind this study is fully aware and shares the benefits of... you guessed it... exercise, meditation, yoga, nutrition, sleep and hydration for brain health in the years ahead. You can improve your outcome better than anyone or anything.

This is beautiful news about our beautiful brains! This is a reason for women to relax a little, and know that, though it may be taking a long time, our body is busy adapting, right there in front of the scientists imaging machinery.

Personally (and with no basis in science) I would say that your brain is evolving, right now, as you read this. Darwin would have a field day!

Niamh Daly, June 2021

* There is, of course, a cohort of about 20-25% of women who experience the transition, and sometimes the later years with really difficult symptoms and health issues. In terms of endocrinology (the frontline of medical research and treatment of hormonal issues), these would be considered disorders of menopause, rather than fairly usual menopause. Also, for women reaching menopause early, the use of HRT, if possible, is advised. This article is speaking mostly about average menopause, whether surgically, medically or naturally induced, in the “normal” window of perimenopause onset to full menopause, ages 40-58.

** This information is directly received by the author from Consultant Endocrinologist Dr Annice Mukherjee who specialises in menopause as well as other hormonal issues.