The brain transforms during menopause
Craig Boylan
From brain fog to anxiety, the cognitive impacts of menopause are familiar to many. But now it seems the brain changes are much more profound than previously imagined, with potentially long-term effects perhaps even explaining why women are at a greater risk of Alzheimer’s disease.
The changes are so dramatic, says Roberta Brinton at the University of Arizona, who studies the female brain, that they are akin to a home renovation: “It becomes a different brain.”
These discoveries underscore the ways in which midlife can influence brain health in older age – and highlight the brain’s remarkable resilience.
“The menopausal transition can unmask neurological vulnerabilities,” says Brinton. “For these women, menopause is a critical period for both identifying neurological risks and intervening appropriately.”
Menopause occurs once menstruation permanently ends, usually around age 50. Ovaries stop producing substantial amounts of the reproductive hormones oestrogen and progesterone, triggering widespread symptoms including sleep disturbances, hot flushes and mood swings.
These symptoms can begin in the decade before menopause – a period known as perimenopause, which is characterised by dramatic fluctuations in oestrogen. This tumult has a profound effect on the female brain, which relies on oestrogen for various functions. The hormone plays an essential role in converting glucose into energy, contributing up to 25 per cent of the brain’s energy production. When oestrogen plummets, “the brain undergoes a bioenergetic crisis”, says Brinton.
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This energy crisis can be seen in brain-imaging studies. In 2021, Brinton and her colleagues used MRI to scan the brains of 161 women between the ages of 40 and 65. Thirty participants were premenopausal (the time before the perimenopause), 74 were postmenopausal, while the rest were in perimenopause.
