Let’s start with what we know: Estrogen is a powerful and pervasive hormone secreted mostly in our ovaries. Beginning in perimenopause, our estrogen levels fluctuate and decline until, several years post-menopause, we produce very little, if any, estrogen. This process is natural and is sometimes disruptive.
We joke and often lament about changes to our skin, bones, and hair, to our ability to sleep well; we experience and often suffer from hot flashes and mood swings; we complain about weight gain and “brain fog.” Loss of estrogen during menopause is every bit as significant a transition for women as puberty.
Less obvious are the changes taking place in our brains. New research is slowly uncovering how estrogen affects our brains and why menopause is such a significant transition.
For most of our lives, there is no difference between male and female brains, according to Dr. Lisa Mosconi, director of the Weill Cornell Women’s Brain Initiative and author of The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer's Disease. “I’ve been looking at brains for twenty years and can guarantee that there’s no such thing as gendered brains,” she says.
Men’s and women’s brains look identical—until menopause. That’s when our reproductive hormone, estrogen fluctuates and diminishes. Testosterone levels in men, on the other hand, remain fairly steady, only decreasing slowly with age.
Estrogen, as part of the neuroendocrine system, is intimately connected with brain activity as well as with reproduction. Estrogen feeds the brain, in that it regulates glycerin levels, which is how the brain produces energy. With fluctuating, falling estrogen levels, neurons in the brain age faster and produce less energy.
“The loss of estrogen means that glucose metabolism in the brain, its primary fuel, is reduced by about 20 to 25 percent. That’s why women experience that they’re off their game. They still can play the game, just not as well,” says Roberta Diaz Brinton, the director of the Center for Innovation in Brain Science at the University of Arizona, who has extensively studied the effect of estrogen on the brains of mice.
Only at this point can a neurologist differentiate between male and female brains: The female brain produces less energy than a male brain of the same age. Furthermore, those hot flashes, mood swings, forgetfulness, and insomnia are all neurological symptoms that originate in the brain as it adjusts to decreasing estrogen. All those annoying symptoms of menopause really are in your head.
Not all scientists agree with the Brinton/Mosconi theory, and none of this means definitively that cognition is affected beyond that passing perimenopausal fog. Our brains may have less energy, but there is no apparent cognitive difference between men and menopausal women.
However, down the road, women are significantly more likely to succumb to the most common form of dementia—Alzheimer’s disease. Two of every three diagnoses of Alzheimer’s are women. And this, says Dr. Mosconi, is important information for women. “The point here is that we really need to better understand what happens to our brains as we go through menopause…, and how to protect our brains in the process.”
While ongoing research attempts to tease out the interaction of hormones and the brain, Mosconi strongly recommends that in the meantime, we can protect our brains with some targeted lifestyle adjustments. “Just like you can’t prevent a heart attack or a stroke definitively, you can’t prevent Alzheimer’s definitively,” says Dr. Richard Isaacson, founder of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine. “But one in three cases can be either preventable or delayed.”
These lifestyle changes are neither extreme nor easy. It’s the same old ho-hum advice your doctor always gives you. But if you could add the option of keeping your brain healthy as you age simply with a few lifestyle choices? Seems like a no-brainer, so to speak. So, according to Mosconi and others, here are the ways you can support brain health:
- Eat well. Specifically the Mediterranean diet, rich in B vitamins and Omega 3s. Eat fish, fresh fruits and vegetables, complex carbohydrates. “What's interesting about this diet is that it's quite rich in foods that contain estrogens in the form of phytoestrogens or estrogens from plants that act like mild estrogens in our bodies,” says Mosconi. Cut back on coffee and alcohol. Drink lots of water.
- Exercise. Not crazy stuff, not necessarily high-intensity burn-out rounds, but consistent, regular, low-to-moderate intensity exercise three to five days per week. Both aerobic (fast walking) and resistance training (free weights) to maintain muscle. Older women (over 70) can do 15 minutes per day.
- Reduce stress. In addition to being generally bad for you, stress produces the hormone cortisol, and cortisol reduces estrogen. They work in tandem. So avoiding stress is really important, not only to mental well-being, but also to brain health.
- Sleep. Sleep is restorative for our brain. Plus, better sleep and less stress go hand-in-hand, so improving either might double the gain. Lots has been written about sleep hygiene, but you’ll have to ferret out what works for you. For many of us, this is another of those menopausal knuckle sandwiches that strike at a demanding time of life. Talk to your doctor; do some research; get to know your new tolerances and tendencies.
We can’t change our biological destiny or the genes we inherited, but we can attempt to understand what’s happening with our bodies, and we can work to keep it in the best shape possible as we head into a challenging transition and an ultimately satisfying time of life.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.