Cable news runs on fear-mongering, political panic and screaming headlines. 1440's daily newsletter gives you:

Join 4+ million readers today.

Sign Up For Free

Perimenopause and menopause affect about half of the world’s population. Research and public discussions about these important milestones are scarce, but slowly increasing.

As a woman in my early 40s, I know that this chapter is coming for me, too. Maybe you’re in my situation, maybe you’re already “in” or “on the other side”, or maybe you’re a man who wants to better understand what’s happening to the women in your life.

In this edition, I’m compiling some of the latest research about this important transition. The TL;DR version is: (Peri)menopause is a major brain event, not just a reproductive change.

The information in this edition is based on two articles: this one and this one.

Let’s start with the basics: Menopause is defined retrospectively after 12 months without menstruation. The average age for naturally occurring menopause is 51 years, and women spend an average of 40% of their lives in postmenopause. Up to 10 years before menopause, the transition begins, referred to as perimenopause.

Ovarian hormones show stronger fluctuations during perimenopause. Estradiol (a type of estrogen) and progesterone start to decrease, whereas gonadotropin hormones, such as follicle-stimulating hormone (FSH), increase.

Estrogen receptors are widely distributed across the body and the brain, which is why there’s a long list of symptoms that occur during the transition and beyond.

Here’s a figure that depicts this graphically:

The most well-known symptom is hot flashes. Both hot flashes and night sweats are associated with body temperature regulation and referred to as vasomotor symptoms. Vasomotor symptoms affect ~80% at some point during the transition.

But there are more than 70 symptoms currently associated with (peri)menopause. Mood and anxiety symptoms, for example, are as common as vasomotor symptoms. Other symptoms include brain fog, impaired cognitive performance, sleep disturbances, and aches in various parts of the body.

And in one study, about 64% of the participating women said “I don’t feel like myself” about half of the time over the last three months.

Estrogen receptors are found in many parts of the brain, such as the prefrontal cortex, hippocampus, and amygdala—important regions for diverse cognitive and emotional functions. So when estrogen levels drop, these receptors lose part of the signals they were receiving before, and that affects the function of these brain regions.

It’s no wonder that the most frequently reported menopause symptoms are brain symptoms.

Hot flashes are also a brain symptom: Estrogen’s influence on the brain’s hypothalamus, a structure that, among many other functions, regulates body temperature, is also reduced. This leads to less effective regulation of body temperature, which is perceived as hot flashes and night sweats.

Your brain runs mostly on glucose for fuel. Estrogen helps it do that by supporting mitochondrial oxidative phosphorylation and maintaining glucose transporter expression.

As estrogen levels decrease, glucose metabolism also declines, and this drop is region-specific. It’s mainly observed in brain regions that are also susceptible to changes due to Alzheimer’s disease.

However, this doesn’t mean that a person will later develop Alzheimer’s disease. To date, it’s not clear if and how these changes relate to long-term Alzheimer’s risk.

Women have about double the risk of suffering from Alzheimer’s disease compared to men, and this difference cannot be simply explained by their greater longevity. The menopause transition might contribute to later vulnerability to Alzheimer’s disease in women, but there isn’t enough research yet.

The short answer is: We don’t know. There’s not enough data yet, especially data from long-term studies that observe their effects over many years.

In the few trials that exist, there’s evidence both for and against these therapies for brain health. It seems to depend a lot on timing, i.e., when medication starts, the form of administration (oral or through the skin), the exact formulation of the product, and each person’s individual characteristics.

Just regarding the formulation, there are currently >200 products on the market, making the scenario very complex. Current recommendations are to rely on precision medicine, i.e., to evaluate each case individually.

Even though the evidence regarding brain health is currently mixed, these therapies can be effective at treating symptoms such as hot flashes and reducing symptom burden.

First of all, if you’re currently affected by this transition: Your symptoms are valid and you deserve proper care, which also includes pharmacological treatment in some cases.

Second, research into this topic is still scarce, and many symptoms beyond hot flashes are less well-known, even in healthcare settings. It helps to keep a symptom log to discuss it with your healthcare provider.

Third, this is a natural transition and you cannot stop it. But you can support your brain and body through this transition by focusing on nutrition, movement (aerobic exercise and strength training), stress management, sleep, and social connection.

Menopause is more than a major transition in reproductive capacity: It’s a change that affects literally every organ, including the brain. Some of the changes and symptoms are common, but the experience isn’t the same for everyone. Every symptom deserves attention, even if it doesn’t look like the stereotypical hot flash.

Menopause is a topic that has only recently gained more attention in research and public discourse, so there’s a lot we don’t yet know. We need more research to understand this transition, which affects ~50% of the world’s population.

P.S.: Are you a history nerd? The HistoryQuizzes.com newsletter sends you daily history quizzes for curious minds. Test your knowledge, learn something new, and join thousands of history lovers. Subscribe for free here.

What else I’ve been up to:

Stress is often framed as negative. Why this isn’t necessarily true, and how you can manage stress beyond the “obvious” measures such as taking time off, is something I cover in my most recent article on Medium:

Not a Medium member? Read this story for free with my friend link.

That’s it for today!

And now?

Until next time!

Best wishes,

Patricia (Dr. Patricia Schmidt) from creatorschmidt.com

P.S.:

Disclaimer:
1) This newsletter is for educational and informational purposes only. It does not constitute medical or mental health advice and is not a substitute for professional healthcare. Always consult a qualified healthcare professional regarding any medical condition, medications, or supplements, and before making any changes to your health routine.
2) This newsletter may contain links to third-party offers and newsletters. The author is not responsible for the content, accuracy, or practices of these external sites but may receive compensation when you sign up for them, at no additional cost to you. This newsletter is free, and sponsorships, ads, and affiliate partnerships help me fund it. Thank you for supporting my writing.