The brain serves many important functions. It gives meaning to things that happen in the world surrounding us. Through the five senses of sight, smell, hearing, touch and taste, the brain receives messages; often many at the same time.
The brain also controls thoughts, memory and speech, movements and the function of all the organs within the body. It also determines how people respond to stressful situations by regulating the heart, respiration rates, temperature and the endocrine system.
The brain is thus, an organised structure, divided into many components or cortices, that serve specific and important functions. In order to achieve optimal performance within each cortex of the brain, it requires sufficient hydration, energy and hormone regulation.
THE MENOPAUSE & BRAIN FUNCTION
It is common for women to experience cognitive difficulties, sometimes referred to as “brain fog,” as they go through the menopause transition. Commonly reported symptoms are being forgetful, or having trouble concentrating or thinking clearly.
In one study, approximately 62% of midlife women self-reported an undesirable change in memory. On a personal note, I can't decide whether my memory has declined in performance at this point of my 47 years, but that's largely because I can't remember how it was :-)!
Objective measurements of cognitive function (i.e. using standardized neuropsychological tests) have indeed shown that women’s perceptions are accurate. Perimenopausal women do appear to experience a downward shift in some aspects of cognitive function, demonstrated by poorer performance on neuropsychological tests, compared to premenopausal and postmenopausal women.
SO, WHAT'S GOING ON?
Although all the factors contributing to menopause-associated alterations in cognitive function are not yet fully understood, there are two pathways thought to underlie these changes, independently or in combination.
These are;
1) the direct effects of declining oestrogen; and
2) the symptoms associated with the menopause transition -
i.e. the catch-22 of poor sleep, leading to irritability, poor concentration and anxiety, resulting in impaired cognitive performance, which leads to anxiety, frustration, irritability, insomnia ....and so the cycle continues.
The fluctuation of oestrogen and progesterone levels throughout peri-menopause followed by the eventual decline of oestrogen through the menopausal transition, has been shown to result in an up to 25% drop in the energy and activity of the brain.
The drop will be even greater if you underwent surgical menopause and therefore don’t have ovaries to provide oestrogen and androgen (progesterone and testosterone) precursors.
OESTROGEN AND BRAIN FUNCTION
Let's look at Oestrogen.
Oestrogen is a sex hormone that is crucial for brain function as it helps brain cells, (neurons), use glucose for energy. The health of the ovaries where oestrogen is produced, is linked to the health of the brain, and vice versa. When oestrogen is high, brain cell (neuron) energy is high, and brain function is faster, but when oestrogen levels are low, the brain starts slowing down and ages faster. Studies have even shown that this slowing down process and lack of oestrogen can lead to the formation of Amyloid plaques which are a hallmark of Alzheimer's disease, so it is now considered that menopause can cause metabolic changes in the brain that may increase the risk of Alzheimer’s disease. However, studies are being expanded to further understand the interventions that women in their 40's and 50's should be taking as a preventative measure to protect against the increased risks of Alzheimer's as a result of declining oestrogen.
If you are interested in learning more about the changing metabolism within the brain of pre- to peri- to post-menopausal women, here is a write up of the studies performed by Dr Lisa Mosconi, a world leading neuroscientist, and Dr. Roberta Brinton from the University of Arizona Health Sciences in Tucson. https://news.weill.cornell.edu/news/2017/10/menopause-triggers-metabolic-changes-in-brain-that-may-promote-alzheimers
It has been found that the negative effects of declined oestrogen are stronger in specific areas of the brain, particularly that of the hypothalamus. The hypothalamus is an area of the brain responsible for thermoregulation, and so, it is no surprise that when oestrogen doesn't activate the hypothalamus correctly, the hypothalamus is unable to control body temperature correctly, and we experience a hot flash!
In short, where oestrogen is lacking to bind to the receptors within each area of the brain, the neurons are not activated, and the ability of that area of the brain to function, is impaired.
Throughout the peri-to post-menopause transition period, women are therefore experiencing a temporary “energy crisis” while the brain adjusts to the declining oestrogen and energy, and this requires a recalibration.
Figure 1 below shows the cortices of the brain that rely on oestrogen for efficient function. As you can see, declining oestrogen levels therefore affects brain function in pretty much every task including;
Working memory & task preparation
Learning
Information processing
Temperature regulation, energy, balance and appetite control
Short term memory
Emotion & Motivation
Sleep - serotonin production
Attention, arousal & anxiety
Fig 1. Abbreviations: ER, oestrogen receptor; GPER, G protein-coupled oestrogen receptor.
THERE IS GOOD NEWS….
Do not be disheartened. Although many PERI-menopausal women experience a subtle decline in cognitive performance compared to pre-menopause, studies have shown that performance does bounce back to pre-menopausal levels once they reach post-menopause. According to Dr. Pauline Maki,
"There is still a lot more to learn about cognitive function during the menopause transition, but women can take heart in the findings to date that indicate memory function appears to be most affected – and in only a subtle way – during perimenopause, but then rebounds."
Similarly, Mosconi et al (2021) found similar results.
This study examined women's brains and cognitive health, transitioning from peri- to post menopause and ultimately found that while "many women experience troublesome cognitive symptoms, from forgetfulness, to brain fog, lack of concentration and irritability, the brain has the ability to find a new “normal” after menopause, at least in most women”
If you have 13mins spare, I highly recommend watching this TED Talk by Dr Lisa Mosconi.
“We hope our finding will help overcome the stigma around menopause and encourage all women to take care of their brains during this transition”. Mosconi (2021)
SO, WHAT ARE THE OPTIONS AND CAN WE DO ANYTHING TO SUPPORT OUR BRAINS AND MITIGATE FOR THE EFFECTS OF DECLINING OESTROGEN?
This is a huge question and one that I will address in relation to brain health specifically, but many of the strategies and tips I suggest, will also have a positive effect on all other areas of physical and metal wellbeing, that are affected by oestrogen decline in menopause; including heart health, muscle and bone health, and pelvic health.
TAKING CONTROL
The peri- to post-menopause transition is a time of increased inflammation as it is, so let's not pour petrol on the fire!
It's a time to be well informed & take positive steps, so we are able to look forward to our 3rd age and beyond.
How do we take control when we feel like we are losing grip?
THERE ARE 3 STEPS OF CONSCIOUS CHANGE:
Awareness, Acceptance & Action
1. AWARENESS
Educate yourself.
The BodyLogic Survey 2018 found a correlation between menopausal and postmenopausal women's awareness of what to expect from menopause, and the effect it had on their lives. Being aware and informed of what is happening, can actually reduce the perception of the severity of the symptoms of this natural occurrence.
Be mindful of the need to recalibrate lifestyle and nutrition choices during this time and take ownership and control.
2. ACCEPTANCE
This is a natural process that every woman will go through. Some may experience it younger than others, or as a result of medical intervention, but it will inevitably happen, so let's accept and embrace it; primarily on the basis that it doesn't have to be a negative experience.
The BodyLogic Survey of 2018 also reported that;
(i) women who were prepared to accept and acclimate to their new lives with menopause were more likely to experience a positive emotional response,
(ii) feelings of maturity and femininity were common among women who were educated about symptoms versus those who were not; and
(iii) acceptance of menopause often offered feelings of healthiness and even relief.
3. ACTION
Act on your knowledge - embark on new hobbies, learn a new skill or language or to play a musical instrument, implement strategies that prioritise your wellbeing and reduce stress, get out more in nature, drink more water (and less alcohol), add more joy and pleasure to your life, improve your diet to regulate gut health....the list goes on. These are all lifestyle choices that we can all make to some extent without there being any risk of adverse effects, so really there is no excuse.
There are of course medical interventions that can be taken and these must always be an individual's choice based on informed discussion with a medical practitioner. I have omitted discussion so far about depression and anxiety deliberately. In years past, there has been a trend for the prescription of anti-depressants for women experiencing "depression and anxiety" during menopause, however few scientific studies support the idea that menopause contributes to true clinical depression, severe anxiety, or erratic behaviour.
It is now widely believed that anti-depressants should not be prescribed at this time unless the woman has a history of depression for which anti-depressants had previously been prescribed.
Thankfully, there is now a significant amount of new scientific evidence to support the prescription of Hormone Replacement Therapy which can be life changing if prescribed correctly.
HRT
The safety of HRT has been hotly debated in recent years, and no thanks to the Women's Health Initiative (WHI) Study of 2002, it has been a very controversial subject, with thousands of women immediately stopping taking hormone replacement therapy because they were ill advised that it increased the chances of developing breast cancer.
The negative reports are largely due to a large trial that the WHI reported in 2002 which has since been shown to be flawed. It actually studied women who are older (in their 60s) and they were given types of HRT that are not prescribed nowadays.
Interestingly, the authors of this study apologised in a mainstream medical journal (NEJM) as they admitted that people misinterpreting the results of their study is one of the main reasons that women are unnecessarily worried about taking HRT.
For the majority of women starting taking HRT when they are under the age of 60 years, the benefits of HRT really do outweigh any risks. This means that it is safe to take HRT and taking HRT can provide you with positive effects to your future health, especially your bones and heart.
There are so many different types of HRT available and the dose and type of HRT can be altered to suit your individual health needs. Each type of HRT has different risks and benefits associated with it and as such, speaking with a Women's Health practitioner who specialises in menopause care is vital in order for you to make the decision as to whether or not it will be the right choice FOR YOU.
It is important to understand that every woman's menopause journey is unique and as such, whether or not HRT is appropriate, in what form and when it is taken, is entirely individual. That said, it is not always a possibility for every woman.
For a full and thorough overview of HRT and its associated benefits and risks, I suggest you download the following PDF written by Dr Louise Newson https://www.newsonhealth.co.uk/uploads/2021/07/HRT-the-basics-v21-02.pdf
If you are concerned or feel like you might be experiencing some menopausal symptoms, I also recommend as a first port of call, downloading the Balance App. This has been created by Dr Louise Newson, a leading scientist, researcher and doctor specialising in menopause health care and menopause education of healthcare professionals. It is widely regarded as a helpful tool for women who would like to discuss treatment for menopause with their GP, as the App allows you to track your symptoms over a period of time, providing you with meaningful information that you are able to take with you and show your GP.
Dr Newson's website https://www.newsonhealth.co.uk is also a wealth of information and fact sheets for both health professionals and every woman.
Lifestyle and Nutrition Interventions
A commitment to supportive lifestyle choices can help you detoxify and keep your brain sharp.
1. CUT OUT THE TOXINS
Too much alcohol, processed foods, and sugary treats along with less sleep and less regular exercise can take its toll on how well your brain functions. When our body is exposed to pro-inflammatory foods, alcohol, tobacco, medications, and foreign substances like drugs, heavy metals, chemicals, persistent organic pollutants, and micro-organisms, our natural detoxification systems can be overwhelmed, triggering metabolic deficiencies, immunotoxicity and neuroinflammation.
By clearing your brain of toxins and improving brain function, your body will also feel stronger, more energetic, and more efficient.
2. GET SOME SLEEP
A lack of sleep – for example, 4-5 hours a night instead of 7-8 hours – can have a negative effect on how your brain functions and exacerbates brain fog and memory difficulties.
It can also lower your immunity and increase your risk of developing heart disease and cancer. There is no system in your body or aspect of wellness that gets away unscathed by a lack of sleep.
I know this may seem like a dream - pardon the pun - if you struggle to get to and/or stay asleep, so here are some suggestions for improving your sleep hygiene.
TIPS TO IMPROVE SLEEP HYGIENE
Keep your bedroom cool – it is much easier to get to sleep and stay asleep if you are on the cool side of comfortable rather than warm. A room temperature of around 18°C is recommended as ideal for a good night’s sleep. You may find avoiding hot drinks before bed and having a fan in the room helps with any hot flushes or night sweats.
Regularity is key – a consistent routine is like an anchor to your sleeping patterns. Go to bed at the same time every night and wake up and get up at the same time every morning - yes, even at the weekends if you are serious about establishing better sleep! A consistent routine improves not only the quantity of sleep but the quality too, leading to a real difference in how your body will function and how you feel during the day.
Other things to avoid to improve your sleep are alcohol, caffeine or any drugs, such as marijuana. While alcohol or marijuana may help you get off to sleep, they are sedatives, so they only give you an artificial kind of sleep which does not have the same physiological benefits as ‘natural’ sleep. They also block your dream sleep, or REM sleep, which is essential for emotional and mental health.
3. EAT A MEDITERRANEAN DIET
A great place to start looking for a menopause friendly diet is one that follows Mediterranean diet principles; this is high in vegetables, nuts, beans, cereals, fish (or other sources of omega 3 oils) and unsaturated fats (like olive oil). It is a diet that is low in processed foods, meat and dairy foods, and low in salt and sugar.
Try to avoid white refined carbohydrates such as in white bread, white rice and pizza, as this causes a rapid release of blood glucose - which can exacerbate mood swings. Changing to low GI (glycaemic index) carbohydrates such as wholegrain bread, brown rice, pulses, beans or sweet potatoes and plenty of low GI vegetables such as salad or greens will help maintain blood sugar levels.You might also find smaller meals more regularly helps keep blood sugar levels and mood swings in check.
4. SUPPLEMENT VIT D & CALCIUM
Ensure your diet contains plenty calcium and Vitamin D; this is not only essential for your bone health, but it will help stabilise emotions and mood too.
5. INCREASE THE AMOUNT OF WEEKLY EXERCISE YOU DO AND INCLUDE RESISTANCE TRAINING IN YOUR REGIME
Aim for a combination of weight-bearing exercise with impact, and muscle strengthening exercise.
RESISTANCE TRAINING in particular improves bone health – bones get stronger as you use them and give them work to do. A class such as BST's 40-FY is the perfect low impact resistance training that provides targeted resistance training for the whole body but without impacting joints or risking pelvic health dysfunction.
Weight training and functional body weight exercise also maintains muscle mass – you lose muscle mass as you get older and regular exercise can slow this down, lowering your risk of falls and fractures.
Cardio workouts such as brisk walking, jogging, cycling or swimming for 30 mins at a time, 5 times a week will support heart health. Going through the menopause puts you at greater risk of diseases of the heart and blood vessels if you do not take HRT. Regular exercise helps to maintain healthy cholesterol and reduce the risk of high blood pressure and heart disease.
Exercise also helps your mood by stimulating the release of endorphins in to your blood stream. Regular exercise can really help if you’re feeling low; it can lift your mood, help you de-stress and give you more energy and motivation.
Finally, and crucially, exercise helps you stay a healthy weight. Falling levels of oestrogen can lead to greater fat distribution around your middle (which in turn raises risks of heart disease, diabetes and cancer). Some menopausal women find their weight creeps up; perhaps because they’re doing less exercise due to their achy joints, or maybe from drinking more alcohol to help unwind or get off to sleep...or maybe both!
A FINAL THOUGHT...
Common social discourse in Western culture, associated with the menopause, also coined "the change" has historically had negative connotations. Yet, if you enter the word "change" in to a synonym finder, there is no end of positive and life affirming words offered, such as;
adjustment, shift, progression, evolution, breakthrough, boost, amelioration, growth, development, maturity, prime, wisdom and finally, my favourites;
verdure, freshness and greenery!!!
So, while change can be challenging at times, we are an incredibly adaptable species and if we allow it, it can also be the catalyst for new beginnings and an evolution in to the ameliorated prime of our lives!
If you don't believe me, take it from him....
Helpful Resources
If you would like to learn more about menopause symptoms and ways in which you can support yourself, please do take some time to visit Dr Louise Newson's website where you will find scientifically factual and unbiased help and support https://www.newsonhealth.co.uk/resources/#factsheets
Call Katie today on 07775 852791 or email me at katielbreeze@hotmail.co.uk
For more details on all the services offered by BST visit https://www.breezesportstherapy.com/
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