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The Role Of Your Brain In Menopause

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Brain Health Expert: Patricia Faust

There are many important influences on our brain function that don’t fall in the category of Covid-19. There is no other comparable transition for women that affects midlife like menopause.

Most of the stories related to menopause have been mainly negative. But this transition can be definitely qualified as an individual experience. Although we tend to think of menopause as the final reproductive life transition, the symptoms of hot flashes, changes in sleep, mood and memory are actually due to changes in the brain.

“Our brains are energy cannibals and metabolize twenty percent of our energy supplies.”

Estrogen And Cellular Energy Production:

We have to understand the part that estrogen plays in this passage. Estrogen receptors are found in the same brain regions that regulate temperature, sex drive, sleep, emotions, attention and memory.

Changes in estrogen signaling (either through changes in estrogen levels or changes in estrogen receptors) will directly affect how these numerous brain circuits function, although the exact mechanisms by which menopause alters brain physiology to generate symptoms isn’t clear. (Dr. Sarah McKay, The Women’s Brain Book).

One working hypothesis focuses on the metabolic link between estrogen and healthy cell function. Our brains are energy cannibals and metabolize twenty percent of our energy supplies. The brain’s main fuel is glucose.

In women, estrogen supports the biochemical pathways that use insulin and generate energy from glucose.  So, the menopausal drop in estrogen might change how efficiently the brain uses glucose and in turn how well neurons function.

Hot Flashes:

This is a defining symptom of the onset of menopause. For some women, this is the only symptom they experience. For others, hot flashes are part of a cocktail of symptoms including insomnia, depression, and brain fog.

Hot flashes may seem like a complete body experience, but all of this action is triggered by the hypothalamus. Much like a neural thermostat, the hypothalamus detects when our core temperature crosses either the upper or lower temperature threshold and signals the body into action.

If you are too hot – you sweat. And, if you are too cold, you will shiver. During menopause, your upper threshold moves down, and your lower threshold moves up. In other words, you become more sensitive to even tiny variations in core temperature.

Estrogen tweaks the thermostat settings. That is why treating women with the estrogen reduces hot flashes. However, the brain is not silent during hot flashes, and in many women, the insular and anterior cingulate cortex activate as they feel their ‘power surge’.

The insular cortex perceives feelings and sensations from our bodies that relate to wellbeing, energy, mood, and temperature. For instance, it processes how we feel about what we are feeling. (Dr. Sarah McKay, The Women’s Brain Book)

“The most common complaint is waking up at night for no apparent reason.”

Disrupted Sleep:

According to Dr. McKay, 40 to 60 percent of menopausal women report problems with sleep. The most common complaint is waking up at night for no apparent reason.

One in three perimenopausal women says sleep problems caused them distress and impact their daytime functioning. Curiously, in women but not men, sleep is partially regulated by sex hormones. So, any of our hormonal transitions – puberty, pregnancy, menopause, and during the menstrual cycle, will have an impact on our sleep.

Menopausal Blues:

If you ever thought that you were the only one suffering from menopausal blues – think again. Women who have had a history of mood disorders should recognize that the years around menopause place them at a higher vulnerability for depression. Feeling sad, anxious, irritable, or suffering mood swings are common symptoms affecting one in five women in midlife. Depression and anxiety are not necessarily going to develop unless you have a longstanding history of mood disorders. Symptoms include emotional flatness, feeling unable to cope, irritability, social isolation, tearfulness, decreased energy, and failure to enjoy normal activities and relationships.

These symptoms come on slowly – perhaps over a decade or more. This is deceiving in that, women don’t believe that this can be treatable. They accept this as part of their lives. There is a difference in treatment too. Instead of treating this with anti-depressants, women of this type of depression generally respond better to hormone therapy.

There is one other piece of good news. Menopausal mood swings are not your new normal. They are treatable, and the blues lift once women shift from perimenopause into late post-menopause.

Brain Fog And Menopause:

Brain fog is a description of symptoms used to describe slow or hazy thinking, difficulty focusing, confusion, lack of concentration, and forgetfulness. The menopausal transition is a time of greater susceptibility to foggy thoughts and memory issues.

Professor John Eden, gynecologist, and reproductive endocrinologist, and director of the Women’s Health and Research Institute of Australia, said trouble in ‘wordfinding’ is a common symptom in menopausal women. In addition, lawyers, in particular, notice the symptom early because of their dependence on verbal gymnastics and sharp recall.

Moreover, memory lapses and inability to concentrate can be attributed to poor-quality sleep and tiredness which become compounded by stress, mood disorders, and the life circumstances women often find themselves experiencing in their forties and fifties.

There is still much that is not known about the origins of the symptoms of menopause. Sonia Davison, an endocrinologist at Jean Hailes for Women’s Health said that “You can’t dissect out hot flashes and sweats from sleep disturbance. Above all, we know sleep is really important for the consolidation of memory. But is brain fog due to disturbed sleep?  We just don’t know.”


Transitioning our reproductive system into menopause is a complicated process. Many of us really suffer from the symptoms of menopause. Our brain is still running the show. Therefore, there has been much research on hormone replacement.

If you start hormone replacement early enough in the perimenopause phase of the transition, you are likely to have a more successful, less angst-filled transition. After that, consult your doctor if you are struggling – there are options to ease the symptoms.

In conclusion, living a brain-healthy lifestyle will ensure that your brain and body are getting the attention they need to keep you in top physical and cognitive shape.

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About the Author:

Patricia Faust is a gerontologist specializing in the issues of brain aging, brain health, brain function and dementia. She has a Masters in Gerontological Studies degree from Miami University in Oxford Ohio. Patricia is certified as a brain health coach and received a certification in Neuroscience and Wellness through Dr. Sarah McKay and the Neuroscience Academy. My Boomer Brain, founded in 2015, is the vehicle that Patricia utilizes to teach, coach and consult about brain aging, brain health and brain function. Her newsletter, My Boomer Brain, has international readers from South Africa, Australia, throughout Europe and Canada. She has also been a frequent guest on Medicare Moment on WMKV and Cincy Lifestyles on WCPO.