Menopause and The Brain
Posted in: Articles

Key points summary:

  • Brain fog is one of the common symptoms experienced by women during menopause
  • Changes in sex hormones, namely oestrogen and progesterone, play a critical role in brain health, affecting mood, cognitive performance and sleep
  • Natural ageing can lead to a decline in melatonin production, leading to circadian shifts and sleep disturbances
  • Since oestrogen plays a role in body temperature regulation, hot flushes can be a common symptom affecting sleep quality
  • It is essential to look beyond hormonal changes and address the symptoms holistically, considering diet, nutrient deficiencies, lifestyle, gut health, liver detoxification and more.  

Do you experience early menopause symptoms such as memory problems, difficulty concentrating and mood changes? Or perhaps you suffer from insomnia? Menopause, although a natural stage of life indicating the end of a woman’s reproductive years, very often comes with many symptoms due to a decline in oestrogen and progesterone.

This hormonal shift is not only linked to physical symptoms but can also have a noticeable effect on mental health and the brain, commonly known as “menopause brain fog”. Sleep during menopause can be compromised, leading to fatigue and cognitive decline. Many women experience anxiety or depression during menopause. While these cognitive symptoms can be distressing, there is a lot we can do to support our body naturally and improve menopause fog symptoms and quality of life. Read our blog to understand how hormonal changes can impact brain health and how to support your mental health through nutrition and lifestyle changes.

Hormonal changes and brain health – understanding the connection

Sex hormones can affect central nervous system (CNS) pathways and play a critical role in brain health. Both oestrogen and progesterone receptors are expressed in brain cells in areas involved in cognition and emotions.

 

Oestrogen plays a significant role in neuroprotection, helping protect neurons from damage and reducing oxidative stress.1 It promotes neuroplasticity, affecting learning and memory by forming new neuronal connections in the hippocampus, the brain’s memory centre. Oestrogen influences the functioning of the hippocampus, affecting attention, focus and how we store and retrieve memories.2 It’s essential for neurotransmitter regulation, influencing the release of crucial neurotransmitters such as serotonin, dopamine and acetylcholine.3 These chemicals are vital for mood regulation, memory and motivation. 

 

Progesterone's neuroprotective function helps reduce inflammation in the brain and, thus, protects neurons from injury. This hormone is essential for myelin formation, a protective sheath around neurons, allowing efficient communication between brain cells and ipso facto impacting cognitive function.4 It affects working memory, therefore multitasking and planning, as well as emotional memory related to how well we control emotions. Progesterone is vital for mood regulation and interacts with the GABA neurotransmitter system,5 which has a calming effect on the brain. 

 

During menopause, oestrogen decreases, increasing the risk of neurodegenerative diseases, cognitive decline and mood disorders. Many women report changes in mood, difficulty concentrating, memory lapses, symptoms commonly referred to as menopause brain fog. Since lower oestrogen can affect serotonin and dopamine activity, menopause and depression very often come in pairs. The drop in progesterone during menopause might be associated with increased vulnerability to stress, impact on memory, learning, and concentration and increased susceptibility to anxiety, irritability and sleep disturbances. 

Menopause and sleep – when counting sheep, doesn’t work anymore. 

Due to progesterone playing a vital role in sleep regulation, a good night’s sleep during menopause can become an elusive dream. In fact, statistics show that sleep disorders are one of the main struggles in menopause. According to the SWAN study, the prevalence of sleep disorders can range from 39% to 47% in perimenopausal women and from 35% to 60% in postmenopausal women.6 Symptoms might include difficulty falling asleep, frequent awakening or early morning awakening. Does this sound familiar to you? Although the aetiology of sleep disturbances is not yet clear, some potential triggers include certain medical conditions, including cardiovascular or endocrine issues, anxiety, depression, psychosocial factors and menopause itself.6 But why can menopause have a detrimental effect on sleep? The relationship between sleep issues and menopause is more complex than just the decline in hormones.

  • Regulation of body temperature – oestrogen plays a role in keeping central body temperature low during the night by interacting with the hypothalamus.7 Thus, the decline in this hormone can lead to hot flushes, sudden feelings of warmth and excessive sweating. Hot flushes can also be linked with fluctuations of blood vessels caused by a decline in oestrogen, leading to a rapid increase in skin temperature followed by a cooling period afterwards.6
  • Lower melatonin production – melatonin is a hormone produced by the pineal gland which promotes sleep. Its production decreases naturally with age.8 The pineal gland becomes less efficient, leading to reduced secretion of this hormone. Melatonin is vital for maintaining the body’s natural circadian rhythm; therefore, reduced production can lead to earlier sleep, wake times, and poor sleep quality.
  • The link between mood disorders and sleep – mood disorders such as anxiety and depression are connected to sleep disturbances. Difficulty in falling asleep can lead to anxiety and vice versa. In addition, studies showed that women experiencing hot flushes are more likely to develop depression.6

The “hidden” drivers of menopause symptoms – looking beyond the hormones 

Beyond the commonly discussed hormonal changes, other factors contribute to menopausal symptoms. In the end, menopause is not a disease; it’s a stage of life. To manage the inevitable changes, we need to look at our health holistically, addressing other areas, such as gut health, blood sugar balance, liver function, thyroid health, lifestyle factors, and nutrient status

  • Gut health – did you know gut health plays a crucial role in oestrogen metabolism? Have you wondered why you are experiencing bloating during menopause? Specific gut bacteria can help to regulate oestrogen levels by breaking it down and excreting it from the body. Dysbiosis can impair oestrogen regulation, leading to a reduction of circulating oestrogens. This alteration can contribute to a wide range of conditions and symptoms.9
  • Blood sugar regulation – our brain relies on a stable supply of glucose to function properly and uses insulin to regulate cognitive processes such as learning and memory. Sudden spikes or drops in blood sugar can lead to brain fog, fatigue or irritability, all of which are common symptoms experienced by menopausal women. Moreover, blood sugar imbalance can lead to insulin resistance, which affects cognitive function.10
  • Liver health and glucuronidation – the liver plays a crucial role in body detoxification processes, detoxifying toxins and waste products. The buildup of toxins due to a sluggish liver can cross the blood-brain barrier, leading to neuroinflammation11 and worsening certain symptoms such as brain fog or memory. The detoxification process of glucuronidation is essential for oestrogen clearance.12 When this pathway is not working properly, oestrogen is reabsorbed, potentially leading to disturbed oestrogen metabolism, affecting mood and mental clarity.
  • Chronic stress – when we are chronically stressed, the production of the stress hormone cortisol increases. Excess cortisol production can impact memory, learning, brain fog and concentration due to impaired neurogenesis (formation of new brain cells).13
  • Thyroid Function—The thyroid gland plays a vital role not only in regulating metabolism but also in supporting brain function. Hypothyroidism may be associated with brain fog, fatigue, depression, and loss of cognitive function.14
  • Nutrient deficiencies – Various nutrient deficiencies, such as omega 3 fatty acids, magnesium, or vitamin D, can affect the nervous system, neurotransmitter function, inflammation, synaptic plasticity and overall brain health, leading to symptoms such as anxiety, depression, cognitive impairment, low mood and poor memory.15–17
  • Lack of exercise – physical activity is crucial for brain plasticity, the brain's ability to form new connections. During menopause, the decline in oestrogen can impair brain plasticity. Still, regular exercise helps counteract this effect by promoting the release of BDNF18 (brain-derived neurotrophic factor), a protein that supports the growth and maintenance of neurons. Lower levels of BDNF have been linked with cognitive decline, memory loss and increased risk of developing neurogenerative diseases such as Alzheimer’s disease.19 Lack of exercise reduced BDNF production can lead to cognitive issues during menopause.20 Exercise is neuroprotective and increases blood flow, oxygen and essential nutrients to the brain, protecting neurons and reducing the risk of neurodegeneration. Physical activity affects the production of neurotransmitters such as serotonin and dopamine,21 compensating for oestrogen drop, improving mood and mental health. Moreover, exercise improves insulin sensitivity,22 regulating blood sugar levels, improving brain fog and memory. Physical activity decreases inflammation23 and has a positive effect on sleep, improving duration and quality of sleep.24

 Supporting brain health during menopause

Many factors, including hormonal changes, diet, lifestyle and other physiological triggers, can impact brain health during menopause. However, you can take many actionable steps to support your cognitive function and overall wellbeing. Below are key dietary, lifestyle and nutrient interventions to make this transition easier. We also included links to relevant blogs for further reading and more detailed information on specific interventions:

  • Focus on nutrients – dense diet – foods rich in antioxidants, healthy fats and anti-inflammatory foods such as omega 3 fatty acids found in oily fish such as salmon, mackerel, sardines, and anchovies are essential for maintaining brain cell structure and reducing inflammation. Colourful fruits and vegetables such as berries, green leafy & cruciferous vegetables are rich in antioxidants that protect the brain from oxidative damage. Healthy fats such as avocados, olive oil, nuts, and seeds can support neurotransmitter function. Fiber and prebiotic-rich foods support gut health, promoting brain health via the gut-brain axis. Prebiotic foods include garlic, onions, and fermented foods such as sauerkraut or kimchi. 
  • Avoid processed foods and refined sugars, which can cause blood sugar spikes and insulin resistance. Opt for whole, unprocessed foods, which are important for brain health and keeping blood sugar levels stable. 
  • Engage in regular physical activity, especially strength training to stimulate the release of BDNF, support neuron growth and brain plasticity. Studies showed that resistance training can improve strength, bone density, and menopausal symptoms, including hot flushes.25
  • Keep good sleep hygiene – sleep is crucial for mental health and cognitive function. Read more on how to support your sleep naturally in our blog, Your Guide to a better night's Sleep.
  • Manage your stress to improve focus, sleep and cognitive function. Read our blog, ‘Top lifestyle and diet tips to de-stress’, to learn how you can improve your stress levels.
  • Add brain-supporting nutrients such as magnesium, vitamin D, and B vitamins essential for neurotransmitter production and mood regulation. Adaptogens such as Rhodiola and Holy Basil can help regulate stress, supporting mood and cognitive health.26,27 Red clover and sage have been researched for their beneficial effect on hot flushes, night sweats, mood, cognitive function, and sleep.28–31 Moreover, red clover is rich in phytoestrogens, which mimic oestrogen in the body, helping to manage menopausal symptoms.29 A number of nutrients are important to support specific detoxification pathways, namely folate and vitamin B12 for methylation, and Calcium-D-glucarate for glucuronidation. Menopausal women are often deficient in folate, B12,32 as well as zinc and copper.33 For more menopause tips, read our blog “Menopause – Your Questions Answered. 

Brain health is profoundly affected by multiple factors going beyond hormonal changes. Hence, supporting its function during menopause requires a holistic approach that addresses multiple aspects of health, including gut health, liver detoxification, blood sugar management, stress reduction, sleep hygiene, and targeted supplementation. With the right dietary and lifestyle changes, such as incorporating exercise, it is possible to improve cognitive function, maintain mental clarity, and support brain health during this transitional phase of life. If you would like to read more about menopause tips, download our Menopause Guide!

 

 

 

 

 References

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2.           Hara Y, Waters EM, McEwen BS, Morrison JH. Estrogen Effects on Cognitive and Synaptic Health Over the Lifecourse. Physiol Rev. 2015;95(3):785. doi:10.1152/PHYSREV.00036.2014

3.           Krolick KN, Zhu Q, Shi H. Effects of Estrogens on Central Nervous System Neurotransmission: Implications for Sex Differences in Mental Disorders. Prog Mol Biol Transl Sci. 2018;160:105. doi:10.1016/BS.PMBTS.2018.07.008

4.           Guennoun R. Progesterone in the Brain: Hormone, Neurosteroid and Neuroprotectant. Int J Mol Sci. 2020;21(15):1-21. doi:10.3390/IJMS21155271

5.           Kapur J, Joshi S. Progesterone Modulates Neuronal Excitability Bidirectionally. Neurosci Lett. 2021;744:135619. doi:10.1016/J.NEULET.2020.135619

6.           Lee J, Han Y, Cho HH, Kim M-R. Sleep Disorders and Menopause. J Menopausal Med. 2019;25(2):83. doi:10.6118/JMM.19192

7.           Charkoudian N, Stachenfeld N. Sex hormone effects on autonomic mechanisms of thermoregulation in humans. Auton Neurosci. 2016;196:75-80. doi:10.1016/j.autneu.2015.11.004

8.           Sack RL, Lewy AJ, Erb DL, Vollmer WM, Singer CM. Human Melatonin Production Decreases With Age. J Pineal Res. 1986;3(4):379-388. doi:10.1111/J.1600-079X.1986.TB00760.X

9.           Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas. 2017;103:45-53. doi:10.1016/J.MATURITAS.2017.06.025/ASSET/83920B41-F22B-46DD-BA9C-71930F683C5B/MAIN.ASSETS/GR2.JPG

10.         Gillespie KM, White MJ, Kemps E, Moore H, Dymond A, Bartlett SE. The Impact of Free and Added Sugars on Cognitive Function: A Systematic Review and Meta-Analysis. Nutrients. 2024;16(1). doi:10.3390/NU16010075/S1

11.         Butterworth RF. The liver–brain axis in liver failure: neuroinflammation and encephalopathy. Nature Reviews Gastroenterology & Hepatology 2013 10:9. 2013;10(9):522-528. doi:10.1038/nrgastro.2013.99

12.         Thomas MP, Potter BVL. The structural biology of oestrogen metabolism. J Steroid Biochem Mol Biol. 2013;137:27. doi:10.1016/J.JSBMB.2012.12.014

13.         Schoenfeld TJ, Gould E. Stress, Stress Hormones, and Adult Neurogenesis. Exp Neurol. 2012;233(1):12. doi:10.1016/J.EXPNEUROL.2011.01.008

14.         Bernal J. Thyroid Hormones in Brain Development and Function. Endotext. Published online January 14, 2022. Accessed September 13, 2024. https://www.ncbi.nlm.nih.gov/books/NBK285549/

15.         Mori TA, Beilin LJ. Omega-3 fatty acids and inflammation. Curr Atheroscler Rep. 2004;6(6):461-467. doi:10.1007/S11883-004-0087-5

16.         Derom ML, Sayón-Orea C, Martínez-Ortega JM, Martínez-González MA. Magnesium and depression: a systematic review. http://dx.doi.org/101179/1476830512Y0000000044. 2013;16(5):191-206. doi:10.1179/1476830512Y.0000000044

17.         Harms LR, Burne THJ, Eyles DW, McGrath JJ. Vitamin D and the brain. Best Pract Res Clin Endocrinol Metab. 2011;25(4):657-669. doi:10.1016/J.BEEM.2011.05.009

18.         Sleiman SF, Henry J, Al-Haddad R, et al. Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the action of the ketone body β-hydroxybutyrate. Elife. 2016;5(JUN2016). doi:10.7554/ELIFE.15092

19.         Nikolac Perkovic M, Borovecki F, Filipcic I, et al. Relationship between Brain-Derived Neurotrophic Factor and Cognitive Decline in Patients with Mild Cognitive Impairment and Dementia. Biomolecules. 2023;13(3):570. doi:10.3390/BIOM13030570/S1

20.         Keawtep P, Wichayanrat W, Boripuntakul S, Chattipakorn SC, Sungkarat S. Cognitive Benefits of Physical Exercise, Physical–Cognitive Training, and Technology-Based Intervention in Obese Individuals with and without Postmenopausal Condition: A Narrative Review. Int J Environ Res Public Health. 2022;19(20):13364. doi:10.3390/IJERPH192013364

21.         Young SN. How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci. 2007;32(6):394. Accessed September 13, 2024. /pmc/articles/PMC2077351/

22.         Lin Y, Fan R, Hao Z, et al. The Association Between Physical Activity and Insulin Level Under Different Levels of Lipid Indices and Serum Uric Acid. Front Physiol. 2022;13:809669. doi:10.3389/FPHYS.2022.809669/BIBTEX

23.         Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature Reviews Immunology 2011 11:9. 2011;11(9):607-615. doi:10.1038/nri3041

24.         Alnawwar MA, Alraddadi MI, Algethmi RA, Salem GA, Salem MA, Alharbi AA. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. 2023;15(8). doi:10.7759/CUREUS.43595

25.         Capel-Alcaraz AM, García-López H, Castro-Sánchez AM, Fernández-Sánchez M, Lara-Palomo IC. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. Journal of Clinical Medicine 2023, Vol 12, Page 548. 2023;12(2):548. doi:10.3390/JCM12020548

26.         Cropley M, Banks AP, Boyle J. The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms. Phytotherapy Research. 2015;29(12):1934-1939. doi:10.1002/ptr.5486

27.         Bhattacharyya D, Sur TK, Jana U, Debnath PK. Controlled programmed trial of ocimum sanctum leaf on generalized anxiety disorders.

28.         Van De Weijer PHM, Barentsen R. Isoflavones from red clover (Promensil®) significantly reduce menopausal hot flush symptoms compared with placebo. Maturitas. 2002;42(3):187-193. doi:10.1016/S0378-5122(02)00080-4

29.         Hidalgo LA, Chedraui PA, Morocho N, Ross S, San Miguel G. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21(5):257-264. doi:10.1080/09513590500361192

30.         Kennedy DO, Pace S, Haskell C, Okello EJ, Milne A, Scholey AB. Effects of cholinesterase inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery. Neuropsychopharmacology. 2006;31(4):845-852. doi:10.1038/SJ.NPP.1300907

31.         Yuki Ikeda Sr, Nasu M. A Randomized, Double-Blind, Placebo-Controlled Evaluation of the Safety and Efficacy of Wild Sage Metabolites in Preventing Snoring, Improving Sleep, and Activating Alpha Wave Brain Frequencies in Healthy Adults. Cureus. 2022;14(2). doi:10.7759/CUREUS.22714

32.         Milart Pawełand Woźniakowska E, Wrona W. Selected vitamins and quality of life in menopausal women. Przeglad Menopauzalny. 2018;17(4):175-179. doi:10.5114/pm.2018.81742

33.         Cobalt, copper, selenium and zinc levels in pre menopausal and post menopausal women in Nnewi South - East, Nigeria. | Request PDF. Accessed September 13, 2024. https://www.researchgate.net/publication/302937568_Cobalt_copper_selenium_and_zinc_levels_in_pre_menopausal_and_post_menopausal_women_in_Nnewi_South_-_East_Nigeria


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