For those who still insist on using menopause as a cute punch line to a sexist joke (likely told by someone who has never experienced a night sweat), it’s important to clarify that the menopausal ebb in estrogen doesn’t just leave us fighting hot flashes, but also has us courting more serious issues such as a weakened memory and an increased risk of cognitive decline. The most common “brain symptoms” of menopause are reviewed below. Many, if not all, of these symptoms can be managed and often wholly reversed by following the program outlined in the chapters to come. Post-menopausal women will also greatly benefit from the lifestyle and medical decisions provided, all of them proven to protect and invigorate the mind at any age.

BRAIN FOG AND MEMORY LAPSES

It’s quite common for women over forty to complain of “brain fog,” exhaustion, forgetfulness, or difficulty concentrating. The memory lapses many women notice are real, and they can begin at a relatively young age, only to worsen as our hormone levels drop. Studies have shown that up to 60 percent of women report reduced focus and mental clarity as they go through perimenopause. Menopause-related cognitive changes happen to women in their forties and fifties, if not earlier—women in the prime of life who suddenly have the rug pulled out from under them. For some women, cognitive performance recuperates years into menopause. For many others, it does not, and may actually further deteriorate or even turn into a dementia diagnosis in later years.

HOT FLASHES AND NIGHT SWEATS

As any woman can attest to, there’s nothing really “hot” about hot flashes. Hot flashes, along with their nocturnal counterpart, the night sweat, are a phenomenon called vasodilation—an indicator that your brain is undergoing a global warming crisis. The sweats are indeed a sign of the brain not doing its job correctly, in this case by failing to properly regulate body temperature. During a hot flash, some women experience an unannounced and sudden onslaught of heat so intense that it causes their face and neck to feel flushed and overheated; sometimes this is just as obvious on the outside as it feels inside. Other women go hot and then chilly instead. The hot flash can sometimes cause an irregular heartbeat or palpitations, and even headaches, shivers, and dizziness, which, all things considered, is really no picnic.

A typical hot flash can last anywhere from thirty seconds to ten minutes, although some can last more than an hour. The severity of the hot flash also differs among women. On average, a lucky 3 percent of women skate through menopause without ever breaking a sweat. Another 17 percent have mild, broadly tolerable hot flashes. But the vast majority of women suffer from hot flashes that can be severe and bring a considerable amount of stress to their lives.

Until recently, experts believed these sudden and intense waves of heat were a so-called temporary problem, affecting a woman for no longer than three to five years after her final menstrual period (which by anyone’s standards strains at the definition of “temporary”). Instead, for many women, hot flashes continue many years postmenopause. This is particularly the case for current or former smokers and women who tend to be overweight, but also for those who are stressed, depressed, or anxious—which gives us even more of a reason to attend to all these problems. Seriously, if men had hot flashes, we’d have found a solution a long time ago!

Moreover, while most people persist in thinking of hot flashes as solely a quality-of-life issue, recent studies have called that theory into question too. It turns out that women who experience hot flashes earlier in life tend to have poorer endothelial function, a sign that their arteries are losing their ability to flex and relax, which can increase the risk for future heart disease. Since current diagnostic tests are not always accurate enough to predict heart disease for younger women, hot flashes may actually serve a positive purpose after all, acting as a red flag in helping to identify younger women who could benefit from early checkups. In the name of toasting a glass half full, we’ll consider this a rather uncomfortable version of a silver lining.

DISTURBED SLEEP

On top of losing its grip over our internal temperature, our brain also falters at regulating our sleep-wake cycles, which points to hormonal declines as the trigger for many women’s sleep issues. Insomnia is a prevalent symptom of menopause, frequently associated with night sweats, depression, and cognitive disturbances. Of course, if a woman is not sleeping well, her mood and eventually her mental equilibrium will no doubt be affected, too. Further, sleep is essential in the formation of memories and in cleaning out amyloid deposits that can lead to Alzheimer’s, which makes resting our busy minds crucial for the long run.

LOW MOOD AND DEPRESSION

Hormonal declines affect mood as well, oftentimes leading to depressive symptoms. Happy highs that are prone to turning into teary-eyed lows, or cheerful times followed by a string of crabby days, can challenge even the most even-keeled among us. This is a tricky area, however, since depressive symptoms caused by menopause can be difficult to distinguish from symptoms of depression due to other causes.

Aside from pregnancy-related depression, these include major depression, which probably has a stronger genetic component, and “situational” depression, which occurs after a particularly traumatic event, like a death in the family or losing your job. It’s important to figure out which form of depression one is suffering from, because treatment can be very different depending on the cause. Far too often a woman will go to her doctor to discuss menopause and leave with a prescription for antidepressants. While antidepressants are needed in some cases, other strategies can and should be put in place to specifically deal with hormonal depression and its root causes.

INCREASED STRESS
Menopause can definitely cause stress, and stress can make all the brain symptoms of menopause a lot worse in turn. Stress itself originates in the brain, and our resilience to stress is largely in our hormones’ hands. Let’s back up and take a closer look at that. All sex hormones are produced through a series of sequential steps that start with cholesterol, that special kind of fat your doctor routinely measures in your blood. The body uses cholesterol to make a hormone called pregnenolone, which is also known as the mother of all sex hormones. Pregnenolone is in fact converted into progesterone, and progesterone can then be used to make estrogen or testosterone. This process tends to sing along without skipping a beat . . . as long as you are not stressed out. When you’re under stress, another hormone steals the show. Enter cortisol, the number one stress hormone.

Here’s the story. Your adrenal glands use pregnenolone, too, but to make cortisol. When you’re under acute but temporary stress (e.g., you have an exam coming up soon, or there’s a medical emergency that resolves quickly), your body will reroute some of its pregnenolone to increase cortisol production. Once the stressor is gone, cortisol production slows down and your body resumes its usual estrogen and progesterone production. But when you’re under chronic stress, your cortisol levels skyrocket and remain high for prolonged periods of time. Your body has no choice but to keep making cortisol by stealing pregnenolone away from your sex hormones.

Several things happen to you then: your pregnenolone goes down (making you feel irritable), your progesterone plummets (keeping you awake at night), your estrogen subsides (giving you hot flashes), and your thyroid intervenes to slow down your metabolism (so now you are exhausted too). If you thought you were having problems before, now you’re really in the soup. In the short term, too much stress leaves you drained, unhappy, and perpetually overwhelmed. In the long term, it can also lead to more serious problems like depression, heart disease, and an increased risk of dementia. Nobody wants that. It’s important to always take steps to avoid or reduce stress. Your body and brain will thank you for it later!

LOW SEX DRIVE

As the hormones that have been regulating the reproductive cycle, libido, and mood are ebbing, these lower levels can have a negative effect on women’s sex life as well. Loss of desire is common in the years before and after menopause, peaking anywhere between the ages of thirty-five and sixty-four. Although these changes do not happen to all women, declining female hormones often lead to vaginal dryness, painful intercourse, difficulty becoming aroused, and an overall loss of sexual desire. If that weren’t enough, hot flashes can make a woman feel unsure of herself and less desirable, carrying a huge impact on every aspect of her life, relationships included.

From a biological perspective, the actual loss of sexual desire is once again taking place inside our heads. The euphoric and pleasurable experience of sex stems primarily from the limbic system, that part of the brain that is also responsible for memory, affection, and mood. Therapies designed to support brain health and hormonal production, whether by means of counseling, medications, or lifestyle interventions, are therefore just as helpful to boost libido and stamina.

In the end, for many women, menopause is no joking matter. Over the last several years I have spoken to women in various states of emotional distress due to their menopausal symptoms, hearing the way that they have been treated by their doctors, colleagues, and even their own partners. I hear similar stories every day of every week, and I know that for every woman I work with, there are thousands of others out there having similar experiences. Surely it is time we started demanding solutions! And by solutions I mean evidence-backed recommendations, not some internet blog telling us to buy more supplements.

In parts 2 and 3 of this book, I will share a number of testing procedures that are indispensable to digging out the root causes of menopausal symptoms as well as other medical conditions known to affect our brains—and many recommendations to alleviate, and whenever possible, reverse the symptoms. Before we proceed, I want to draw your attention to a particular question I asked myself when I first started researching menopause.

Why Do We Have to Go Through This at All?

For anyone with ovaries, menopause is a fact of life, one we tend to take for granted. But menopause is a long-standing biological riddle, one that scientists haven’t managed to fully explain. In fact, there are only two species on the entire planet that outlive their fertility: women . . . and whales!

When we look at this within an evolutionary framework, we could ask why we continue to live beyond the time we’re fertile, while females of other species die once they lose the ability to reproduce. It would seem that if females continued to reproduce for the duration of their lifetimes, that would only maximize the passing on of their genes. So why are we built to do otherwise?

New research on whales—killer whales, no less—provides a clue: perhaps menopause is nature’s way of avoiding a mother-daughter reproductive conflict. Killer whale societies are matriarchal, and sons and daughters live out their lifetimes with their mothers rather than their fathers. In addition, mothers stay close by to help raise their grandchildren. In this scenario, it is indeed advantageous for the mothers to lose their fertility, thereby eliminating any reproductive competition with their daughters and daughters-in-law.

This societal pattern in killer whales is similar to that of ancient humans. While living in hunter-gatherer societies, the men went hunting while the women stayed behind to raise the children. It is possible that avoiding reproductive competition might also underpin human menopause. Since women today are living far longer than their female ancestors, the time has come to roll up our sleeves and figure out how we can protect and invigorate our minds, even as our estrogens ebb.

Menopause: A Wake- Up Call

Until fairly recently, menopause was written off as the unnatural outcome of women’s increased life expectancy, the unfortunate upshot of their living well beyond what nature intended. Subsequently, medicine met it with little more than a shrug. In recent years though, research has made tremendous progress in demonstrating that menopause is not only a pivotal aspect of women’s health, deserving of proper attention, but also a wellspring of information destined to inform the future of women’s health care.

When menopausal symptoms are attended to with adequate research and customized care, the host of potential issues that often accompany this hormonal shift can often be avoided. When it comes to a woman’s cognitive health, menopause remains the only factor known to increase Alzheimer’s risk in women and women alone, putting us at a distinct disadvantage based solely on gender. Between the way this hormonal juggernaut can produce symptoms that constrain women’s quality of life for decades, and the fact that it puts us at risk for one of the most devastating diseases known to humankind, it warrants our fullest attention, and pronto.

Instead of keeping the blinders on when faced with the challenges of menopause, perhaps it’s the wake-up call we’ve been waiting for, prompting us to take action. The choices we women make during this transition can have profound effects on our future health. In order to make the right choices, you want to identify your risk factors and predispositions so that you can personalize your plan with what will work best for you.

Reprinted from The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease by arrangement with Avery, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2020, Lisa Mosconi, PhD.

This excerpt was featured in the April 12th edition of The Sunday Paper. The Sunday Paper inspires hearts and minds to rise above the noise. To get The Sunday Paper delivered to your inbox each Sunday morning for free, click here to subscribe.