Menopause symptoms: How to prepare for effects on your brain

By Andrea Kane, CNN

(CNN) — Menopause, which marks the end of a woman’s reproductive life, is something roughly half of the world’s population will go through if they live long enough. But this stage — like so much surrounding women’s health — is poorly understood.

A drop in hormones, primarily estrogen, is the driving force behind menopause’s signature event: the reduction and eventual end of fertility. Yet women experience a long list of other symptoms during perimenopause (the years leading up to menopause) that are not limited to the reproductive organs, such as hot flashes, brain fog, mood swings, exhaustion and sleep disturbances.

But it was only relatively recently that researchers learned that estrogen’s influence can be felt far beyond the uterus and ovaries.

“The fact that estrogen has an impact on the brain was only discovered in 1996,” Lisa Mosconi, an associate professor of neuroscience and the director of the Women’s Brain Initiative at Weill Cornell Medicine in New York City, told CNN Chief Medical Correspondent Dr Sanjay Gupta. “For context, men landed on the moon 30 years prior.”

Mosconi and her team imaged the brains of more than 160 women between the ages of 40 and 65. The women were premenopausal (still getting regular periods), perimenopausal and postmenopausal (after they had stopped getting periods for more than one year).

What she discovered was startling and even revolutionary: women’s brains underwent a remodeling. That’s to say, some areas shrank, others grew, and regions got rewired. (While her paper was published in 2021 in Nature Scientific Reports, Mosconi has kept adding women’s brain scans to her database.)

“Menopause is the third of the three P’s — these three phases that the female brain goes through in life — which are puberty, pregnancy and perimenopause… And those three phases are seen very differently culturally and in society, but from a neurological perspective, from a brain perspective, they have a lot in common,” Mosconi explained, noting that they all involve big changes in the brain, not just the body.

As for the brain changes during menopause, Mosconi said, “there’s this huge neurological system that links your brain with your ovaries that is so important for reproduction, for hosting a baby, for hosting a pregnancy — that then needs to be dismantled once you’re no longer reproductive.”

“And all three phases come with vulnerability — there are a lot of unpleasant symptoms that can arise due to menopause — but also with resilience. And I think the resilience aspect has been completely overlooked in medicine, in science and certainly in culture,” Mosconi said.

She adds that what happens during menopause can have implications for brain health in later years.

Listen to the full Chasing Life podcast episode with Professor Lisa Mosconi and Dr Sanjay Gupta right here:

If you were assigned female at birth, what can you do to weather this major midlife shift in the best way possible? Here are Mosconi’s top five tips:

Say ‘no’ to tobacco

The number one tip Mosconi offered is to avoid cigarette smoking, and even passive smoke, calling it “a very selective ovarian toxin.”

“It literally disrupts the tissues of the ovaries and impairs the process… by which follicles eventually develop into menstruation,” Mosconi said. “And that’s the reason that heavy smokers tend to experience menopause at an earlier age than nonsmokers.”

Smoking can make the symptoms of menopause worse “which is something nobody really wants or needs,” she added. That’s not all. “Active smoking is a huge ‘no’ for both menopause but also for brain health,” she said. “It really increases oxidation and free radical production in the entire body and brain, which accelerates cellular aging. So it makes your age faster at a neurological level, which is definitely not something anybody needs.”

If you are exposed to second-hand smoke, she advises investing in an air purifier. It is really important, she said, “because it can make “a huge difference” in deceasing smoke exposure.

Get moving

Mosconi’s second tip may not surprise anyone, given it has been shown to be so helpful as we age: exercise.

“Physical activity is really supportive of hormonal health and brain health,” she noted.

And when it comes to hormonal and brain health, she said aerobic exercise — including brisk walking — gives you the “biggest bang for your buck.” It’s particularly helpful for alleviating the intensity and number of hot flashes, she said, as well as for addressing brain fog and memory lapses, and improving cognitive function. For better sleep, flexibility, stress reduction and balance, she recommends yoga or Pilates; for improving strength, her go-to is resistance bands or light weights.

Eat right

Again, no surprise here: A plant-based diet full of whole foods is good for everyone.

“A balanced, healthy diet, rich in produce, fruits, vegetables and foods that contain antioxidants,” Mosconi said. “You can never eat enough plants, so eat more plants.”

“There’s a lot of research on diet and brain health and there’s a lot less research on diet and brain health for women — nonetheless, we do have the information. I think that it’s very consistent and it shows that… plant foods really are the name of the game for women’s health for a number of reasons.”

Those reasons include that they contain fiber (which Mosconi said helps regulate estrogen, progesterone and testosterone in the blood) and antioxidants.

“The brain is the one organ that is most easily affected by oxidative stress, which is this kind of almost inflammation, almost a rusting of brain cells … that happens with aging, with metabolic activity,” she said. “It’s really important that our diets are very high in antioxidants that can counteract the aging effect that takes place in the brain, especially for women. Antioxidants are only found in plant-based foods.”

Prioritize sleep

Sleep hygiene is very important for hormonal health as well, Mosconi said. In fact, getting restorative rest is essential to many aspects of brain and body health, from immune function to maintaining a healthy body weight, to consolidating memories.

Talk to a doc about HRT

Hormone replacement therapy (HRT) received a bad rap years ago. But more recent studies have found that at the right time and for the right women, HRT is safe and can alleviate some of the most vexing symptoms of menopause — a stance that is reflected in the 2022 North American Menopause Society position statement.

“Do talk to a health care provider about hormones and find out whether or not you are eligible for hormone replacement therapy and whether or not that might be helpful to you specifically,” Mosconi said.

“Estrogen for women, and testosterone for men, are not just hormones that are involved in reproduction, they’re not only important for fertility, they’re also extremely important for brain health and brain function,” she said. “They keep your brain active. They keep your brain energized, they keep your brain young because they also have an anti-aging effect.”

Mosconi is putting her money where her mouth is. “I’m in my 40s and I’m premenopausal, which means I have a regular cycle. And this is a great time to prepare, so I do a ton of stuff,” she said.

“I have changed my whole routine to prepare for menopause: I have changed my diet, I have changed my exercise… I prioritize sleep hygiene in a very, very specific way… I do stress reduction. I get rid of all sources of environmental toxins in the house as best I can,” she said. “And I’m also tracking hormones and cycles, and preparing mentally … trying to decide whether or not I would take hormones.”

We hope these five recommendations prepare you for taking care of your brain during perimenopause and beyond. Listen to the full episode here. Join us next week on the Chasing Life podcast when we explore what happens to your brain during and after a concussion.

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CNN Audio’s Madeleine Thompson contributed to this report.