All of these findings are now pulled together in one new analysis of multiple brain-imaging studies, to give the clearest picture yet of what’s happening inside the brain during menopause. And it might just help pave the way for treatments in the future.
Researchers said that with the loss of estrogen, there are actual structural changes in the brain. One of the clearest shifts is in the volume of gray matter in regions such as the frontal and temporal lobes and the hippocampus associated with memory, learning, and decision-making. These declines have been related to declines in different types of memory.
But here’s the kicker: the brain seems to kick back. The review found evidence that gray matter volume may partially recover post-menopause; in other words, the brain seems to adapt to its new hormonal landscape.
Another finding: white-matter hyperintensities-bright spots that show up on brain scans and reflect tiny lesions-are more common at menopause. These lesions are associated with cognitive decline and mood disturbances, and they tend to appear more frequently in women who experience early menopause or severe hot flashes.
During this time, the density of estrogen receptors in the brain seems to be increased as well. This is believed by experts to be the attempt of the brain to compensate for the falling estrogen levels.
While the review concentrated on detailing what happens in the brain, doctors say the drop in estrogen remains the most probable propelling force.
“Our brains are wired with estrogen,” says Dr. Fatima Naqvi, an ob-gyn at Atlantic Health. “When your ovaries produce less estrogen, your brain starts to remodel itself. It’s kind of like, ‘Okay, what’s going where? And how are we going to work with not as much hormonal support?’”
But hormones aren’t the only factor. Dr. Jennifer Wu, an ob-gyn at Northwell Lenox Hill Hospital, says disruption of sleep, stress, and an overall change in life during menopause may make the mental fog worse. “It isn’t just hormones or blood flow. Often, women are not sleeping that well, and it is a very stressful time. It is understandable when concentration is just a little bit harder.”
Though researchers hope the new insights lead to targeted therapies, experts say women don’t have to wait to take action. Naqvi encourages “brain-friendly” habits, adding Omega-3-rich foods like salmon and walnuts to your diet, exercise, and a healthy diet are great, to begin with, and might help prepare the brain for transition.
