Your Mind on Menopause
Perimenopause is a transition in a woman’s life that can bring hormonal fluctuations impacting both cognitive function and mood. While these changes can be distressing, they are often temporary and not necessarily indicative of future cognitive decline. Understanding these shifts can empower women to manage this phase proactively.
Cognitive Changes: What’s Happening in the Brain?
Many women experience brain fog, forgetfulness, and difficulty processing new information during perimenopause. Research suggests up to 60% of women experience some form of cognitive impairment during this period, yet most pass standardized cognitive tests despite feeling mentally foggy.
Hormones and the Brain
Estrogen supports brain energy metabolism, and its decline can lead to decreased energy production in areas responsible for thinking, learning, and memory.
Estrogen crosses the blood-brain barrier and is made in the brain from cholesterol.
Reduced estrogen levels may contribute to brain changes of grey and white matter loss and potential amyloid deposition, which is linked to Alzheimer’s disease.
Women with genetic Apolipoprotein E (APO E) risk factors for Alzheimer’s may be particularly vulnerable to cognitive decline during perimenopause.
Is This a Sign of Dementia?
Cognitive impairment in perimenopause is typically an "absence of learning" rather than a permanent decline.
Most women regain cognitive function post-menopause as the brain adapts to new hormonal levels.
Early menopause (before 45 years) or surgical menopause is linked to a higher dementia risk, where hormone therapy (MHT) may offer benefits and some risk protection.
Factors like ADHD, burnout, nutritional deficiencies, metabolic issues, and major life transitions may also contribute to cognitive symptoms.
Nutrition for Cognitive Health
The MIND diet, a blend of the Mediterranean and DASH diets, has been shown to slow cognitive decline and improve brain health. Key nutritional recommendations include:
Omega-3 Fatty Acids: Particularly beneficial for individuals with deficiencies.
Flavonoids and polyphenols: Found in berries, cocoa, and matcha tea, they reduce mental fatigue and improve cognitive performance.
Phytoestrogens (Soy): Daily intake may improve cognition when consumed within 10 years post-menopause.
Balanced Nutrition: Avoid extreme caloric restriction, which can negatively impact brain function.
Reduce alcohol intake: Limiting alcohol consumption is generally recommended for better brain health during perimenopause.
Creatine Supplementation: Some evidence suggests taking may support cognitive health.
Lifestyle Strategies for Cognitive Health
Exercise: Engage in moderate-intensity exercise for at least 150 minutes per week. This has been show to have positive effects on the brain.
Cardiovascular Health: Managing hypertension, hyperlipidemia, and diabetes is crucial for brain health.
Sleep Quality: Managing vasomotor symptoms and establishing good sleep hygiene can improve cognitive function.
Stress Management: Incorporate mindfulness techniques like yoga or journaling to reduce stress and improve focus.
Mood Changes and Mental Health
Hormonal fluctuations in perimenopause can significantly impact mood. Women in perimenopause are three times more likely to experience a major depressive event than those in their reproductive years. This risk is even higher for those with a history of depression.
Why Does Mood Change?
Bigger fluctuations in our hormones LH, FSH, and estrogen can contribute to mood instability.
Estradiol influences serotonin, meaning hormonal shifts can trigger mood symptoms.
Women with a history of PMDD or postpartum depression may be especially vulnerable to mood changes in perimenopause.
Increased life stressors during this period (e.g., caregiving, career pressures, empty nest) create a "window of vulnerability."
Evaluating Mood and Mental Health
Screening tools like PHQ-9 and GAD-7 can help assess depression and anxiety.
Conditions like cardiovascular disease, diabetes, and thyroid dysfunction should be considered when evaluating mood symptoms.
Treatment Approaches
Nutritional Support: Omega-3 fish oil, SAMe, saffron, and other nutrients have demonstrated mood benefits.
Lifestyle Interventions: Exercise, mindfulness-based stress reduction (MBSR), CBT, and light therapy are effective adjuncts.
Pharmaceutical interventions (MHT and SSRIs): Recommendations by prescribing primary care providers can be considered based on the benefits and risks of each individual.
Final Thoughts
Cognitive and mood changes during perimenopause are common but not always permanent. With the right strategies, including nutrition, exercise, and emotional support, women can navigate this transition with greater resilience and well-being.
Want to learn more from Dr. Jules Passy? You can watch her Bio Video here and book online with her here.
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