This is such a vast topic and yet one that until very recently wasn't thought of as a major part of the menopausal change and less likely to be spoken about. For me I feel it is the one area that had the most vast impact on my changing body.More so than physical symptoms; for the main reason that it started to happen before there were any physical changes. I didn't know or even think about what was going on only that it was happening and that on top of the other stressors in my life it was just, well.... life. When I heard that it could be menopause and I started researching and then supplementing things really started to change. Now 8 years later (and still in Peri!) I can reflect and collate information and examples from my experiences and that of my clients and now with the new book by neuroscientist Dr Lisa Mosconi - The Menopause Brain to help make some more sense of it all. I found it positive and open-minded on all aspects of dealing with your changing mind through the decade or more that is menopause. I felt that Dr Mosconi was tightly edited in the Davina programme to support the dementia/oestrogen/HRT link but her book is a well-rounded exploration (with vast research and experience) into how the menopause changes our brain years before the ovaries tell us we're in menopause. The bottom line is that this is a brain-upgrade with a bumpy ride along the way so, this months blog looks into how does the menopause change my brain?!
Please note that this book only investigates the effects of oestrogen and not progesterone. In chinese medicine the perimenopause and symptoms tie in tightly with the decline of progesterone and so even though this book is enlightening it is only part of the picture I feel.
How does the menopause change my brain?!
There is the science of how declining oestrogen alters the pathways in your brain and causes a host of symptoms and feelings (read the book for this detail). This can culminate in you feeling like you're going mad, losing your mind or even, in the worst of case scenarios feeling suicidal. Some of the latest statistics include:
75% of women in menopause experience brain-associated symptoms (a lot higher than previously suggested)
60% of women from peri to post menopause struggle with brain fog - this can be resolved!
Women spend 40% of their lives in the menopause transition - WHAT?!!!!
With this somewhat alarming newly-released data from recent studies we really should be taking the effect of what's happening to our brains more seriously. The good news is that the outcome is very favourable and that losing your keys (perimenopause) is in no way related to now knowing what keys are for (dementia). The current problem is that in western medicine there is no one who is specialising in the brain - menopause - uterus link. If you see an Obgyn they are only interested in the anatomy down there and a psychiastrist doesn't know the medical/menopausal links with brain changes yet, as this is really new science.
Holistic therapists do know though! We may not be able to tell you the science behind it but we know very well the emotional and physical links, symptoms and issues and have a compassion and curiosity to help you resolve how you feel and find your feet again.
Brain fog is the umbrella term used for all brain-related symptoms and here are some examples of how it may manifest:
Short term memory issues - from losing the keys to forgetting appointments. I used to have my diary in my head now I have an electronic one that tells me what's going on! And the irony of today is that whilst I was searching this I forgot to take my dog to the groomers -grrrrrrr!!
Difficulty concentrating - this can be an inability to focus or you find the duration is now shorter; definitely the latter for me.
Feeling mentally slower - easily fatigued, overwhelmed or slower to think and process. Where did my mental arithmetic go? Also doubting yourself and so double checking continously.
Reduced multitasking - men have never been able to do this! But now you're finding you're losing track and forgetting where previously you wouldn't.
Loss of words! Big time - Losing your train of thought? The thingy with the widget? You know what I mean. Embarrassing through to being seen as incompetent if you're in the boardroom. This is probably one of the worst symptoms as it can strike visibily at work and undermine your confidence.
You can see why these insidious traits can undermine your confidence in your own abilities and lead to anxiety; causing more stress. The catch 22 being that more stress can then exacerbate these symptoms. What should be pointed out here (which the book hasn't investigated) is that the stress hormone uses the same chemistry in your body as progesterone. Your body will choose survival first and so will create cortisol from the adrenals before making progesterone (the calming hormone - when the ovaries are making less progesterone). This causes you to fall into a stress cycle: suppressing progesterone further and enabling you to become further stressed. Stress has a major impact on how your brain functions.
Science is now showing that the oestrogen decline happens in the brain 10 or so years before it reaches your ovaries. They're all connected by your endocrine system (this the series of organs that link together to create and maintain the balance of your hormones). Ovaries are at the end of the track but the glands in your brain like the pituitary are at the start. Then as this travels down the system it hits the pancreas where insulin is produced. As the oestrogen dwindles insulin resistance manifests. Then on to the kidneys where adrenalin and cortisol are produced. These go out of kilter with stress and over-exercise, triggering too much to be released too easily. The final stop is the ovaries and the cessation of periods.
Looking at how the oestrogen decline manifests in the body in this light may explain why so many symptoms happen years BEFORE your periods stop. The culmination of hormonal imbalance and the health issues that it exacerbates reach a climax with hot flushes around the time your oestrogen is reaching empty. The way you feel and the way your brain is reacting IS the start of it all aka perimenopause and this new research now sheds light on this and is tangible insight, validating what we've all been feeling; that something is seriously changing within. Our brains don't get tested for perimenopause or oestrogen/progesterone-decline related symptoms but maybe there is a future where it will.
Menopause brain, oestrogen and the knock-on effects
Now you know you're not imagining it; your brain is literally changing at a time of life when you're peaking in your career plus, you may have young ones at home and your parents are needing more help too. On top of your brain and body changing life is also becoming tougher logistically. On top of all this your body's organs are starting to say: enough is enough, I need some help; but you don't know to listen!
This is where I stepped into all things physically-menopause related. Using my Chinese medicine I took the bundle of symptoms from night sweats to fatigue and tracked back to the underlying imbalances in your bodily functions. Chinese medicine is a model of how your body works and is a powerful too for assessing and resolving health issues and has proven fantastic in resolving menopause symptoms. The oestrogen change that I tracked above (from The Menopause Brain by Dr Lisa Mosconi) has the effect of putting any health imbalances you have firmly under the microscope. Your body which had been dealing with things just enough, now can't when oestrogen starts to alter your intricate hormonal balancing act.
Symptoms that have been triggered by a change in oestrogen are actually caused by your vital organs not doing so well in any case. In clearing up these health imbalances you'll be doing your body a massive favour for longterm health and having a positive impact on your mental wellbeing too.
How can I help relieve my brain symptoms in menopause?
Starting with this fact: 90% of your brain chemistry starts in your gut tells you that if you take control over what's happening in your gut you can improve how you feel and your brain cognitive processing. Loss of oestrogen is one contributing factor to all of the brain-fog associated symptoms but nutrition and lack of are the other important aspect. When I worked on this I started to feel emotionally more resilient and yes the memory improved (today is an exception and I blame the bank holiday!).
One major brain symptom which you may not associate is sleep interuption. Without a good nights sleep you're not going to get on top of how your brain is functioning and how robust you are emotionally. The brain needs sleep to perform many functions during the night and one of these is to flush out toxins; and this isn't a quick job. The glymphatic system needs around 7 to 8 hours to fully detox and to do this the brain has to shrink slightly and be well hydrated. One of the issues with the loss of oestrogen is that our capacity to retain fluids is reduced so hydration before bedtime is as important as the sleep itself. If you have brain symptoms and you aren't sleeping well work on your sleepabove all else. This blog is a great starting point as it breaks down your sleep into the hours and associated symptom/organ relationship which is the key to resolving the physical causes of why you can't sleep continuously through.
Sleep is the starting point but you may be like me and sleep well but still have the symptoms I've mentioned today. That's when you turn to your gut and the lack of nutrition; you have to support the decrease of stress levels in your body. You may eat well, that's a good start but if you have symptoms then you have stress and to combat stress you need more nutrients than you can probably eat.
If 90% of your brain chemistry starts in your gut how can you help your gut produce the right chemicals?
Taking on board more of the right nutrition AND ensuring your gut is in it's best state - this is the health of your microbiome. The microbiome is the bacterial environment in your gut and very few people have a really good one; if you have regular bugs and allergies you haven't got a good gut. The gut bacteria is easily killed off by stress, processed foods, sugar, alcohol and antibiotics. The gut loves greenery! Your liver loves the greens as well, anything that tastes bitter is good for you from Asparagus to Rocket. The healthy bacteria in your gut are like bunny rabbits - they thrive only when being fed greens so always feed your gut bunnies first and you can't go wrong! If your gut is below par (as mine was) this throws up a lot of symptoms from IBS and allergies to body odour as well as fatigue, brain fog and anxiety. To turn these symptoms around you need a good Probiotic (this repopulates the gut with a variety of bacteria and was a total game changer for me; life long hayfever just went!). A supermarket probiotic is not a good one.
Prebiotics are the food you eat like greens, wholegrains, fruit and fermented foods from Kimchi to Kombucha (which I love!). If you have a high level of stress in your life you won't get enough nutrients from your food to combat your high cortisol levels which in turn cause symptoms like brain fog and aching joints. You'll either need to manage your stress levels so affectively that you'll become very zen (and if you start Yoga or Qi Gong this may help) or you'll have to add in good plant-based supplements to up nutrient levels. For the longterm you do need to address your relationship with stress in your life, and that starts with connecting with your body and realising that stress is taking a physical toll. For my clients I aim to get them starting to really notice a powerful reduction in symptoms in under 4 weeks and for this you do need uber nutrients. I have a great supplement starter guide here.
For your brain to work well it wants water and it wants fats - good fats. For too long the low fat diet has fed the body the wrong type of food for your brain to thrive. Good fats are called Omega 3's and you'll get them in foods such as fatty fish (salmon, mackerel, herring) and nuts and seeds; plus you can take a supplement if your diet isn't rich in these foods. Oils in, sugars out! Then your brain starts to work better. Sugar causes inflammation which hinders the brain; oils feed the brain and help the neural pathways connect and fire well!
A major area I thought missing in Dr Mosconi's book is liver health. Night sweats in western medicine are placed under the same banner as Hot Flushes but in Chinese medicine they have a completely different cause. Night sweats are a sign that your liver is struggling and needs a detox. As I mentioned before bitter veggies are good for your gut and they also help your liver work better. One of the main herbal blends that I put my clients on is one to support daily liver health. Reducing night sweats really is a quick win. Yes, maybe it's associated to your changing oestrogen levels but it's proven (and it does happen in men too!) that it IS TO DO with how well your liver functions. Clean up your liver and cut down on simple carbs in your evening meal and you will reduce/resolve your night sweats in a matter of nights.
Hot flushes on the other hand are far more complex as they are the culmination of a host of health issues that have gone before them. There is good news though; work on resolving your other major symptoms, improve your nutrition and hot flushes will reduce. Stress, lack of nutrition and a change in oestrogen (which triggers a reduction in collagen) create a perfect storm for hot flushes to appear. When they happen overnight they are normally triggered at a time of stress. Flushes start later in the night than sweats. Sweats are around 1 to 3am (the time of night that the liver has to cleanse your blood and the harder it works the hotter it gets); you wake up already hot/sweaty. Flushes happen after you wake up normally from around 4/5am onwards. On waking you have an adrenalin surge and then whoosh you feel the flush. They emanate from the soles of your feet or the small of your back; both important Acu points in Chinese medicine that are associated to the  Kidneys . Kidney 1 in the soles of your feet or the Ming Mein (Gate of Life) in the small of your back which tells us practitioners that we have to sort out your Kidney energy. The cause can be a lack of something in the body (in practical terms nutrition) and another factor is whether your body is too hot or too cold; this can be determined quickly by me and this then creates the plan to resolve them. One factor that can help knock them down by around 20% very quickly is to have citrus fruit or in supplement terms Vitamin C (plus Bioflavonoids). I've written an entire blog dedicated to vitamin C it's that important.
When your body starts to work better it creates enough excess nutrients for your brain to work better too. Though you may notice that your brain symptoms come first, the way to resolve them is to take physical steps to improve your health. As Dr Mosconi states: taking steps in nutrition, exercise and lifestyle are a valuable component of your brain (and physical) health whether HRT is a part of your menopause plan or not.
Exercise, train and feed your brain!
At the moment the dialogue is: I think I'm menopausal; give me HRT. I'm undecided whether HRT is the right path for me but what I am sure is right is to address the health imbalances that your symptoms are telling you you have. Do not put up with brain fog, insomnia, hot flushes or joint pain as they are all indicative of deeper health issues further down the line. When the hormonal transition sheds light on how your body is coping at this time of life it is giving you a powerful chance to change some health habits that are going in the wrong direction. I've listened to and addressed all my symptoms as they have arisen and my aim is to never have a hot flush!
Will my brain ever feel right again after menopause?
Yes it will! The menopause transition is a time in your life where your body is changing and changing takes energy. If you're using up more energy than your body generates plus you're not receiving enough energy intake (aka nutrition) AND you have the higher levels of stress than any previous generation it's going to hit hardest in the years that are perimenopause. Think about when you have a virus. Before it breaks you have some days of extreme tiredness... and then the symptoms of illness appear. Then when you sound really grotty you actually on the mend and feeling better; this is the hot flushes stage. At the recent menopause fayre when I spoke to women about symptoms they would say: oh it's just hot flushes now I can manage those I'm nowhere near as bad as I was. I gasp with horror because women are seeing hot flushes as the easiest part of their transition, but unlike a cold that passes hot flushes may not; they are indicative of a struggling cardiovascular system - I reiterate: DO NOT PUT UP WITH HOT FLUSHES.
Years of tiredness PRECEED the cessation of your periods. Hot flushes can happen at any point as can night sweats and all the other symptoms. Symptoms all have their specific root causes and women will each experience a different combination of symtoms to her friend or sister as there are other variables in all of this: your lifestyle, your long term health issues AND your mindset.
Specifically though, when looking at how your brain feels and your associated emotions a survey of postmenopausal women stated that 65% of women are happier! This is a good start, but let's aim for 100!!
If 75% of women have brain-fog associated symptoms but 65% of them are happier post menopause then at least 40% of women feel they are better post menopause when they had experienced brain fog at some point. So what's going on in your brain then? One theory is that the menopause is the chance for a brain upgrade! I do like the sound of that! It would tie in with the Japanese saying that post menopause is your Second Spring. As part of this brain upgrade it's shedding the information that you don't require anymore; the intimate details of the motherhood phase. You learn a lot when you have a child and you have you develope heightened senses.What if the menopause is signalling your brain to let go of a skillset that is not required any longer? This creates space for a new skillset and thought processes to appear. There are studies that have proved that being curious and positive about your menopause actually aid symptom relief. Whereas holding onto the past and struggling to let go of who you were are detrimental; this would tie in with your brain trying to change for a new phase of life and you fighting to stay where you were. Dr Mosconi even goes as far as to say that you're having your operating system updated; being a computer geek I like this idea!
Menopause is a critical time to detect signs of medical risk for the future - take action now!
Whether this is the case or not there is one thing that is certain - your body transitioning takes energy and this is tiring on you when you're living a hectic lifestyle that is the culmination of 20/30 years of your adult life. When you transitioned the last time you were a teen and you stayed in bed till late and people gave you space. When you gave birth there were offers of help or at the very least the compassion of: well she's got a new born baby.
This time though you are everyone's ROCK and I found out first hand that when I started telling people I was tired and I couldn't work at the same capacity that it was met with a level of contempt. My old employers didn't know my brain and energy were changing they just saw a project manager who wasn't performing as well and I didn't know any better only to tell them only that I was exhausted, grieving and felt like my job was killing me. I suspect a lot of women are in the same position too; stress takes a massive toll at this stage in life and increases the fatigue levels exponentially as well as interfering with your hormonal balancing.
The good news though is that in finding out this information (well done if you've read this far!) you can firstly understand what the hell is going on and be calmed by the knowledge that you are not going mad, you do not have dementia and that there is plenty that you can do you change your current state.
Your brain is changing yes, this has a knock on effect to how your hormones work in your body yes. This change highlights that your body has a certain number of health imbalances. Now know that if you address these imbalances specifically with a holistic professional (i.e. not your GP they don't know this stuff). You will start to feel physically healthier and more energised; emotionally calmer with more brain clarity; memory and brighter moods will return post menopause and sooner if you take action now.
Ignore your symptoms, and your brain and body will struggle and this may continue years if not decades after your periods end. Remember the statistic - women can spend 40% of their life in menopause?
The average life expectancy of a UK female is 80.7 years (I think that has reduced!). 40% of that is 32.3 years!! I'm still reeling from this statistic.
Next steps to support your brain health in menopause
Nutrition, sleep, stress reduction, gut and liver health. Before this triggers overwhelm you need to take small steps and embed little changes to become habits; follow guided help for the best results. It's never to late to start and if you follow my plan then you start noticing real changes in 4 to 8 weeks. If after that you still have hot flushes then you need to repeat but up your nutrition (supplements) and seriously examine the stressors in your life!
My book Understanding Your Menopause steps you through these small changes to specifically bypass the overwhelm and it has fantastic results: "Your book has helped me tremendously. My husband says this is the most mentally stable he's ever known me and we've been together for 12 years!" Kay Adcock. This is done with the help of vitamins and minerals and a little, but powerful knowledge; then HRT is up to you!
If you're really struggling then please do get in touch with me, I offer a free no obligation chat and sometimes you just need to be pointed in the right direction; it's just you don't know what that is.... but I do!
Excerpts taken from The Menopause Brain - Dr Lisa Mosconi (available on Amazon)
Meet Andrea - Holistic Menopause Specialist
Andrea is a shiatsu and Chinese medicine practitioner who uses the principles and wisdom of Chinese medicine in a completely practical way to help you resolve your symptoms naturally and effectively. If you live locally you can book in for a wonderfully relaxing Shiatsu for Menopause, otherwise Andrea does online indepth consultations where you'll leave with an actionable plan to follow. Andrea is also passionate about doing workplace talks and recently created Gloucestershire's first Menopause Fayre.
KNOWLEDE . PAUSE . FLOURISH
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