Does Menopause Affect the Brain?
Why Menopause Changes the Brain And Why You're Not Losing Your Mind
“I thought menopause happened in the ovaries.”
So did I.
For years, that’s what most of us were taught. Your ovaries gradually stop producing oestrogen and progesterone, your periods eventually stop, and that’s menopause.
That’s true.
But it’s only part of the story.
What many people don’t realise is that menopause is just as much a brain transition as it is an ovarian one. In fact, many of the symptoms women struggle with most—brain fog, poor sleep, anxiety, difficulty concentrating, hot flushes and even changes in mood—are controlled by areas of the brain.
That got me wondering.
If so many symptoms seem to start in the brain, what is actually happening up there?
It turns out scientists have been asking the same question.
Can We Actually See Menopause Happening in the Brain?
In 2021, neuroscientist Dr Lisa Mosconi and her team carried out one of the most fascinating menopause studies I’ve ever read.
Instead of asking women how they felt, they looked directly at their brains.
They recruited healthy women who were premenopausal, perimenopausal and postmenopausal. Then, to make sure they weren’t simply seeing the effects of ageing, they compared them with men of the same age.
That was clever.
If a 55-year-old woman’s brain looks different from a 35-year-old woman’s brain, is that because she’s older… or because she has gone through menopause?
By comparing women with age-matched men, the researchers could begin to separate the effects of ageing from the effects of menopause itself.
Then they used several different types of brain scans. Each one looked at something slightly different.
One measured the structure of the brain.
Another looked at how different parts of the brain communicate with each other.
And another measured something that I found particularly fascinating…
How much energy the brain was using.
Your Brain Is Surprisingly Expensive to Run
Although your brain weighs around 2% of your body weight, it uses approximately 20% of the energy your body produces.
That’s an extraordinary amount.
Why?
Because your brain never really stops working.
Even while you’re asleep, it’s organising memories, regulating your breathing and heartbeat, controlling your body temperature, processing hormones and deciding what information is important enough to keep.
During the day it’s doing even more.
Every conversation you have.
Every decision you make.
Finding the right word in a sentence.
Remembering where you left your keys.
Reading this article.
Recognising someone’s face.
Planning what to cook for dinner.
Ignoring background noise while focusing on the person speaking to you.
All of that is happening because billions of nerve cells are constantly sending electrical signals to one another.
Every single one of those signals costs energy.
That energy comes largely from glucose.
The brain is, quite simply, an incredibly hungry organ.
What the Researchers Found
One of the scans they used was called a PET scan.
Rather than taking a picture of the brain, it shows how much glucose different areas of the brain are using.
The researchers discovered that, during the menopause transition, some parts of the brain weren’t using glucose as efficiently as they had before.
Now this is important.
The study didn’t show that brain cells were dying.
It showed that some regions of the brain appeared to be producing less energy than they had previously.
That immediately made me think of something.
Imagine your house suddenly has half the electricity it normally does.
You probably wouldn’t notice the fridge switching off because you’d make sure that stayed on.
You’d keep the heating going if you could.
You’d probably leave the lights on in the rooms you needed.
But perhaps the outside lights wouldn’t come on.
Maybe the tumble dryer could wait until tomorrow.
You’d start prioritising.
I wonder whether the brain does something similar.
The researchers don’t say that, but it’s one way of imagining what’s happening.
If there’s temporarily less energy available, perhaps the brain protects the most important functions first, while some of the more demanding jobs become a little less efficient.
Could that help explain why women often notice difficulty concentrating, forgetting words halfway through a sentence, or feeling mentally exhausted after tasks that used to feel easy?
The study can’t answer that question yet.
But it certainly gives us something to think about.
What Is Grey Matter?
The researchers also found changes in something called grey matter.
You’ve probably heard the phrase before, but what actually is it?
If you imagine the brain as a vast city, grey matter is where most of the buildings are.
It’s packed with the cell bodies of billions of nerve cells. This is where information is processed, decisions are made, memories are formed and signals are organised before being sent elsewhere.
White matter, on the other hand, is more like the road and railway network connecting those buildings together.
Grey matter does much of the thinking.
White matter carries the messages.
During the menopause transition, researchers found that the volume of grey matter became smaller in some regions of the brain.
That sounds alarming.
Unfortunately, some newspaper headlines stopped there and suggested that menopause causes the brain to shrink.
But that’s not really what the study showed.
One of the most encouraging findings was that after menopause, some of these changes began to recover.
The brain appeared to reorganise itself.
Rather than showing permanent damage, it looked much more like adaptation.
Personally, I think that’s a much more hopeful way of looking at it.
The Brain Is Still Learning
One of the things I loved most about this research is that it reminds us how remarkable the brain really is.
Our brains aren’t fixed.
They’re constantly changing throughout life.
Scientists call this neuroplasticity, which refers to the brain’s ability to adapt, strengthen existing connections, and create new ones in response to change.
That’s exactly what seems to be happening during menopause.
The researchers also looked at how the brain produces ATP, the tiny molecule that powers almost every process inside our cells.
Women whose brains appeared better able to maintain this energy production also tended to preserve their thinking skills particularly well.
Again, that suggests adaptation rather than decline.
The Really Interesting Part
Here’s the bit that fascinated me most.
The researchers could clearly see that the brain’s energy use was changing.
What they don’t yet know is exactly why.
Is the brain deliberately using less glucose while it adapts?
Is it switching to other fuel sources?
Is it becoming temporarily less efficient before finding a new balance?
At the moment, nobody knows for certain.
Science doesn’t always have all the answers immediately, and I actually find that reassuring.
Research isn’t about proving what we already believe.
It’s about asking better questions.
This study answered one enormous question.
Yes, menopause really does involve measurable changes within the brain.
But it also opened up many more questions that scientists are now working hard to answer.
So, What Should We Take Away From This?
For me, the biggest message isn’t that menopause changes the brain.
It’s that your symptoms are real.
If you’ve struggled to find words.
If you’ve forgotten why you walked into a room.
If you’ve felt mentally exhausted.
If you’ve wondered whether you’re somehow losing yourself.
You’re not imagining it.
Your brain is adapting to one of the biggest hormonal transitions of adult life.
Perhaps most importantly, this research suggests that adaptation is exactly what the brain is designed to do.
It isn’t giving up.
It’s learning how to work differently.
And I think that’s a far more hopeful story than we’ve been told for many years.
Has This Sparked Your Curiosity?
When I first started reading this research, one question kept coming back to me.
Why does changing one hormone seem to affect so many different parts of the brain?
How can one hormone influence memory, sleep, body temperature, mood, concentration, anxiety and even the way our brain produces energy?
The answer lies in understanding oestrogen.
Most of us think of oestrogen as a reproductive hormone, but that really only scratches the surface. Oestrogen is also one of the brain's most important chemical messengers, influencing how nerve cells communicate, how they produce energy, and even how they protect themselves.
If today's article has sparked your curiosity, you might enjoy reading How Oestrogen Supports the Brain. I think you'll be surprised by just how much this remarkable hormone does.
References
Mosconi L, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports. 2021;11:10867.
Nature. How menopause reshapes the brain. Nature. 2023.