What Happens in the Brain During Menopause?

Although half the population experiences it, many of the details about how menopause plays out from person to person remain poorly understood.

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Menopause marks a major transition. After decades of coordinating countless physiological systems, estrogen and progesterone levels plummet. As a result, menstrual cycles cease, and the body recalibrates to dramatically weaker signaling from these sex hormones. Although half the population experiences it, many of the details regarding how menopause plays out from person to person remain poorly understood. This is because the transition has, until recent years, gone largely understudied.

Caitlin Taylor is a neuroscientist and academic coordinator at the University of California, Santa Barbara.

Caitlin Taylor

Caitlin Taylor is a neuroscientist and academic coordinator at the University of California, Santa Barbara, where she studies how sex hormones affect the brain. Taylor and her colleagues are working toward getting a stronger grasp on how symptoms and brain changes vary among individuals during perimenopause, defined as the years leading up to their final period, through early post-menopause. This year, they plan to launch the Longitudinal Menopause Project. This multi-pronged research effort will use a host of biomedical information — including brain imaging, blood tests, and symptom tracking — to study menopause-related brain changes among women aged 40 to 55. They hope this new data will ultimately contribute to improved care recommendations for people experiencing menopause.

BrainFacts spoke to Taylor about how fluctuating hormone levels during perimenopause affect the brain, the relationship between menopause and cognition, and what people approaching or experiencing this transition can do to keep their brains healthy.

What are the phases associated with menopause?

Pre-menopause is when you have regular menstrual cycles. Perimenopause is basically when your  hypothalamic-pituitary-gonadal (HPG) axis starts to dysregulate. This is when the body, which has been humming along with estrogen and progesterone as influencers of a lot of different processes, now has to adjust to decreasing levels of these hormones. So that can lead to a number of different experiences and symptoms. 

Menopause itself is one day. It is when you've been 12 months without a period. After that, you are postmenopausal. And that doesn't mean, “Oh, we're free and clear, everything's done.” That's just one of many markers across this transition period. While postmenopausal, there are still women who experience symptoms like hot flashes, night sweats, or insomnia — the body is still settling and regulating across this change.

What’s happening in the brain during this transition? 

There are estrogen and progesterone receptors all over the body, including in the brain, particularly in regions involved in higher-level functioning like memory and learning and attention. Most studies have looked at estrogen, so that’s why I’m focusing on it, but progesterone also has influences in the brain. But estrogen has been directing all sorts of functions, like how neurons use energy and how mitochondria function.

Estrogen levels can fluctuate wildly across the transition, and when those levels are less predictable, the brain can't rely on that signal as much anymore. There are consequences of these systems uncoupling. For example, estrogen is a big influencer in thermoregulation. When estrogen isn't there to help modulate that system, you'll get hot flashes, which are vasomotor symptoms that can be a big disruptor to a lot of people.

You also have a lot of estrogen receptors in the hippocampus and the prefrontal cortex, and so a lot of women will complain about brain fog, or attention differences, or difficulty retrieving words. But this is just in the brain — all body systems are learning to basically function without estrogen. This is where we get a host of symptoms that can vary between people in terms of what is happening and the severity of what they're experiencing.

What’s the relationship between menopause and brain aging?

Menopause has historically been seen as decline, as if this is the aging brain falling apart. There have now been a number of studies to suggest this is a transition or the brain adapting to new circumstances, which in this case is a hormonally different environment.

It's also tough to study because you're looking at it in conjunction with the chronologically aging brain. Teasing apart what's going on in one system, versus the other, versus in tandem is very challenging. But really, the evidence is showing changes in the brain's strategies for functioning. The nature of how neurons may talk to each other or modify their connections may be changing or reduced to a certain extent. But you may see different systems recruited for doing a cognitive task, or you might see greater activation, whereas previously you needed maybe slightly less. 

You'll see evidence of cognitive decline to a certain extent. Women may score lower on memory tests, for example, than they would have at a younger age. But their scores are equivalent to age-matched men. We're not seeing gross neuronal death or anything. It's not all doom and gloom because we see different cognitive strengths and strategies in different age brackets, and they all have their value.

It's not like menopause causes dementia, but this is a historically overlooked major inflection point in health risk. To not interrogate what is changing before and after you get these differences in risk for developing dementia or Alzheimer’s is shooting yourself in the foot. We're trying to figure out the extent to which your menopause experience basically is just an indicator of your dementia risk, or the extent to which your experience affects your risk. We don't know those differences yet, but we know all signs point to this being a really important time period to look at what's going on in the brain as it could be expressing higher risk for later decline or cognitive outcomes.

This interview has been edited for length and clarity. 

About the Author

Bella Isaacs-Thomas

Bella is the Staff Writer and Editor for BrainFacts. She previously worked as a digital science reporter at PBS NewsHour, where she was named a fellow in the 2022-2023 class of the National Science-Health-Environment Reporting Fellowships (SHERF) and earned a 2021 D.C. Science Writers Association Newsbrief Award for writing. She graduated from the University of Michigan with a bachelor's degree in 2018.