Perimenopause, your brain and mental health

In our previous articles, we discussed that perimenopause is the transitional phase before menopause, usually occurring in women between the ages of 40 and 50. During this period, hormonal shifts can also lead to significant changes in the brain, influencing both cognitive functions and mental health. In the third part of this series, we will explore how these hormonal changes can affect brain health and mental wellbeing and discuss strategies to better manage these potential challenges.

Perimenopause and mental health

The risk of major depression and noticeable increases in depressive symptoms go up two to three times during the menopause transition. Sex hormones like oestrogen and progesterone interact closely with brain chemicals such as serotonin, GABA, glutamate and dopamine. Changes in oestrogen during perimenopause and menopause can affect how stress hormones and serotonin are processed, leading to mood swings and other issues.

Progesterone, although less discussed, also plays a vital role in mood regulation during perimenopause. Its byproduct, allopregnanolone, calms the brain and reduces anxiety by affecting GABA(A) receptors. Progesterone influences serotonin by altering related genes and proteins and some early evidence suggests it protects the brain, enhancing stress resilience.

Changes in cognitive function and brain structure during perimenopause and menopause

A recent study used advanced brain imaging techniques to examine the brains of 161 women aged 40 to 65, including those who were menopausal, perimenopausal and post-menopausal. The study reveals how menopause transforms the female brain and suggests that these changes include compensatory adaptations that help maintain brain function despite lower oestrogen levels. The findings show that as the brain adjusts to reduced oestrogen in postmenopausal women and it often returns to structural and functional levels like those before menopause, although this is not true for all women.

Perimenopausal and menopausal women also often face memory and cognitive issues due to decreasing oestrogen levels. Oestrogen receptors, ER-alpha and ER-beta, in the brain's limbic region, play crucial roles in mood, memory and behaviour regulation. Hormonal changes affect brain functions, causing temporary cognitive decline. Menopause can also alter brain areas that process negative emotions, like the ventral limbic and medial temporal lobes, could lead to mood swings and memory problems due to the presence of oestrogen receptors in these regions.

Better coping with stress and cognitive changes

Research shows that mastering new coping mechanisms like mindfulness, breathwork, and cognitive behavioural therapy can boost stress resilience. Find what works for you and make it a habit.

Moreover, research on Hormone Replacement Therapy (HRT) with synthetic or [bioavailable hormones](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131235/#:~:text=BHRT%20Effectiveness,emotional%20lability%20(53%25%20vs.) is ever evolving.

A recent study from 2023 for example shows that starting hormone replacement therapy (HRT) soon after menopausal symptoms begin increases the brain's chances of protection, according to a recent analysis. The duration of HRT also plays a crucial role: women who began HRT during menopause and continued for more than 10 years had a 26% reduced risk of dementia.

As we've discussed, perimenopause affects not just the ovaries but also our brain health, potentially leading to cognitive and mental health changes. Consult a health professional early about risks and benefits to understand your options and make informed decisions about managing perimenopause symptoms. Don’t wait until symptoms are unmanageable; you can seek advice even if you still have regular periods.

Disclaimer: This article is intended for educational purposes. The information, or comments herein, does not amount to, or replace, professional advice and should not be relied upon as or substitute for professional or medical advice from a qualified professional.