Menopause and the Brain – Cognitive and Nervous System-Related Symptoms

Mallory Junggren

Written by Mallory Junggren

Mallory Junggren

Written by Mallory Junggren

If you’re like many women, you probably think of menopause as the time of your life where you’re no longer menstruating or can become pregnant. By definition, menopause is one single day, which coincides with the cessation of menstruation for 12 consecutive months,1 so, this makes perfect sense.

However, in addition to its clear impact on our ability to get pregnant, menopause can also affect other important functions and areas of our bodies including:

  • the central nervous system
  • the peripheral nervous system
  • our musculoskeletal system
  • our cardiovascular system

Changes to these functions may be the cause of a myriad of other symptoms you’re experiencing during this time, but you might not automatically think of them as being associated with menopause.

Why Menopause Affects Cognition and The Nervous System

Vasomotor symptoms, such as hot flashes and night sweats, may begin during perimenopause and can continue for up to a decade or longer.2 But, what many women may not realize is that there are at least 34 recognized symptoms of menopause, some of which are directly affected by changes in our brain chemistry and can have an effect on cognitive function.

Perimenopause is a transitional period earmarked by fluctuations in our reproductive hormones, including estrogen, progesterone and testosterone. This decline in estrogen and progesterone, in addition to a corresponding drop in a chemical called serotonin (a neurotransmitter that helps to support mood), play a role in the onset of some cognitive related menopause symptoms, such as brain fog.3 As with most-all perimenopause and menopause symptoms, fluctuating hormones are also connected to cognitive function, as well as concentration, memory and focus.

When menopause occurs, your ovaries stop producing high levels of estrogen.4 Why is this important? Estrogen is what is known as a “neuroprotective hormone” – a fancy way of saying that it helps to protect our brain, nerves and their functions.5

Nerves within our bodies work to control our pain receptors and can influence certain areas of cognition and sensation (such as our ability to remember things or to think clearly, as well as the onset or worsening of certain nerve sensations – like tingling or pins and needles). So, when there’s less estrogen being produced in our body, cognitive symptoms, such as brain fog or occasional forgetfulness, may start to appear or become more pronounced. You may also start to notice other nerve-related symptoms in different parts of your body, such as sharp, fleeting nerve pain or an increase in “pins and needles” sensations in your hands and feet. These sensory symptoms can also be linked to the decline of estrogen in the body, as they typically originate in the brain.

Multiple studies have demonstrated a correlation between the effects of declining estrogen levels in the brain and cognitive symptoms experienced – showing that it can affect memory, learning, and mood in menopausal women.6 But once postmenopause begins, and the volatile fluctuations of hormones settle down, cognitive symptoms may decrease or even resolve on their own.7  

Changes in the Brain During Menopause

Changes in the brain that have been associated with the menopausal transition include a decrease in the level of energy present. This reduction in energy levels in the brain can negatively impact several of our cognitive functions.8 Let’s briefly dive into why this is.

The areas of the brain involved in memory and learning all contain estrogen receptors. As mentioned, estrogen levels are volatile and then plummet during perimenopause into menopause, which is why symptoms, such as brain fog or problems remembering things, losing your train of thought, etc., may be experienced by some women.9

Like estrogen receptors in other parts of our body, those within our central nervous system, including the brain, become active when estrogen binds to them. Lower levels of circulating estrogen can directly affect cognitive functions that are regulated within specific areas of the brain. This includes cognition and memory, mood, body temperature regulation, sleep quality, and the maintenance of our circadian rhythm (our natural sleep and wake cycle).10,11 

Common Cognitive and Nervous System-Related Menopause Symptoms  

The duration and intensity of symptoms stemming from changes in our brain chemistry during menopause often vary. However, research has found that around 80% of women will experience one or more of these nerve-related or cognitive symptoms during this transitional time.12 The most common symptoms can include:

Vasomotor Symptoms

Hot flashes and night sweats are the most iconic vasomotor symptoms of menopause, however additional vasomotor symptoms can include heart palpitations or changes in blood pressure. You may not think of the more classic symptoms of hot flashes and night sweats as being related to brain function; however, they actually are controlled by certain activities originating in the brain’s thermoregulatory zone, which can be thought of as the body’s master thermostat; it is located in the hypothalamus area of the brain.13  

Vasomotor function involves the dilation or constriction of blood vessels in our body, which is under the control of our nervous system. Symptoms such as hot flashes are related to blood flow14 and are thought to occur when decreased estrogen levels cause the body’s thermostat to become much more sensitive to even slight changes in body temperature. In other words, the window of what our bodies deem comfortable, regarding temperatures, narrows significantly during this time. Symptoms typically occur in the face, neck, and chest, which causes an immediate sensation of heat and sweating that many menopausal women are familiar with. Fluctuating vasomotor activity can also negatively impact sleep quality and may increase anxiety levels during menopause.15  

Cognitive Menopause Symptoms

Symptoms affecting cognition are commonly experienced during perimenopause, and can continue into, or increase in severity, during menopause, due to the volatility and then significant drop of estrogen.

Some of the common cognitive symptoms associated with this estrogen decline can negatively impact:16

  • focus and concentration
  • verbal learning
  • memory
  • fine motor speed
  • motor function

So, if you feel like you’ve become more forgetful during perimenopause or menopause, or if you can’t seem to focus as well as you used to, changes in your brain chemistry, due to declining estrogen, may be why.

Also, it’s important to not discount the role that quality sleep can play regarding the severity of cognition-related menopause symptoms. Constant awakening during sleep due to vasomotor symptoms can directly impact your quantity and quality of sleep, which can also negatively impact daytime cognitive function.

Nervous System-Related Menopause Symptoms

Our central nervous system is composed of two main parts, our brain and spinal cord. Our peripheral nervous system, on the other hand, is comprised of the nerves that are found outside of our brain and spinal cord and contributes to how our body reacts to external stimulation. Together, these systems work to regulate and maintain the many complex functions occurring throughout our bodies.

Our peripheral nervous system works to send signals from our brain and spinal cord to our muscles, organs, glands, and skin.17 Low levels of estrogen within the brain can reduce the speed that our bodies receive these signals, resulting in some of the nervous system-related symptoms women can experience during menopause.

Changes in hormones, which also impact these nerve signals, may be associated with the onset of something called peripheral neuropathy, which typically presents with symptoms such as a sensation of pins and needles, along with weakness or numbness.18 Peripheral neuropathy has many causes, including diabetes and vitamin deficiencies; it can also accompany certain auto-immune diseases,19 so if you’re just starting to experience any of these symptoms (numbness, weakness or the sensation of pins and needles) consider checking in with your healthcare provider, as a precaution.

Another nervous system related symptom that may be experienced during menopause, known as paresthesia, is the sensation of tingling, or the feeling of pins and needles in the feet, hands, and fingers. More abrupt, stabbing sensations can also occur in other locations in the body.20 If you’re only just starting to experience any of these symptoms, or you’re finding them to be disruptive, it’s important to let your healthcare provider know.

Seeking Help from a Healthcare Professional

Cognitive or nervous system-related symptoms can be particularly unnerving for women in perimenopause or menopause, causing fear and concern that a more serious medical issue may be present. Checking in with your healthcare provider about these concerns and symptoms will often lead to reassurance and effective tips for management or a specific treatment protocol.

Lifestyle changes can also be beneficial. If you smoke or use nicotine products, this may be a good time to stop. Nicotine has been shown to reduce estrogen levels, potentially worsening many of the symptoms associated with menopause. Smoking can also constrict blood vessels which can worsen the duration and severity of vasomotor symptoms, not to mention the multiple other health risks associated with this habit.21

Getting enough sleep, exercising, and eating a healthy diet may also help to curb these disruptive symptoms.21 Most importantly, don’t ever feel like you have to “just deal” with the symptoms of menopause you’re experiencing, as there are solutions out there that can help you maintain a great quality of life.

Resources

  1. https://www.nia.nih.gov/health/what-menopause
  2. https://www.nature.com/articles/s41598-021-90084-y
  3. https://mydoctor.kaiserpermanente.org/mas/news/menopause-and-brain-fog-how-to-cope-with-this-frustrating-condition-1873875
  4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/estrogens-effects-on-the-female-body
  5. https://pubmed.ncbi.nlm.nih.gov/12042878/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879914/
  7. https://www.healthline.com/health/menopause/menopause-brain-fog
  8. https://news.weill.cornell.edu/news/2020/06/new-study-indicates-women-develop-brain-changes-associated-with-alzheimer%E2%80%99s-disease
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820286/#:~:text=In%20particular%2C%20membrane%2Dassociated%20ERs,of%20estrogens%20in%20these%20regions
  10. https://www.nature.com/articles/s41598-021-90084-y
  11. https://www.sciencedirect.com/science/article/pii/S1084952121000835#:~:text=Estrogens%20interact%20with%20the%20circadian,behavior%20across%20the%20estrous%20cycle.
  12. https://news.weill.cornell.edu/news/2020/06/new-study-indicates-women-develop-brain-changes-associated-with-alzheimer%E2%80%99s-disease 
  13. https://www.medicalnewstoday.com/articles/317801#:~:text=Vasomotor%20symptoms%20are%20those%20that,and%20changes%20in%20blood%20pressure.
  14. https://news.weill.cornell.edu/news/2020/06/new-study-indicates-women-develop-brain-changes-associated-with-alzheimer%E2%80%99s-disease
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394691/#:~:text=Cognitive%20deficits%20have%20been%20described,speed%2C%20and%20reduced%20verbal%20memory.
  16. https://my.clevelandclinic.org/health/body/23123-peripheral-nervous-system-pns
  17. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
  18. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
  19. https://www.healthline.com/health/paresthesia#symptoms
  20. https://www.webmd.com/women/news/20120503/menopause-smokers-have-more-hot-flashes
  21. https://www.brainandlife.org/the-magazine/online-exclusives/the-neurologist-is-in-is-it-menopause-or-my-neurologic-disease/#:~:text=The%20key%20to%20managing%20these,following%20up%20with%20your%20doctor.

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