Thankfully, menopause is not the taboo subject it once was. This climacteric period between a woman’s reproductive and elderly years is generally perceived as one of great physical, emotional, and mental challenges and adjustments. This period of life often coincides with family changes, physical fatigue, and a general loss of motivation. Most of the discussion in recent times has centered on hormone replacement therapy used to treat the most common vasomotor symptoms such as hot flashes, night sweats, vertigo, atrophic vaginitis, uterine prolapse, and various forms of cancer. However, the brain’s role in more serious post-menopausal conditions affecting women–specifically, those related to estrogen receptors–is becoming more fully understood, with some surprising findings. 
All Healthcare is Not Created Equal
Not surprisingly, research on female brains remains underdeveloped. So many women suffering the more severe effects of menopause are still dismissed by their doctors as having nothing wrong with them, being depressed (and summarily marched to the pharmacy with a prescription for SSRIs), or simply experiencing a natural part of aging. Women are led to believe they should just put up and shut up. However, many woman are forced to give up their careers and suffer from a catalogue of emotional, mental, and physical symptoms, including osteoporosis and an accumulation of the protein plaque, amyloid beta, which is linked to the possible future development of Alzheimer’s Disease (two-thirds of all people with late onset AD are women, which menopause can speed up if predisposed to the condition). These serious conditions highlight how unreasonable and unfair it is to dismiss women’s symptoms, and no-one could imagine a man with prostate issues being told that it is what it is so they should just get on with it. 
… and Neither Are Men and Women
Whereas the risk of cardiac and cerebrovascular diseases is about the same for men and women starting in their late 50s, women’s brains are literally wired differently from men’s due to issues related to estrogen loss. In fact, women are biologically four times more prone to experience migraines and three times more likely as men to suffer from brain tumors, strokes, and autoimmune conditions like multiple sclerosis. This further explains why women are more likely to suffer from depression and anxiety, especially in the middle of life, when the brain’s structure is visibly alters. Furthermore, three areas of the brain–the hypothalamus, hippocampus, and amygdala–are responsible for regulating body temperature, sleep and stress, and memory and emotions, respectively, and are associated with the negative effects of menopause. While both the gray and white matter shrink and there are clear disadvantages to menopause, the good news is that estrogen loss also affects the hypothalamus, hippocampus, and amygdala in positive ways by increasing blood flow and levels of adenosine triphosphate (ATP). This nucleotide compound is critical for the storage of energy within the cells along with the synthesis of ribonucleic acid (RNA), which plays a vital role in the conversion of stored DNA to protein. This ground-breaking research has also found that many negative changes associated with menopause are temporary and that the brain is able to compensate in other areas, so it’s not all doom and gloom. 
In a study on endocrine vs. chronological aging, Dr. Mosconi, an Associate Professor of Neurology at the Woman’s Brain Initiative at Weill Cornell Medicine NY, and her fellow researchers concluded that, “the female aging process coincides with the endocrine transition of perimenopause” and that the loss of estrogen accelerates the aging process at a far greater rate than that of men of a similar chronologic age.  Rather than thinking of aging as a linear process, Mosconi describes the aging of women’s brains as having three major “bumps”: puberty, pregnancy, and menopause. There are periods of surges that are followed by a steady decline of hormones. Dr. Mosconi’s studies show that even in and after menopause, the brain is plastic and has the ability to adapt so that even though there is around a 30% reduction in brain energy levels in women, it doesn’t denote a steady and permanent decline. While a build-up of amyloid beta is a cause for concern, taking some form of HRT during perimenopause (at the first sign of symptoms) can play a significant role in prevention, especially where there is a genetic predisposition, and provides other benefits such as reducing the progression of hardening of the arteries, a condition that can lead to heart attack and strokes (atherosclerosis). Mosconi stresses that there is not a one-size-fits-all approach to HRT and that treatment needs to be individualized. For women around the world, many of whom are still hesitant to take HRT because of the now discredited results of the 2003 Women’s Health Initiative, gaining access to HRT or overcoming reticence to taking it are the first priorities.
Not Better or Worse, Just Different
Mosconi and her researchers used various forms of scanning technology to monitor the brain activity of perimenopausal, menopausal, and post-menopausal women (aged 40-65). They discovered that many of the brain’s changes were transient, with some completely reversing within a few years, which was not previously known. The precuneus, responsible for social cognition and memory, was particularly predisposed to rebound, with gray matter in general being completely restored in some women. Mosconi described this as the brain’s “finding a new normal” post-menopause, which provides some hope and comfort to the many women who find this life stage far from breezy.
Estrogen is one of the female brain’s best allies. It protects the brain from aging and stimulates neural activity. Exercise also decreases the risk of dementia by 30%, which has to be one of the biggest incentives possible for middle-aged women. Exercise, a Mediterranean-style diet rich in antioxidants, minimizing stress, practicing weight control, and managing lipid levels all contribute to a less problematic menopause and keeping your brain in the black or gray, as it were. To quote Winston Churchill, “if you’re going through hell, just keep going” because there’s a good chance that if you do the right things, your brain will help you to come out the other side well-prepared for your next stage of life.
 Understanding the Life Stages of Women to Enhance Your Practice’, Yuko Tekeda, 2010
 Mosconi, L., Rahman, A., Diaz, I., Wu, X., Scheyer, O., Hristov, H., Vallabhajosula, S., Isaacson, R., de Leon, M. and Brinton, R., 2018. Increased Alzheimer’s risk during the menopause transition: A 3-year longitudinal brain imaging study. PLOS ONE, 13(12), p.e0207885.
 Mosconi, L., Berti, V., Dyke, J., Schelbaum, E., Jett, S., Loughlin, L., Jang, G., Rahman, A., Hristov, H., Pahlajani, S., Andrews, R., Matthews, D., Etingin, O., Ganzer, C., de Leon, M., Isaacson, R. and Brinton, R., 2021. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports, 11(1).
 Mosconi, L., Berti, V., Quinn, C., McHugh, P., Petrongolo, G., Varsavsky, I., Osorio, R., Pupi, A., Vallabhajosula, S., Isaacson, R., de Leon, M. and Brinton, R., 2017. Sex differences in Alzheimer risk. Neurology, 89(13), pp.1382-1390.