This article is the third of a four-part series in partnership with MHealthy and the U-M Menopause Clinic to further awareness about menopause.

You forgot where you put your phone. Again. You can’t seem to retrace what you did when you last saw it. Words fail you sometimes; the name of a colleague you sit next to slips through your mind in a cloud that re-energizes into an outburst of anger when you can’t focus long enough to get through your emails.  

These lapses are not “all in your head” during perimenopause. In reality, said Natalie Saunders, MD, associate professor of obstetrics and gynecology at Michigan Medicine, and Menopause Society-certified practitioner, they’re all in your brain. 

“Perimenopause and menopause are considered to impact patients’ reproductive systems most significantly,” Saunders said. “However, we’re also learning more about how perimenopause disrupts the brain; in particular, areas of the brain that control executive functioning and memory. We know that menopause also lowers glucose, the primary fuel brain cells use to connect with other cells.”

This disruption in the brain is related to hallmark symptoms of perimenopause, including hot flashes, fatigue, sleep disturbance, and mood fluctuation. 

In an effort to elevate awareness about menopause and encourage support, Saunders will host a free webinar, “Navigating Menopause Together,” with Shubham Kalwani, DO, assistant professor in the U-M Department of Family Medicine and Department of Obstetrics and Gynecology. Saunders and Kalwani are Menopause Society-certified practitioners. 

Your Brain in Perimenopause

Ever since women’s first menstruation, a brain-pituitary-ovary axis has worked harmoniously to stabilize their reproductive cycles:

• A surge in hormones caused the uterus lining to thicken in preparation for a fertilized egg.
• The ovaries released mature eggs into the fallopian tubes.
• In the absence of a fertilized egg, hormone levels decreased in the uterus, causing the shed of blood and fluid through the vagina. 

During perimenopause, however, this balance begins to wobble, in part, by a decrease in estrogen flowing from the ovaries to the brain.

“It’s almost like puberty in reverse,” Saunders explained. “Estrogen from the ovaries has been protecting regions of the brain that control our attentiveness, focus and emotions. When these estrogen levels start fluctuating, sometimes wildly during perimenopause, it affects those centers of our brain, sometimes significantly.”

The Mood-ality of a Brain on Perimenopause

In addition to physical symptoms, the brain’s hormone roller coaster can cause a dip in dopamine and serotonin, mood-stabilizing chemicals, which can trigger irritability, anxiety and depression. Although menopause doesn’t directly cause depression, studies show that 20% of women experience symptoms of depression during perimenopause. 

“When a patient isn’t sleeping well, doesn’t feel like herself, and isn’t receiving relief from symptoms that affect her quality of life, it isn’t surprising that a level of depression can develop,” Saunders said. “Because the effects of perimenopause are so individualized, the severity of depression can vary from feeling somewhat unmotivated or sad to major depressive disorder.”

It’s important, she added, for patients to discuss these feelings with their doctors, especially if they’ve experienced depression earlier in their lifetimes. 

“We have effective treatments for depression, whether it’s medication, cognitive talk therapy, or a combination of both. Women don’t have to suffer physically or mentally because perimenopause has biologically altered their brains.”

DIY for Better Brain Health

Coping with a perimenopausal brain also includes attention to self-care. Saunders said good nutrition, appropriate exercise and regular social interaction are non-medicinal mood stabilizers that can lessen the symptoms and severity of depression.

Yogi, meditation, tai chi and Pilates, in particular, have been proven to decrease stress, entice better sleep and promote emotional regulation. 

“It seems so basic, but taking good care of yourself during this transitional time is really important,” she said. “If you’re not sleeping well at night, sneak a nap in during the day. Surround yourself with people you enjoy and who support you, especially when you’re having an off day. And understand that food and drink are fuel for your body that can make it glide or sputter.”

While self-care is not a catch-all for a brain on perimenopause, giving yourself some TLC can complement other treatments and offer a sense of self-management.

“We can’t stop perimenopause,” Saunders said, “but we can get through it better with a combination of medical care, when needed, and taking good care of ourselves, both physically and mentally.”

Part four of this series, “The Good Bones of Menopause,” will be published on Tuesday, Oct. 27.