We need to know how menopause changes women’s brains

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During menopause, which marks the end of a woman’s menstrual cycles, her ovaries stop producing the hormones estrogen and progesterone, ending her natural childbearing years. But these hormones also regulate the functioning of the brain, and the brain regulates their release, which means that menopause is a neurological process as well. “A lot of the symptoms of menopause can’t be produced directly by the ovaries, if you think of hot flashes, night sweats, anxiety, depression, insomnia, brain fog,” says Lisa. Mosconi, associate professor of neurology at Weill Cornell Medicine and director of her Women’s Brain initiative. “These are brain symptoms, and we should think of the brain as something that is affected by menopause at least as much as your ovaries.”

In June, Mosconi and his colleagues published in the journal Scientific Reports one of the few studies that looked in detail at what happens to the brain throughout the menopause transition, not just before and after. Using various neuroimaging techniques, they scanned the brains of more than 160 women aged 40 to 65 who were at different stages of the transition to examine the structure, blood flow, metabolism and function of the organ; they did several of the same analyzes two years later. They also imaged the brains of men of the same age group. “What we found in women and not in men is that the brain changes a lot,” says Mosconi. “The menopause transition is really about a lot of remodeling. “

On average, women in the United States enter the transition from menopause – defined as the first 12 consecutive months without a period – around age 50; once diagnosed, they are in postmenopause. But they can start to have hormonal fluctuations in their forties. (For some women, this happens in their 30s, and surgical removal of the ovaries causes immediate menopause, as do some cancer treatments.) These fluctuations cause irregular periods and potentially a wide variety of symptoms, including flushing. heat, insomnia, mood swings, impaired concentration and changes in sexual arousal. During this phase, known as perimenopause, which lasts an average of four years (but can last from several months to a decade), Mosconi and colleagues observed that their female subjects experienced both material loss. gray (the brain cells that process information) and white matter (the fibers that connect these cells). After menopause, however, this loss stopped and in some cases the brain grew in size, but not to its size before menopause. The researchers also detected corresponding changes in the way the brain metabolizes energy, but these did not affect performance on tests of memory, higher-order processing, and language. This suggests that the female brain “goes through this process, and it recovers,” says Jill M. Goldstein, professor of psychiatry and medicine at Harvard Medical School and founder and executive director of the Innovation Center on Sex Differences in Medicine at Massachusetts General. Hospital. “He’s adjusting to a new normal.”


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