Journal

In post-menopausal women, the earliest change in the brain appears to be a fall in the amount of glucose used by the brain, indicating reduced brain activity. This is due to falling estrogen levels, this hormone being vital for brain glucose metabolism.

Vasomotor symptoms (VMS) are the symptom characteristic of the menopausal transition but may occur before, during, or after menopause. These symptoms include hot flashes and night sweats.

At present, it is thought that the hippocampus, parahippocampus, and multiple regions of the prefrontal cortex of the brain are involved in the origin of the cognitive decline associated with severe VMS.

VMS is associated with high blood pressure, high blood lipid levels, a tendency towards insulin resistance and diabetes risk, and sometimes a procoagulant profile. The risk of future stroke is also suggested to be higher in women with more severe objective VMS.

VMS is also associated with increased cortisol levels, at about 20 minutes following the event, which is known to be linked to memory impairment. These events may also often cause a 5% decrease in blood flow. Thus, VMS may be determinants of cognition at this midlife transition point.

…compared to males, women undergoing or past menopause showed higher structural connectivity and myelination, which may indicate that the neural networks in these regions are more efficient following the onset of menopause.

Menopause itself, therefore, does not herald a drop in cognitive ability, unlike the transitional period itself. In fact, women do better at cognitive tasks than men over their adult life, including during dementia! Instead, menopause may be considered “a dynamic neurological transition that reshapes the neural landscape of the female brain during midlife endocrine aging, [with] an adaptive process serving the transition into late life.”