A Very “Demure and Mindful” Menopause Primer
Rachel’s Ruminations
A Very “Demure and Mindful” Menopause Primer
The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence
by Lisa Mosconi, PhD
When the topic of menopause comes up, what do most people think of first?
· Hot flashes
· Night sweats
· Abdominal weight gain
One of my respected colleagues recommended this book on social media right after it was published. Because a large percentage of my patient population struggles with hormone imbalance, I thought this read was very apropos for myself clinically and as a potential resource for my perimenopausal ladies. I erroneously assumed the book would primarily be about memory loss, more commonly reported as “brain fog,” and mood changes (depression, anxiety, mood swings, irritability) because of fluctuating and declining estrogen levels as women transition through menopause. Was I surprised to learn that the brain plays a huge role in this entire process, not just cognition!
Did you know that estrogen was not even discovered until 1934???
And that scientists did not discover until the late 1990s that sex hormones were key for brain function as well as reproduction!!!
The book is divided into 4 parts; part 1 is essentially a menopause primer which provides foundational elements needed to understand what menopause is, how it impacts the brain, and how medicine fails to recognize this crucial connection. Dr. Mosconi captivates her audience with the clever title of chapter 1: “You are Not Crazy” (and I will tell you what, this is a huge fear/complaint during menopause due to those fluctuating hormones!), followed by another catchy header for chapter 3: “The Change Nobody Prepared You For” (so true, until recently this topic was somewhat taboo). She cites that 75% of women develop brain symptoms during menopause! Dr. Mosconi mentions on page 6 that women are uninformed about menopause and caught off guard, feeling betrayed by both their body AND their brain—most doctors don’t make the connection between menopause and symptoms like anxiety, insomnia, depression, or brain fog—and are sent home with a prescription for anti-depressants. On page 7 she goes on to write that ob/gyns are not trained in med school to diagnose and manage brain symptoms; fewer than 20% of ob/gyn residents receive formal training in menopause medicine, which consists of a few hours. 75% of women who seek care for menopausal symptoms end up NOT receiving treatment. Neurologists and psychiatrists are not trained to treat menopause either…
Honestly, most of my tabs for this book were in part 1. I learned a new term “neuro-sexism” which is the myth that women’s brains are inferior to men’s brains (to learn more, read chapter 2 “Busting the Bias Against Women and Menopause”). I knew that historically medical research included male-only samples. I was shocked to learn on page 20 that this is still predominantly true—countless drugs have been approved that were never tested on women or female animals. The vast majority of preclinical studies still use male animals, so this data only applies to half the world’s population and leads to a persistent medical gender-bias.
Only 10-15% of women will sail through menopause unscathed. Most women experience an array of over 30 symptoms in various combinations. Mosconi explains that hot flashes are actually triggered by the brain as are about 50% of the myriad maladies of menopause. In chapter 4, Mosconi compares the “bodily” vs “neurological” symptoms.
Bodily symptoms include:
· Menstrual changes
· Vaginal dryness
· Pain with sex
· Stress incontinence
· Overactive bladder
· Joint pain/stiffness
· Muscle tension/aches
· Bone frailty
· Breast tenderness & swelling
· Loss of breast fullness
· Irregular heartbeat/palpitations
· Body composition changes
· Weight gain
· Slowed metabolism
· Bloating
· GERD (reflux)
· Nausea
· Hair loss
· Brittle nails
· Dry skin
· Itching
· Changes in taste
· Dry/burning mouth
· Tinnitus
· Hearing loss
· Noise sensitivity
· Allergies
Neurological (aka brain) symptoms include:
· Hot flashes
· Night sweats
· Insomnia
· Low libido
· Impaired cognitive performance
· Forgetfulness
· Impaired recall (names, dates, details)
· Word retrieval problems
· Difficulty expressing thoughts verbally
· Reduced focus/concentration
· Increased distractibility
· Brain fog/sluggishness
· Trouble thinking clearly
· Increased difficulty processing information
· Decreased decision making ability
· Decreased multitasking abilities
· Easily overwhelmed
· Lack of motivation/ambition
· Reduced stress resilience/increased perception of stress
· Dizziness
· Fatigue
· Headaches/migraines
· Depression
· Anxiety
· Mood swings
· Irritability
· Panic attacks
· Electric shock sensations
She goes on to delve into the 4 different hot flash patterns (I had no idea there were distinctions!). In a different section of this chapter, she states that more than half of perimenopausal women get less than 7 hours of sleep per night and 33% have difficulty staying asleep.
Part 2 focuses on the brain-hormone connection where Dr. Mosconi discusses the role of hormones for brain health and how this interplay is critical in understanding menopause with enticing chapter preludes like “Brain and Ovaries: Partners in Time” and the “Upside” and “Why” of Menopause. She discusses the 3 Ps: Puberty, Pregnancy, and Perimenopause in chapter 6; these are 3 pivotal times during which the brain and hormones change dramatically.
In part 3, Dr. Mosconi succinctly yet thoroughly elaborates on hormonal and nonhormonal therapies and dispels some myths which is so helpful because menopausal hormone therapy (MHT) has gotten a bad rap since the Women’s Health Initiative study was released in the early 2000s. She also addresses gender-affirming therapy for transgender individuals.
In typical current nonfiction health format, part 4 dives into what perimenopausal women really want to know—key natural strategies to help deal with menopause. She covers everything from exercise to diet & nutrition, to supplements & herbs, to avoiding endocrine disruptors, along with the power of a positive mindset.
For even more reasons to take the connection between brain function and women’s health seriously, consider these statistics about postmenopausal women:
· Twice as likely as men to be diagnosed with anxiety and/or depression
· Twice as likely to develop dementia
· Three times more likely to develop autoimmune disease
· Four times more likely to suffer from headaches and/or migraines
· More likely to develop brain tumors
· More likely to die from stroke
Clearly, women’s brains are not the same as men’s—they differ hormonally and chemically.
In a very intellectual and thorough manner, Dr. Mosconi proves how menopause changes your brain based on brain scans. She provides solutions for addressing the symptoms of menopause without prescriptions. She encourages empowerment through ideas on how to control your lifestyle, environment and mindset.
The good news is that despite this arduous transition (unhappiness and discontentment increase 3 years prior to and this dissatisfaction continues 2-3 years post last menstrual period), up to 65% of postmenopausal women report experiencing an even stronger sense of well-being after menopause, including improved happiness & life satisfaction, greater independence, and more connection with partners and friends! So don’t give up hope if you are in the midst of this monumental journey! I encourage you to embrace and maintain a positive mindset during this process and view it as a turning point after which your interests, priorities, and attitudes will shift in a positive and uplifting way.
Rachel Oppitz, ND
