How Menopause Affects Your Brain

Forget what you’ve heard about senior moments. The chemical shifts of menopause do change how a woman’s brain works — but in a good way.

By Kathryn Olney

How Menopause Changes Our Views and Reactions

For the 150,000 American women who enter menopause each month, neuropsychiatrist Louann Brizendine, MD, has cheering news: "The change will set you free." That counterintuitive tone informs her new book, The Female Brain, which has sparked controversy for its stance that there are measurable brain differences between men and women and that hormones maintain those differences. "It may not be politically correct, but it’s biologically true," says Brizendine, who has run the Women’s Hormone Clinic at the University of California, San Francisco, for 12 years. The decline in hormones that comes with menopause, she argues, allows us to stop putting others’ needs before our own, sometimes for the first time in our lives. Here, she explains how — and why — menopause is the beginning of a brave new way of thinking.

Q. I really identified with your patient Sylvia. Like her, I am suddenly irritated by things my husband and three kids have done for years, things that didn’t get to me before. I’m 50. Is this shift is due to changes in my brain?

A. Yes, you are leaving your "mommy brain" behind. Before menopause, the brain is constantly triggered by and reacting to the needs of others, particularly children and husbands. As you go into menopause, the highs and lows of estrogen and progesterone that have been cycling through your brain since puberty come to an end. That means your brain is on a more continuous footing, hormone-wise. Note that I’m not saying "more stable" footing, because that implies that previous to menopause you weren’t stable.

Q. Can my brain still be set free if I slap on a hormone patch every three days?

A. The brain is changing its fuel, even if you go on hormone therapy. The dose of therapeutic hormones is five times lower than in birth control pills, so it’s a really tiny amount. During a menstrual cycle, for example, the amount of estrogen in your system fluctuates from a low of 50 pmol/L to a high of 300 pmol/L. But with HT, it starts at 5 pmol/L. So even if you are on HT, it’s 10 to 15 percent of what you had before menopause — and you’re getting it at a constant level.

Q. So is that why I feel as if I can draw boundaries better than before?

A. Exactly. Before menopause, a woman’s hormones encourage her to avoid conflict. Our estrogenized brain circuits cause us to respond to stress with nurturing activities that are intended to protect our relationships. From puberty to menopause, a woman walks a fine line between making sure she’s at the center of her relationships and risking pushing those relationships away through anger or aggression. The urge to walk this line doesn’t stop until the hormone supply that fuels it is cut off, which happens in menopause. As the ratio of testosterone to estrogen rises, the anger pathways in a woman’s brain become more like a man’s. Now she gets angry, whereas before she may have just bitten her tongue. At the very least, she’ll stand up for herself and say, "I’m not doing that anymore."

Q. I loved that when Sylvia’s kids came home from college, she would still throw their laundry in the wash, but told them to "match their own damn socks."

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