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title: "Brain Health in Perimenopause and Menopause: Enhancing Lifestyle, Diet, and Sleep"
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Menopause_ Brain Health, Lifestyle, Diet, and Sleep

Brain fog, often described as subjective cognitive difficulties, is a common complaint among midlife women, particularly during the menopausal transition. Research suggests that changes in estrogen levels, especially the decline of Estradiol (E2), play a significant role in these cognitive symptoms. Understanding the relationship between estrogen and brain fog is important for counselling and treatment strategies.

"Circulating sex hormones decrease in the course of aging, more rapidly at menopause in women, and slower in men. This drop in estradiol affects modulating neuroprotection and resilience in the aging brain downstream of spatiotemporal estrogen receptor alpha (ERα) and beta (ERβ) signaling, as well as in terms of the sex differences observed in Alzheimer’s disease (AD) and Parkinson’s disease (PD)." (Nalvarte et al, 2021)

Navigating the changes that come with the [menopausal transition](/blog/understanding-menopause-symptoms-stages-and-what-to-expect)requires attention to several aspects of health, with brain health playing a crucial role. A balanced diet, regular physical activity, and quality sleep can significantly improve your cognitive function and mood during this window of time. Research has shown that omega-3 fatty acids and a plant-focused diet can support mental wellness and help reduce brain fog and mood swings.

"Menopause can influence cognitive performance, but cognitive complaints in midlife women are common and not necessarily a sign of Alzheimer's disease or other serious cognitive disorders."(Henderson & Maki, 2016)

Lifestyle changes can make a significant difference. Embracing habits like [mindful eating](/blog/emotional-eating-understanding-and-overcoming-our-food-mood-connection)and regular exercise not only supports your brain but also enhances your overall quality of life. Sleep disturbances are common during the menopausal transition, impacting both mental and physical health. Practicing good sleep hygiene can reduce symptoms and improve well-being.

# Understanding the Menopausal Transition

Perimenopause and menopause are natural phases in a woman’s life characterized as part of the [menopausal transition](/blog/managing-hot-flashes-in-the-perimenopause-transition). This window of time can affect various aspects of health, including a woman's mood, sleep, and cognitive function.

"Menopause-related brain fog is common in midlife women, with small declines in objective memory performance but generally within normal limits." (Pauline & Maki, 2024)

# Hormonal Changes and Their Effects

 Perimenopause is the decade of a woman's life prior to the low of her final menstrual period (FMP). Menopause officially begins when you have not had a menstrual period for 12 consecutive months (1 full year). Hormonal fluctuations can disrupt sleep, further impacting mood and cognitive function. As levels of estradiol (estrogen) decline within the menopausal transition, women may start experiencing physiological changes such as: 

- hot flashes
- night sweats
- mood swings
- sleep changes

Estradiol, in particular, plays a crucial role in brain health, and fluctuations can lead to symptoms like brain fog or cognitive difficulties.

"Estrogen decline during menopause is linked to cognitive changes, sleep issues, and mood changes, with mixed clinical effects." (Jones, et al, 2019)

# Dietary and Lifestyle Considerations for Menopause

When managing menopause, diet plays a crucial role in promoting brain health and overall well-being. Consuming certain nutrients and following a balanced diet can help manage symptoms and support your body during this phase of life.

# The Mediterranean Diet and Brain Health

The [Mediterranean diet](/blog/research-study-link-between-omega-3-fish-oil-supplementation-and-increase-in-bdnf) is a well-researched eating pattern that benefits brain health during menopause. This diet emphasizes fruits and vegetables, which are high in antioxidants that protect brain cells from damage. Incorporating extra virgin olive oil can improve cognitive function due to its healthy fats.

Rich in oily fish like sardines, salmon and mackerel, this diet provides essential omega-3 fatty acids necessary for brain health. It also encourages the consumption of legumes and nuts, which are linked to improved mental clarity. Limiting processed foods and reducing alcohol intake can further enhance cognitive function and prevent mood swings, making the Mediterranean diet an effective choice for menopausal women. For more details on lifestyle changes during menopause, consider exploring this resource.

You can download my free MED Diet checklist [here](/med-diet/hormone-health) .

# Sleep and Cognitive Function During Menopause

During menopause, sleep disturbances can significantly affect cognitive function. Managing these disturbances and practicing good sleep hygiene are crucial for maintaining mental clarity and preventing cognitive decline.

Sleep disturbances are common in menopause and can lead to memory problems and mild cognitive impairment. Symptoms like insomnia and fragmented sleep can be addressed through lifestyle changes and therapy.

Cognitive behaviour therapy (CBT) is effective in treating insomnia by changing negative patterns around sleep. Adjusting your environment, such as keeping the bedroom cool and dark, may also help. Nutritional changes, like reducing caffeine and alcohol, are key as these substances can negatively impact sleep quality. For some, hormone therapy options may be advisable with guidance from a healthcare provider. Addressing these factors can enhance sleep quality and support cognitive health.

# Principles of Sleep Hygiene

I talk a lot about having good sleep hygiene. It involves establishing a calm wind-down routine and maintaining a regular sleep schedule by going to bed and waking up at the same time each day can help regulate your internal clock.

Creating a relaxing bedtime routine, such as:

- dimming the lights in the evening and have less bright lights as this signals to your brain that evening is approaching
- calming the brain by doing relaxing activities such as reading a book, deep breathing exercises, or listening to calm music, can signal your body to wind down
- keep your bedroom free from electronic screens which means no phone or tablet or computers in the bedroom (if you use your phone as an alarm clock, plug it in another room like the bathroom far from your bedside table)
- a warm bath/shower/hot tub/sauna at least one hour before going to bed is very relaxing to the body (avoid taking one too close to bedtime as your body temperature needs to cool slightly in order to sleep)
- keep your bedroom cool, and wear light pajamas to bed and thinner comforters depending on the season (yes you want to keep your room slightly cooler especially in the summer months you need to dress and change your bedding accordingly)
- consider essential oils such as lavender room spray as an aromatherapy it is calming to your nervous system

Exercise during the day can promote better sleep, but avoid vigorous activity close to bedtime. By focusing on these sleep hygiene practices, you can safeguard and maintain your sleep.

# Mental Well-being and Cognitive Health

The menopausal transition often brings mood swings and anxiety, which can impact cognitive health. Managing stress through various techniques, including mindfulness and cognitive therapies, can help improve your overall mental health.

Mindfulness and cognitive therapies can help enhance cognitive function and mental well-being. Mindfulness focuses on being present in the moment, which reduces stress and improves mood. Techniques like meditation and deep-breathing exercises can help lower anxiety levels.

Cognitive therapies, such as CBT, offer tools to challenge negative thought patterns. This therapy helps you develop healthier ways of thinking, reducing anxiety, and depression. Speak to a licensed therapist or psychologist about the best option for you.

# Menopause, Hormone Therapy, and Brain Health

Menopause often brings changes in hormone levels that can affect your brain health. Hormone therapy, especially using estrogen or progesterone, may offer some benefits. There are also alternative treatments worth considering.

"The female sex hormone estrogen has been ascribed potent neuroprotective properties. It signals by binding and activating estrogen receptors that can mediate gene transcription and rapid non-genomic actions. In this way, estrogen receptors in the brain participate in modulating neural differentiation, proliferation, neuroinflammation, cholesterol metabolism, synaptic plasticity, and behavior." (Nalvarte, et al, 2021)

# Benefits and Risks of Hormone Therapy

Hormone Therapy (HT) can help balance estrogen and testosterone levels, offering potential benefits for brain health. Studies suggest that HRT may help reduce symptoms such as mood swings and "brain fog." It might also support memory and cognitive functions. However, according to the [Menopause Society](http://www.menopause.org) (formerly known as NAMS - North American Menopause society), [hormone therapy](/blog/managing-hot-flashes-in-the-perimenopause-transition) is not indicated indicated only for the treatment of brain fog, without the other real indications for it's use which are vasomotor symptoms (hot flashes, night sweats) and for the prevention of bone loss.

Personalized medical advice can guide whether HT is suitable for your situation. Balancing benefits and risks is key when considering hormone therapy.

# Physical Health Correlates with Brain Health

Making changes in daily habits can support your brain health during menopause.  This is particularly critical during menopause as hormonal changes can affect mood and cognitive function.  Regular physical activity plays a vital role in maintaining a healthy weight, which is important since menopause can sometimes lead to weight gain. 

Exercise is a cornerstone of brain health during menopause. Regular exercise, including both aerobic and [strength training](/blog/weight-training-and-protein-and-creatine-maximizing-your-fitness-results), boosts mood and reduces stress. It also supports cognitive health by increasing blood flow to the brain.

Physical activity helps manage sleep disturbances, which are common during menopause. Adequate sleep is crucial for cognitive function and emotional stability. Incorporating workouts into your routine enhances mental clarity and helps in managing menopausal symptoms more effectively.  This approach maximizes the benefits for brain health and overall well-being.

Maintaining physical health during menopause is crucial for brain function. Cardiovascular health and bone mineral density are two important factors to focus on. Keeping these in check can support your brain health as you navigate changes in your body.

# Cardiovascular Health in Menopause

During menopause, changes in hormone levels can impact your cholesterol markers and your overall heart health. Women are more at risk for heart disease during the menopausal transition, making it essential to monitor your blood pressure and cholesterol levels. Regular check-ups with your doctor are vital during this time. I recommend a minimum of checking these annually with your primary care provider.

Staying physically active can help manage these risks. Exercise improves blood flow and supports heart function, which benefits your brain. All physical activity is beneficial, but aim for at least 30 minutes of moderate exercise most days, a minimum of 150 minutes of physical activity per week up to 300 minutes per week for weight loss is the exercise recommendations for adults over 40.

Including heart-healthy fats like omega-3 fatty acids in your diet can also be beneficial at least 2-3 times a week. These can be found in fish/seafood, pumpkin seeds, walnuts, and flaxseeds , which may help reduce inflammation and support both cardiovascular and brain health. The highest source is from fish and seafood or a good quality supplement.

# Social Support Systems 

Navigating menopause can be challenging, but having the right support can significantly improve your quality of life. Understanding the impact of social networks and access to educational resources can enhance coping strategies during this time.

- Church groups/spiritual support
- close neighbours/friends
- exercise buddies at the gym
- book club friends
- your partner/family/friends you can share your concerns with - without feeling judged

Any support from family & friends whom you can trust and/or share the same interests as you is a huge win-win.  Strong social networks can play a critical role during menopause. Friends and family who support you emotionally can make this transition less stressful. Sharing experiences and advice with others can help you feel understood and less isolated.

Women who engage in regular social activities tend to report better overall well-being. These interactions can also boost cognitive function by keeping your mind active and engaged.

# Educational Resources and Support Groups

Access to educational resources and support groups is vital for managing menopause effectively. Resources such as books, online services, and webinars can provide valuable information about symptoms and treatments.

Support groups offer a space to share real-life experiences and tips. Connecting with others who are experiencing similar challenges can be reassuring and empowering. These groups often provide practical solutions and emotional support. Using these resources can enhance your knowledge and improve your ability to navigate menopause with confidence. If you need support, don't be afraid to ask for help.

# Resources for mental health concerns or conditions

- Ontario 211 quickly and confidentially connects adults and children to mental health agencies. It can be found by calling 211 or 1-877-330-3213 or visiting their website [here](http://www.211ontario.ca).
- ConnexOntario [www.connexontario.ca/en-ca](http://www.connexontario.ca/en-ca)
- Canadian Mental Health Association (CMHA): National community mental health organization that offers support and resources for all Canadians [www.ontario.cmha.ca](http://www.ontario.cmha.ca)
- Wellness Together Canada: Provides free online resources, tools, apps and connection to trained volunteers and qualified mental health professionals when needed https://www.wellnesstogether.ca/en-CA or call 1-866-585-0445 (available 24/7) 

Estrogen decline during menopause is associated with both subjective and objective cognitive changes, commonly referred to as brain fog. The menopausal transition can affect brain health in several ways including brain fog. Managing your lifestyle, diet, and sleep can help improve these issues. R egular physical activity is beneficial as exercise supports not only physical health but also mental well-being by reducing stress. C onsuming nutrient-rich foods can aid in managing weight and reducing the risk of cardiovascular and other health conditions. Diets high in fruits, vegetables, and fish/seafood support brain health such as the MED diet.

Download the free MED Diet checklist [here](/med-diet/hormone-health).  Addressing sleep disturbances can increase your overall quality of life. For some women who suffer from hot flashes and night sweats, considering Hormone Therapy (HT) is a safe and valid option. While hormone therapy is indicated for some women with vasomotor symptoms a personalized approach is needed. As always please discuss any changes with your primary care provider prior to starting any new treatment.

I'm also available for free discovery calls and would love to support you in your health journey. You can book [here](https://dramytung.janeapp.com/#/free-discovery-call) .

To your best health,

Dr. Amy Tung, ND, MSCP

Naturopathic Doctor

Menopause Society Certified Practitioner

# References:

Brinton, R., Yao, J., Yin, F., Mack, W., & Cadenas, E. (2015). Perimenopause as a neurological transition state. Nature Reviews Endocrinology, 11, 393-405. https://doi.org/10.1038/nrendo.2015.82.

He, L., Guo, W., Qiu, J., An, X., & Lu, W. (2021). Altered Spontaneous Brain Activity in Women During Menopause Transition and Its Association With Cognitive Function and Serum Estradiol Level. Frontiers in Endocrinology, 12. https://doi.org/10.3389/fendo.2021.652512.

Henderson, V., & Maki, P. (2016). Cognition and the menopause transition.. Menopause, 23 7, 803-5 . https://doi.org/10.1097/GME.0000000000000681.

Maki, P., & Jaff, N. (2024). Menopause and brain fog: how to counsel and treat midlife women.. Menopause. https://doi.org/10.1097/GME.0000000000002382.

Mosconi, L., Berti, V., Quinn, C., McHugh, P., Petrongolo, G., Osorio, R., Connaughty, C., Pupi, A., Vallabhajosula, S., Isaacson, R., De Leon, M., Swerdlow, R., & Brinton, R. (2017). Perimenopause and emergence of an Alzheimer’s bioenergetic phenotype in brain and periphery. PLoS ONE, 12. https://doi.org/10.1371/journal.pone.0185926.

Nalvarte, I., Leander, K., Nilsson, P., & Maioli, S. (2021). Estrogen receptors and the aging brain. Essays in Biochemistry, 65, 913 - 925. https://doi.org/10.1042/EBC20200162.

Weber, M., Rubin, L., Schroeder, R., Steffenella, T., & Maki, P. (2021). Cognitive profiles in perimenopause: hormonal and menopausal symptom correlates. Climacteric, 24, 401 - 407. https://doi.org/10.1080/13697137.2021.1892626.

# Disclaimer:

The information in this blog is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health professional with any questions regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking treatment because of something you have read in this blog.

Individual results may vary, and the strategies discussed here are not guaranteed to work for everyone. This content does not create a patient-client relationship and should not be used as a replacement for personalized medical care.