Menopause and your brain: what changes, and what helps

If you are in menopause, or noticing the first hormonal changes in your body, this article is for you.

Many of the women who train with me are 40+ and have started to notice changes. For many, menopause creeps in with a series of bodily sensations that can be overwhelming. Several years before your last period, in the phase called perimenopause, you may experience broken sleep, hot flushes, night sweats, heart palpitations, itching, aching joints, brain fog, low mood and a fatigue that sleep doesn't fix. The list is by no means complete.

These symptoms are real. But they are not driven by falling hormone levels alone. Oestrogen acts in many places in the body, including the brain, and the brain and nervous system go through their own transition.

Your brain changes too

In 2021, neuroscientist Lisa Mosconi and colleagues published a brain imaging study in Scientific Reports of women aged 40 to 65, before, during and after menopause, compared with men of the same age. They found changes in brain structure, connectivity and energy metabolism, including how the brain uses glucose, that followed menopause status rather than age alone.

Just as important was what came next: after menopause, many of the measures stabilised, and some brain regions showed signs of recovery and adaptation. In other words, the menopausal brain is not breaking down. It is adjusting to a new hormonal situation, and that adjustment takes energy.

Hot flushes start in the brain

Hot flushes are a good example. Body temperature is regulated by the hypothalamus, deep in the brain. As psychiatrist and researcher Robert Freedman describes in a review in the Journal of Steroid Biochemistry and Molecular Biology (2014), the comfortable temperature range the body tolerates narrows around menopause. Then even a small rise in core temperature can trigger a full heat-loss response: flushing, sweating and a racing heart. The narrowing is linked to falling oestrogen and to higher activity in the stress branch of the nervous system.

How your brain reads your body

This is where something I find fascinating comes in: interoception, the brain's ability to sense, interpret and respond to signals from inside the body. It helps regulate temperature, blood sugar, blood pressure, digestion and emotional states. A key region for interoception is the insula, deep in the cerebral cortex.

Researchers have linked disturbed interoception to both physical and emotional symptoms, for example in a large review on depression by Cara Harshaw in Psychological Bulletin (2015). My way of looking at menopause builds on that idea: when the brain is adjusting to new conditions, it may read the body's signals less accurately and react more strongly than the situation requires.

And please note: this is an unconscious process. Do not read "drama queen" into any of this.

The good news: you can do something

Training is not a cure for menopause. But it is one of the most useful tools you have. In a randomised controlled trial from Linköping University, published in Maturitas in 2019 by Emilia Berin and colleagues, postmenopausal women with frequent hot flushes did 15 weeks of strength training three times a week. Their moderate to severe hot flushes fell from an average of 7.5 to 4.4 a day, while the control group barely changed. It was a small study of 58 women, but the result is encouraging.

Strength training also protects what oestrogen used to help protect: muscle and bone. And in my experience, many women who train with my method tell me they sleep better, feel calmer and feel more at home in their bodies again.

Don't fight your body

What you do NOT need is to fight your body, cut calories drastically or exhaust yourself with hard training in an attempt to get back the body you had ten years ago. In my view, a large energy deficit and constant physical strain only add to the stress your system is already dealing with.

Instead, give your body what it needs now:

• Strength training, little and often. Short sessions that challenge your muscles, rather than long sessions that drain you.
• Enough food, and enough protein. Your muscles need building material to respond to training.
• Calm breathing. Slow, paced breathing has reduced hot flushes in controlled studies described in Freedman's review, and it costs nothing to try.
• Sensory stimulation. Exercises for balance, eyes and body awareness help the brain read the body more accurately.
• A conversation with your doctor. Training works well alongside medical treatment such as hormone therapy. It is not a replacement.

A new phase, not the end

Yes, the hormones linked to reproduction decline. But menopause is not your body's attempt to write you off. It is a transition, and many women come out of it with a different kind of strength and clarity.

Support your brain and body through this phase, meet the new needs that arise, and you give yourself the best chance of renewed drive and a calm sense of strength, well into old age.

STRONG THINGS, Anna's digital strength club, is coming in English. Join the waitlist to be the first to know.