Your Brain During Menopause

Understanding the neurological changes of menopause and how evidence-based wellness modalities can help

If you're navigating perimenopause or menopause, you've likely experienced symptoms that go far beyond hot flashes—brain fog, sleep disruptions, mood changes, and memory concerns. For years, these neurological symptoms were dismissed or poorly understood. But groundbreaking research from neuroscientist Dr. Lisa Mosconi is changing that narrative, revealing that menopause is actually a profound neurological transition that reshapes the female brain.

Even more encouraging? This research points to a critical window of opportunity during midlife when specific interventions may support brain health and potentially reduce the risk of cognitive decline later in life.

In this article, we'll explore Dr. Mosconi's landmark findings on how menopause affects the brain, and examine how evidence-based wellness modalities—including float therapy, infrared sauna, cold plunge, and halotherapy—can support women through this transition. These aren't just trendy spa treatments; they're scientifically-backed interventions that address the specific neurological changes happening in your brain during menopause.

What Dr. Lisa Mosconi's Research Reveals About the Menopausal Brain

Dr. Lisa Mosconi, Director of the Women's Brain Initiative at Weill Cornell Medicine, has conducted pioneering research using advanced neuroimaging to understand how menopause impacts the brain. Her findings are both fascinating and empowering.

The Brain Undergoes Significant Changes During Menopause

In her landmark 2021 study published in Scientific Reports, Dr. Mosconi and her team used multiple brain imaging techniques to scan 161 women between ages 40 and 65 at different stages of menopause. What they discovered was remarkable: menopause causes substantial differences in brain structure, connectivity, and energy metabolism[1].

The changes involved brain regions responsible for higher-order cognitive processes—the areas that handle memory, attention, and executive function. Critically, these changes were specific to menopausal endocrine aging rather than simply chronological aging, as determined by comparison to age-matched men[1].

Key findings included:

• Gray matter volume declined in multiple brain regions during the transition

• Brain energy metabolism (glucose use) decreased significantly

• White matter volume declined throughout the brain

• Amyloid-beta deposition (Alzheimer's plaques) was more pronounced in perimenopausal and postmenopausal women carrying the APOE-4 genotype[1]

  
  

But Here's the Good News: The Brain Adapts

While these changes might sound alarming, Dr. Mosconi's research revealed something hopeful: the brain has remarkable adaptive capacity. Brain biomarkers largely stabilized post-menopause, and gray matter volume actually recovered in key brain regions important for cognitive aging[1].

Even more encouraging, the brain demonstrated compensatory mechanisms:

• Increases in cerebral blood flow in regions where volume declined

• Elevated mitochondrial ATP production (cellular energy)

• These compensatory changes correlated with preservation of cognitive performance post-menopause[1]

This suggests that with the right support, the brain can successfully navigate this transition and emerge resilient on the other side.

Estrogen Receptors Increase During Menopause

In groundbreaking 2024 research using specialized PET imaging, Dr. Mosconi discovered something unexpected: estrogen receptor density in the brain actually increases during the menopausal transition, remaining elevated even into the mid-60s[2].

This finding challenges conventional thinking. Rather than simply losing estrogen's effects, the brain appears to upregulate its receptors—possibly as a compensatory mechanism trying to capture whatever estrogen remains available[2].

Higher estrogen receptor density was associated with:

• Lower gray matter volume and blood flow

• Higher mitochondrial ATP production (energy generation)

• Changes in thermoregulation, mood, cognition, and libido[2]

The Critical Midlife Window

Perhaps most importantly for intervention strategies, Dr. Mosconi's meta-analysis of hormone therapy studies revealed that timing matters critically. Her 2023 systematic review found that midlife estrogen therapy (started within 10 years of menopause) was associated with a 32% reduced risk of dementia, while late-life therapy showed no benefit and potentially increased risk[3].

This suggests there's a critical window during perimenopause and early post-menopause when interventions may have the greatest impact on long-term brain health[4].

References

Scientific References

[1] Mosconi L, Berti V, Dyke J, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11(1):10867. PMID: 34108509

[2] Mosconi L, Jett S, Nerattini M, et al. In vivo brain estrogen receptor density by neuroendocrine aging and relationships with cognition and symptomatology. Sci Rep. 2024;14(1):12680. PMID: 38902275

[3] Nerattini M, Jett S, Andy C, et al. Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia. Front Aging Neurosci. 2023. PMID: 37937120

[4] Mosconi L, Nerattini M, Williams S, Fink M. New Horizons in Menopause, Menopausal Hormone Therapy, and Alzheimer's Disease: Current Insights and Future Directions. J Clin Endocrinol Metab. 2025. PMID: 39815764