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Your Brain on Perimenopause: 6 Ways to Stay Sane

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Women I know who are dealing with perimenopause all want answers to pretty much the same questions: How do I deal with hot flashes? Will I ever be able to sleep through the night again? And, perhaps the most urgent one: Am I going completely crazy? I suppose the answer to the latter depends on many things, but according to my research (and my own definition of the word “crazy,” which of course is quite lackadaisical — I mean, I’m a writer), I can assure you that you are probably quite sane. You’re just going through the estrogen withdrawal related to perimenopause and menopause — you know, like an addict coming off nicotine or heroin. There, that’s comforting, isn’t it?

Here are some of the ways your brain is changing now that you’re going through perimenopause.

Your memory is… what’s that word again? … declining.

If your husband or boyfriend or brother can’t think of the actor in that movie, it’s surely because he’s getting old. But when you can’t think of her name, it’s not because you’re aging — it’s because you’re losing estrogen.

In a 2013 study of over 2,000 women, scientists found that when the women were pre-menopausal, they performed well on various memory tests. When their estrogen fell during perimenopause, they didn’t perform as well. But if they were given estrogen supplements before they hit menopause (that is, before they went 12 months in a row without a period), their scores once again rose — and scores rose again in women who were post-menopausal. Therefore, it was determined that rather than due to aging or a drop in estrogen that made their scores fall, it was the fluctuations of estrogen during perimenopause that caused memory lapses.

Which means that once you’re post-menopausal, your memory should be back to normal once more! (Hmmm, will your husband be able to say the same thing in five years?)

Your hot flashes are more than merely annoying.

Another reason your memory might not be what it once was? According to research, the more hot flashes a woman has, the worse her memory is. But thanks to the brain’s plasticity, once a woman ceases to have hot flashes, her memory bounces right back.

It’s normal for both men and women to have very tiny little strokes as we age. (I know, I was happier before I knew that fact as well.) The result is a slight slowing down of our thinking process over time. But perimenopausal women who have more hot flashes have more ischemic changes in the brain than women who have fewer hot flashes; in other words, hot flashes are probably causing us to have more of these tiny strokes. Which raises the question, if we treat — and thus reduce — hot flashes, can we reduce these tiny strokes, and thus avoid the attendant memory loss? Many scientists believe the answer may be yes. (As for how to treat and avoid hot flashes, see below…)

Your emotions are all over the place.

“I want to divorce my husband, but our house is worth less than we paid for it, all our money is going to the kids’ college, and I just feel if we divorced, I’d be in poverty. But he has a two-million-dollar life insurance policy! So I’m thinking of doing him in.”

My friend Jane (name changed to protect the not-very innocent) told me this over coffee at Starbuck’s. (I thought if she was going to get away with murder, she was going to need to do a better job of it than confess her crime in a public place beforehand, but what do I know?)

“Geez!” I shouted/whispered. “What’d he do?” I wondered what unspeakable act my friend’s spouse had committed to make her want to kill him after 18 years of marriage.

But she just shrugged and sipped her mocha. “I’m always cleaning up after him. It’s like I have three kids, not two. I think he loves the Packers more than he loves me. I want to move to Boca Raton and open up a shell shop on the beach.”

While Jane’s story is extreme (and I’m happy to report her husband is still alive and well — at least at the time of this writing), its theme is not unusual. Many women I know, including myself, have dealt with a plethora of emotions — including anger and sadness — during perimenopause, which seems to come from out of nowhere.

As one of my friends put it, “I don’t know who I am anymore. Some days I love my girlfriend. Some days I don’t. Some days I love my job. Some days I’m ready to quit. One minute I’m feeling confident about being 50, like I know what I’m doing. The next, I feel empty, sad, lonely. Which emotion is real? Who is the real me?”

I can’t answer this question for everyone, of course, but I know that when my doctor prescribed for me low-dose birth control pills, I began to feel more like “myself.” (“Myself,” it seems, includes a little more and more regularly flowing estrogen than perimenopausal Kelly naturally has.)

So our brains on perimenopause are forgetful, stroke-y, anxious, depressed, and occasionally murderous...

Menopause Brain Fog: What Can We Do About It?

Menopause is defined by not having your period for 12 consecutive months. Symptoms may not go away immediately upon reaching menopause. So how can we treat our “estrogen withdrawal?” Put another way: How can we make it through perimenopause on this side of the glass house?

1. Relax.

The most annoying command in the English language must be, “Relax.” But that’s exactly what Harvard University stress expert Alice Domar, PhD says to do, and her research backs her up. In studies she conducted, Dr. Domar reports that women who participated in organized relaxation saw a 30 percent decrease in their hot flashes, as well as decreases in tension, anxiety, depression, mood swings and unstable emotions. So meditate, walk, download that relaxation app, and... relax.

2. Go to sleep.

Getting a good night’s sleep helps us stabilize our moods (and also helps us from gaining weight, by the way). But insomnia is a common complaint among perimenopausal women due to estrogen fluctuations and hot flashes. Some tips: sip Valerian root tea a half-hour to forty-five minutes before bed; sleep with a fan, moisture-wick pajamas, and a room no warmer than 68 degrees; don’t use electronic devices before bed; and limit caffeine and spicy foods for hot flashes and night sweats.

3. Move.

As reported in CNN, a 2016 study published in The Journal of the North American Menopause Society of 6,000 Latin American women found that 16 percent of sedentary women (those who got less than 30 minutes of exercise three times a week) had severe menopausal symptoms — including hot flashes, insomnia, vaginal dryness, and depression — whereas only 11 percent of the active women had severe symptoms. The takeaway? Swim, walk, jog, dance… move!

4. Consider herbal supplements.

Many women have found herbal supplements such as Black Cohosh useful for hot flashes. Estroven is a menopause dietary supplement with six different products ( such as one for sleeping cool, weight management, and more), all of which receive 4 and 5-star reviews.

5. Ask your doctor about hormone replacement therapy.

There is no question that in an ideal world, the best way to treat estrogen loss would be to replace it with estrogen. But the question of whether or not women should take estrogen and progesterone is a complicated one, and is not a decision that should be made lightly, or without proper medical supervision. The North American Menopause Society has a statement on its website that reads “The Experts Do Agree About Hormone Therapy” — but that statement is complicated. Please read it and discuss with your doctor if HRT is right for you

6. Know that you’re (more or less) perfectly sane — and not alone.

On my worst days, I don’t feel like much of a poster woman for sanity. After I’ve gone on the treadmill, lifted weights, done crunches, and I’m stretching on the mat, all it takes on those days is one stupid Ed Sheeran song to come on the radio to find myself crying in the gym. I know my emotional swing has something to do with adrenaline and serotonin and estrogen and whatever embarrassing hormone it is that makes people cry over sappy love songs, and that knowledge makes me feel a little better. I breathe out, breathe in, and tell myself I’m not alone. Other women are going through this, too. It’s some sisterhood of estrogen withdrawal that affects us in our entirety—our bodies and our brains—and it isn’t always pleasant, and sometimes it’s quite difficult, but it helps to know we’re not alone.

Let’s just not test our friendships by seeing if we can count on one another for bail money.

This post was written by Kelly Dwyer, a novelist and freelance writer.

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