Brain Changes in Perimenopause: How hormones influence brain function causing anxiety, brain fog, insomnia and low mood

Perimenopause is the transitional phase of hormonal change that occurs before menopause, lasting between two to ten years. Progesterone and estrogen production changes during this time can bring about significant changes in a woman's body, including her brain. These neurocognitive changes can have a profound impact on daily life, affecting concentration, mood, sleep, and overall well-being. Many women find these changes to brain function the biggest challenge of perimenopause, and the effects on career and relationships can be lifechanging.

Understanding the Hormonal Changes of Perimenopause

Perimenopause begins with a decline in progesterone levels, which leaves estrogen unbalanced and sometimes fluctuating between high and low. As you move closer to menopause, estrogen can begin to decline and be low more frequently also. These hormones play crucial roles in regulating various bodily functions, including brain activity. Hormones influence your neurotransmitters, the chemical messengers that transmit signals between nerve cells in your brain. As estrogen and progesterone levels fluctuate they can disrupt the balance of neurotransmitters in your brain leading to a reduction of the benefits on mood, sleep and concentration from these necessary chemical messengers in your brain.

Symptoms of Brain Changes in Perimenopause

The impact of your changing hormones on neurotransmitters during perimenopause and menopause can a big influence on mood and brain function. These symptoms can be some of the most difficult for perimenopausal women to manage, as they try to function as normal raising a family, performing at work and juggling multiple responsibilities. Some of the most common cognitive changes perimenopausal clients report are:

1. Poor Concentration and Brain Fog:

• Difficulty focusing and concentrating

• Feeling "foggy" or unable to think clearly

• Trouble remembering things or following conversations

• Feeling unmotivated or overwhelmed at work or managing household responsibilities.

2. Sleep Disturbances:

• Difficulty falling asleep is a common complaint in perimenopause

• Overnight waking with an inability to fall back asleep

• Unrefreshing sleep leading to fatigue during the day

3. Anxiety and Mood Swings:

• Increased anxiety or irritability with no apparent reason

• Mood swings and emotional instability

• Feelings of sadness, low mood or hopelessness

4. Worsening of Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD) symptoms:

• Low progesterone in your luteal phase can result in reduced GABA, causing low mood and increased anxiety in the week before your period.

• As estrogen reduces, dopamine and serotonin upregulation is reduced which can lead to reduced motivation, reduced self-esteem, insomnia and anxiety at certain times of your menstrual cycle.

Neurotransmitters Impacted by Perimenopausal Hormone Changes

• Serotonin: This neurotransmitter is associated with mood, sleep, and appetite. Estrogen upregulates serotonin levels in the brain to promote positive mood and good quality sleep. Reduced levels of estrogen can result in mood swings, social anxiety, low pain tolerance and low self-esteem. Serotonin regulates sleep as a precursor to Melatonin, and low levels can cause insomnia and sleep disturbances, common issues in perimenopause.

• Dopamine: Dopamine is involved in motivation and attention. Changes in estrogen levels can impact dopamine production, affecting concentration and focus. Dopamine also regulates pleasure, reward and satiety. Low levels of dopamine can make it difficult to recognise when you have had enough to eat. The brain may seek dopamine from eating high-reward (ultra processed) foods and overeating or binge eating behaviours can occur as the brain creates an associate with food and pleasure and reward.

• GABA: GABA is our calming neurotransmitter, promoting a feeling of peace and wellbeing. It also promotes sleep and helps us maintain restful sleep throughout the night. Estrogen and progesterone both have effects on GABA production, and their reduction can lead to difficulty falling asleep or staying asleep. Low levels of GABA can also result in increased anxiety, panic attacks, palpitations and Premenstrual Syndrome or Premenstrual Dysphoric Disorder.

• Norepinephrine: This neurotransmitter is involved in arousal, attention, concentration, and stress response. Norepinephrine supports REM sleep, and low levels can reduce sleep quality. Fluctuations in estrogen can influence norepinephrine levels, contributing to anxiety and irritability. Low levels of norepinephrine are associated with chronic stress and fatigue, poor long-term memory, low mood and urinary stress incontinence.

• Acetylcholine: Acetylcholine is involved in the brain's ability to form new connections between neurons and reduced levels make it more difficult for the brain to process information efficiently. Hormonal fluctuations during perimenopause can lead to reduced acetylcholine levels which can impair cognitive function. This results in brain fog symptoms including difficulty concentrating, remembering things, and following conversations.

Coping with Neurocognitive Changes in Perimenopause

While these changes can be challenging, there are strategies to help manage them:

• Nutrition: Ensure your diet is balanced with protein, good fats and micronutrients needed to supply the precursors and cofactors needed to make sufficient neurotransmitters. Eating adequate fibre and nutrients to support liver detoxification can support hormone clearance to reduce imbalance symptoms.

• Lifestyle adjustments: Regular exercise, stress management techniques, and adequate sleep can help improve mood and cognitive function and support healthy hormone and neurotransmitter production.

• Nutritional Supplements: Supplements to provide the nutritional precursors and cofactors for neurotransmitter production can improve mood, sleep and cognitive function when adequate dietary intake is difficult to achieve.

• Herbal medicine: Imbalances of estrogen and progesterone can be reduced by certain herbal medicines. Neurotransmitters can be stimulated by herbal medicines to reduce difficult neurocognitive symptoms such as anxiety, low mood, brain fog and insomnia.

• Social connection: Connecting with others who are experiencing similar changes can provide emotional support and practical advice. Having a community of understanding and supportive people around you can help you feel less alone and boost the neurotransmitters needed for positive mood.

If you're experiencing significant neurocognitive changes during perimenopause, it's important to remember that you are not alone and there is support available. Working with a naturopath can help you understand your symptoms and develop a personalised treatment plan to get back to feeling like yourself again. To discuss treatment options you can book a free discovery call appointment to find out how naturopathy can help you.

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