Memory lapses, mental fog, broken nights, mood swings… At menopause, many women feel like their brain is playing tricks on them. What is really happening? A new imaging study is reassuring. We take stock with neuroscientist Lisa Mosconi, author of Menopause starts in the brain.
You enter a room and no longer know what you were looking for. You forget the name of a neighbor. In the middle of a meeting, you lose the thread of your sentence. You reread the same page three times without being able to concentrate. Around 51-52 years old, the average age of menopause, these little hiccups become more frequent and can be worrying. Many women consult and wonder if it is the beginning of Alzheimer’s disease. Most often, this is not the case. These cognitive difficulties are linked to hormonal upheavals.
Brain and ovaries communicate constantly through the hypothalamic-pituitary-gonadal axis. It all starts from the hypothalamus, located at the base of the brain, which releases in bursts a hormone, GnRH, which commands the pituitary gland, located just below, to produce two hormones: FSH (follicle-stimulating hormone) and LH (luteinizing hormone). FSH stimulates the growth of ovarian follicles, which produce estradiol; the LH surge triggers ovulation, then the production of progesterone. The loop is closed by feedback: when estradiol and progesterone are abundant, they signal the hypothalamus and the pituitary gland to slow down.
As menopause approaches, the supply of follicles becomes depleted and the ovaries become less and less responsive. FSH rises, estradiol levels peak and trough, before collapsing. This disruption does not remain without effect on the brain. The hypothalamus also houses the center that regulates body temperature, hence hot flashes and night sweats. Insomnia, anxiety or memory loss also have their source in the brain.
A brain that runs in slow motion
Estradiol causes neurons to burn glucose for energy. “If your estradiol is high, your brain energy is high”summarizes Lisa Mosconi. When it falls, the neurons slow down. His team measured it using brain scans, like the one shown below.
Positron emission tomography (PET) can visualize the energetic activity of the brain. A woman was scanned for the first time at age 43, when she had regular cycles and no symptoms of menopause. Eight years later, in postmenopause, her brain appears darker: “This change in brightness reflects a 30% drop in brain energy”writes Lisa Mosconi. And this case is not isolated: many participants in his research program show the same development, unlike men of the same age.
Two regions are particularly sensitive to estradiol: the hippocampus, the center of memory, and the frontal cortex, which manages reasoning, multitasking and language. “When estradiol drops, the frontal cortex doesn’t get everything it needs to function consistently. This explains the memory loss and brain fog,” she explains.
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Gray matter takes a break at menopause
A new study published in September 2026 in Nature Communications provides additional lighting. Sophie van ‘t Hof and her colleagues (Universities of Amsterdam and Leiden) compared the three major transitions in a woman’s life: puberty, pregnancy and menopause. These three stages each reshape the brain, due to the hormonal upheavals that characterize them.
The researchers analyzed MRI scans of women going through puberty (34), pregnancy (70) or menopause (120), and compared them to control groups of similar ages (before or after these stages). Unlike PET seen above, MRI does not measure the energetic activity of the brain, but its volume, and in particular that of the gray matter, which houses the bodies of neurons.
Result: the arrival of the first period and pregnancy are accompanied by an accelerated decline in the volume of gray matter compared to controls. These losses partly affect the same regions in both cases (prefrontal, parietal and temporal cortex).
On the other hand, in women going through the menopausal transition, the volume of gray matter does not decrease significantly. However, in controls before or after menopause, it continues to decline slowly, as is the case throughout adult life. Menopause therefore does not seem to accelerate brain aging: on the contrary, it seems to briefly pause it.
Do these results contradict those of Lisa Mosconi? Not necessarily, because the two approaches do not measure the same thing. A brain can maintain its volume while temporarily idling. Ultimately, the symptoms women experience are real, but they do not necessarily reflect loss of brain tissue.
Taking care of your brain during menopause
For Lisa Mosconi, menopause reorganizes the brain, but this rewiring takes time: it takes up to ten years for the brain to find a new balance, with an outcome that is most often favorable: “The brain has the capacity to find a new balance after menopause in most women”she emphasizes. There are ways to help women during this period, particularly through diet.
According to Lisa Mosconi, three elements are particularly important for the brains of women in menopause: “fiber, antioxidants and anti-inflammatory nutrients”. Of Italian origin, she follows a Mediterranean diet which she has made more plant-based. Vegetables, fruits, legumes, whole grains, oilseeds and olive oil form the basis. She also emphasizes the need to drink well: “The brain is made up largely of water. Even mild dehydration causes fatigue and irritability. »
Finally, exercise and an activity that allows you to better manage your emotions (meditation, yoga, etc.) are important to get through this period as well as possible.
