Understanding Your Brain Through Perimenopause and Menopause

Okay, I want to talk to you about something that might make you want to pour a large glass of wine (but don't, because we'll get to why that's not brilliant for your brain in a minute).

Here's the sobering bit: nearly two-thirds of the 7.2 million Americans living with Alzheimer's are women. And no, it's not just because we live longer. There's something else going on, and it's directly linked to our hormones.

Dr. Louisa Nicola, a neurophysiologist who studies Alzheimer's, dropped some proper knowledge bombs in this podcast with Dr. Mary Claire Haver. The main takeaway? Alzheimer's doesn't just rock up when you're 70. It's been quietly setting up shop in your brain since your 30s and 40s - a sneaky 30-year progression that nobody tells you about.

Here's what's happening: proteins called amyloid beta and tau tangles start accumulating in your brain. Your hippocampus (the memory centre) takes the first hit, which explains why you can't remember where you put your keys or why you walked into a room. Sleep is meant to clear these proteins through something called the glymphatic system - basically your brain's overnight cleaning crew. But if you're not sleeping well (hello, night sweats), this cleaning system can't do its job properly.

Now for the oestrogen connection, because of course it all comes back to hormones. Women are more prone to tau protein buildup than men. Oestrogen, progesterone, and prolactin normally keep these tau proteins in check by inhibiting the enzyme that makes them toxic. So when oestrogen drops during perimenopause, you lose this protective scaffolding.

Oestrogen also helps your brain metabolise glucose (its main fuel source) and supports the connections between brain cells. When oestrogen declines, your brain struggles to get the energy it needs, and those vital connections start weakening. It's like removing the support beams from a building whilst it's still standing.

The good news? Understanding what's happening means we can actually do something about it. Sleep, nutrition, and exercise aren't just nice-to-haves - they're essential tools for protecting your brain during this transition.

A friendly reminder: I'm sharing what I've learned, not prescribing what you should do. Always chat with your GP about what's right for your unique situation!

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