Five Things I Wish I Knew Ten Years Ago About Menopause and Brain Health
At 54, I’ve spent more than two decades as a neurologist focusing on helping patients maintain their neurologic wellbeing. But when it came to my own midlife transition and what was happening in my brain, there’s so much I wish I’d known sooner.
Menopause isn’t just a hormonal shift — it’s a neurologic one. And yet, most women (and doctors) don’t know what that means for brain health.
1. I wish I knew I shouldn’t wait for hot flashes to think about perimenopause.
For me, hot flashes didn’t appear until 52 — nearly a year after my final period — and by then, my brain had already seen a dramatic drop in estrogen and progesterone.
What that means:
Hot flashes occur due to changes in the hypothalamus causing disruption of our internal temperature set point. But our brains are remarkably good at compensating so that by the time hot flashes occur, most of us are already late in the menopausal transition. In fact, hot flashes are often among the last symtoms to occur, appearing most commonly 1–3 years before the final period or even 1–2 years after it (as was the case for me).
By that point, most women have already experienced nearly a decade hormonal changes. Since hot flashes are one of the most dramatic signs of menopause they are often what prompt many woman to seek medical help. And that’s important since there is growing evidence that minimizing hot flashes is associated with higher memory scores on cognitive testing.
2. I wish I’d known that my brain was about to ride a hormonal roller coaster.
Mood swings, sleepless nights, and sometimes feeling like my brain was stuck. These weren’t random midlife changes, they were my brain’s response to fluctuating hormones.
What that means:
Perimenopause begins 7 to 10 years before the final menstrual period. For most women this means related symptoms start in the the early 40s. During this transitional period, hormone levels don’t just fall, they fluctate dramatically between highs and lows. These changes influence the brain’s key chemical messengers, structure and energy consumption and contribute to the mood swings, sleep disturbances and brain fog that many of us experience.
3. I wish I’d recognized brain fog, migraines, sleep disturbances and mood swings as the earliest signs of perimenopause.
Like most women, in my early-mid 40’s I assumed how I felt was just due to being busy. Let’s be honest, it’s a crazy world and we all wear a lot of hats that can be overwhelming. But, recognizing these symptoms as part of the menopausal transition would have been empowering in so many ways.
What that means:
If I’d understood the connection, I would have been motivated to take action sooner including targeted lifestyle changes and timely hormone therapy. The key is shared decision-making with a clinician who understands both hormones and the brain, and who’s willing to take a whole-person, integrative approach that addresses your unique physiology and goals.
I’ll admit, I’m not always very good at “being kind” to myself so I might not given myself much grace, even if I’d known all this. But, for the sake of my family and most of all, my future brain, I know I would have sought ways to manage these disruptions more effectively if I’d better understood their phsyiologic basis and what they meant for my long term health.
4. I wish I’d known that advanced diagnostic testing could help me work smarter to manage my brain and cardio-metabolic health as well as my waistline.
Comprehensive metabolic and body-composition testing, starting in my early 40s, could have helped me understand my physiology, minimize the expanding midlife belly, and better protect my heart and brain health.
What that means:
I wish I knew that the hormonal changes of menopause were what was driving not just weight gain but also a shift toward increased abdominal and visceral fat. This redistribution is a key factor in many women’s worsening lipid profiles, blood pressure and the development of glucose intolerance and metabolic risk. Like many women, these changes were slowly happening even though I was exercising and eating as “healthy” as ever.
There’s no time to waste because the same risks that drive heart disease — insulin resistance, inflammation, and visceral fat — also accelerate brain aging. By tracking these factors through advanced diagnostic testing that goes beyond what’s done in routine visits, I’ve been able to act strategically with exercise, nutrition, sleep, supplements, and sometimes medication to improve my numbers (and my waist size) while protecting my long-term health.
5. I wish I’d had the insight I have now — to help more patients.
As a neurologist, over the past 20+ years I’ve seen countless women in their 40s and 50s with fatigue, migraines, middle-of-the-night waking, brain fog, and mood changes. I knew there was a hormonal connection, but like most physicians including neurologists, I didn’t yet understand how profoundly menopause affected the brain or that these shifts could have lasting consequences.
Most of all, I didn’t yet know how to help or that early, targeted intervention could change a woman’s long-term cognitive health. That’s why today, the intersection between hormones, cardio-metabolic health, and the brain is exactly where I focus my work.
A New Way to Think About Menopause and the Brain
Today, at Healthspan Neurology, my goal is to stay curious and keep learning so I can help women understand how hormonal transitions influence brain function and how to strengthen cognition, mood, and long-term neurologic resilience through personalized, evidence-informed care.
As one of the few neurologists in the country who are Menopause Society Certified Practitioners, with advanced training in prescribing menopausal hormone therapy, I’m dedicated to bridging the gap between neurology and women’s health — helping women navigate this transition with clarity, science, and compassion.
👉 Learn more about Mind Over Menopause™ and how personalized, preventive neurology can support your hormonal and cognitive health through midlife and beyond.
