Mind Over Menopause
Neurologist-Led Brain Health for Midlife Women in Rochester, NY
Menopause is a neurologic transition. The symptoms most women attribute to "just hormones" — brain fog, poor sleep, mood changes, migraines, and hot flashes — are driven by changes in the brain. At Healthspan Neurology, we evaluate and treat them that way.
Menopause and the Brain
Women are nearly twice as likely as men to develop Alzheimer's disease. That disparity is not coincidental — it is rooted in the biology of the menopausal transition.
Estrogen is profoundly neuroprotective. As levels decline during perimenopause and menopause, the brain's energy metabolism shifts, inflammation increases, and vulnerability to Alzheimer's-related changes grows. The menopausal transition is not just a reproductive milestone — it is a critical window for brain health intervention.
Most women don't know this. Most of their doctors aren’t equipped to address it.
What Many Women Don't Know About Menopause
It starts earlier than most women expect Perimenopause can begin 7 to 10 years before the final menstrual period — meaning hormonal brain changes often begin in the late 30s or early 40s, long before hot flashes appear.
Brain symptoms are usually the first signs Brain fog, sleep disruption, mood changes, migraines, and fatigue are frequently the earliest signs of perimenopause — driven by fluctuating hormones that affect the brain's chemistry, structure, and energy use. Up to two-thirds of women report brain fog during perimenopause.
Hot flashes come later Hot flashes are among the most recognized menopause symptoms, but they often appear after years of hormonal brain changes are already underway. They originate in the hypothalamus — the brain's temperature regulation center — and by the time many women seek help, the neurologic transition has been in progress for years.
Cardiometabolic health and brain health are inseparable Hormonal shifts during perimenopause affect insulin sensitivity, body composition, inflammation, and cardiovascular health — all of which directly influence long-term brain health and Alzheimer's risk.
Who This Program Is For
Mind Over Menopause™ is designed for women in their late 30s through early 60s who are experiencing neurologic symptoms of the menopausal transition and want a more thorough, brain-focused evaluation than they've received elsewhere.
You may benefit if you:
Notice brain fog, memory lapses, or difficulty with word recall
Experience sleep disruption, mood changes, anxiety, or fatigue
Have migraines that have worsened or changed around perimenopause
Are considering hormone therapy but want a neurologist's perspective
Have tried hormone therapy without adequate relief
Are concerned about long-term brain health and Alzheimer's risk
Are taking multiple supplements and aren't sure what's actually helping
What to Expect
Mind Over Menopause™ unfolds over one to three visits — in person in Rochester or via telemedicine throughout New York State.
Evaluation and care may include:
Neurologic & Cognitive Assessment Full neurologic examination and bedside cognitive testing to establish a clear baseline and identify any concerns
Brain Imaging MRI when clinically indicated to rule out other contributors to symptoms
Laboratory Testing Hormone levels, metabolic and cardiometabolic markers, inflammatory markers, nutritional status, and thyroid function — because menopause doesn't happen in isolation and neither do its risks
Menopausal Hormone Therapy Evidence-informed guidance on whether hormone therapy is appropriate for you, what type, and at what dose — including for women who haven't had adequate success with prior treatment
Sleep & Circadian Rhythm Evaluation and management of sleep disorders and circadian disruption, pharmacologic and non-pharmacologic
Migraine Management Diagnosis and treatment of perimenopausal and menopausal migraine, which is frequently undertreated and often worsens during this transition
Supplement Review & Rationalization Many women arrive taking a long list of supplements they've accumulated from various sources. We review what you're taking, what the evidence actually supports, and what can be safely discontinued — so you're not spending money on things that aren't helping
Lifestyle & Prevention Strategies Personalized guidance on nutrition, movement, stress, and other modifiable factors that support both immediate symptom relief and long-term brain health
How This Is Different
Traditional menopause care focuses on symptom relief. Gynecologic care is essential — but it is not neurologic care.
As one of the few board-certified neurologists in the country who is also a Menopause Society Certified Practitioner, Dr. Gajaweera evaluates menopause through the lens of the brain. That means identifying what's driving your symptoms, not just treating them. It means considering your long-term Alzheimer's risk alongside your immediate quality of life. And it means catching what gets missed — cardiometabolic risks, undertreated sleep disorders, ineffective supplement regimens — and making sure those are addressed, even if that means referring back to your primary care physician.
Frequently Asked Questions About Menopause and Brain Health
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It is real and it is well-documented. Fluctuating estrogen levels during perimenopause directly affect the brain's chemistry, energy metabolism, and neurotransmitter function. Up to two-thirds of women report cognitive symptoms during the menopausal transition. It is not anxiety, it is not depression, and it is not imaginary.
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Yes — women are nearly twice as likely as men to develop Alzheimer's disease, and the biology of that disparity is rooted in menopause. Estrogen plays a neuroprotective role, and its decline during the menopausal transition increases the brain's vulnerability to Alzheimer's-related changes. The menopausal transition is one of the most important windows for Alzheimer's prevention in women.
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The relationship between hormone therapy and Alzheimer's risk is nuanced and actively studied. Timing matters significantly — evidence suggests that initiating hormone therapy during the menopausal transition, rather than years after, may offer cognitive benefit. This is an area where a neurologist's perspective is particularly valuable, and it is central to how we approach care in this program.
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Yes. Inadequate symptom relief from hormone therapy is often related to timing, formulation, dose, or route of administration — not to hormone therapy itself. It may also reflect contributors that hormone therapy alone cannot address, such as sleep disorders, migraine, or metabolic factors. A thorough neurologic evaluation frequently identifies what was missed.
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Earlier than most women expect. Perimenopause can begin in the early 40s, and the hormonal brain changes that accompany it begin well before the final menstrual period. Waiting until menopause is established means missing some of the highest-impact intervention opportunities.
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Yes. We offer both in-person visits in Rochester and telemedicine appointments for patients throughout New York State.
Getting Started
Your first step is a complimentary introductory call. We'll discuss your symptoms, your history, and whether Mind Over Menopause™ is the right fit for you.