Mind Over Menopause
Menopause Brain Health for Cognitive Longevity
Menopause is a neurologic transition.
The brain fog, poor sleep, mood changes, migraines, and hot flashes most women attribute to "just hormones" are driven by changes in the brain. Mind Over Menopause™ is the Cognitive Longevity Program, built for the menopausal transition — everything Dr. Gajaweera uses to identify and reduce dementia risk, plus a dedicated hormone and MHT safety specific to this stage of life. Available in person in Rochester, NY, and via telemedicine throughout New York State.
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 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.
Cardiovascular, metabolic and brain health are inseparable, especially during perimenopause. Together they affect insulin sensitivity, body composition, inflammation, and atherosclerotic risk — all of which directly influence long-term brain health and Alzheimer's risk.
Why Current Care Falls Short
Most women raising brain fog, sleep disruption, or mood changes with their doctor are told it's "just menopause" — and offered symptom relief, if anything. Gynecologic care is essential, but it isn't neurologic care. And most neurologists, in turn, aren't trained to evaluate menopause. Few clinicians on either side are equipped to assess MHT safety, evaluate Alzheimer's risk, or consider cardiometabolic, inflammatory, and hormonal factors together — through the lens of the brain you'll have in twenty years.
As one of the few board-certified neurologists who is also a Menopause Society Certified Practitioner, Dr. Gajaweera built Mind Over Menopause™ to fill that gap.
Who This Program Is For
Mind Over Menopause™ is designed for women in their late 30s through early 60s who are navigating perimenopause or menopause and want to understand what it means for their long-term brain health. 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
How Mind Over Menopause™ Works
The Cognitive Longevity Program, built specifically for the menopausal transition.
This is a year-long program over 4 visits — 3 visits over your first 6 months to evaluate and initiate your plan, followed by a final visit 5 to 6 months later, once your treatment plan has had time to take effect.
Here's what to expect.
Step 1 — Comprehensive Assessment
Your first visit is 90 to 120 minutes. We begin with a detailed review of your history, symptoms, and what's driving you to seek answers now. Dr. Gajaweera then conducts a detailed review of your medical and family history and any prior testing followed by a computerized cognitive battery of testing, such as Creyos to assess your baseline, possible cognitive deficits and track progress over time. Advanced testing is ordered and tailored to you — spanning genetics, brain imaging, cardiovascular and metabolic health, and emerging blood biomarkers for Alzheimer's pathology, alongside other menopause-specific labs as indicated.
Step 2 — Risk Stratification & Results Review
We review your full results together — imaging, genetics, labs, hormones — identifying both strengths to build on and vulnerabilities that need attention. This includes an MHT evaluation: an evidence-informed assessment of whether hormone therapy is appropriate for you from a neurologist's perspective — including for women who haven't had success with prior treatment, or whose providers have advised caution and want an independent neurologic opinion.
Step 3 — Your Personalized Prevention Roadmap
Together we build a targeted, prioritized plan — covering cardiovascular and metabolic health, sleep and circadian rhythm, migraine management, nutrition, movement, stress, and hormone health, including evidence-informed use of medications or supplements where appropriate.
Serving women in Rochester, NY in person, and throughout New York State via telemedicine.
Step 4 — Reassessment
Your final visit, 5 to 6 months after your roadmap is set, is where we take stock. We repeat key testing — including your cognitive battery — to see what's changed, review how your plan has translated into real symptom relief, and assess how your hormone therapy or other interventions are working. From there, we adjust your plan. Once you've completed your first year, Continuing Care is available annually or biannually to keep your plan current as your life and risk factors evolve.
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One Year Program Fee
Typically over 9-12 months
4 visits
8+ hours clinical time (not including administrative time)
First visit: 2 hours
Visits 2, 3 & 4: 90 min each + phone/portal check-ins
Digital Cognitive Assessment - two sessions to track over time
In person or telemedicine
$2,700
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Continuing Care
For Graduates of CLP or MOM only
Annual/Biannual Visits as needed
2 Visits
1st visit: 30 minute pre-visit phone call to review & order testing
2nd visit: 90 minute visit to review results and recommendations
Digital Cognitive Assessment - one session
In person or telemedicine
$800
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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Women make up 2/3 of 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. This doesn’t mean menopause causes dementia but that the menopausal transition is an important window of opportunity for dementia 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 15–20 minute introductory call — directly with Dr. Gajaweera, not a scheduler or staff member. We'll talk through your symptoms and history, and together decide whether Mind Over Menopause™ is the right fit for protecting your brain health through menopause. Available in person in Rochester, NY, and via telemedicine throughout New York State.