Estrogen’s Usually to Blame

And for now, at least, that's in the news

For maybe the first time in recorded history, menopause is a mainstream topic of conversation.

This is mostly good news. Menopause is a perfectly normal process, and we all benefit from raising awareness of it, increasing education about it, and destigmatizing it.

Still, whenever a health topic enters broad public discussion, you get everyone from opportunistic grifters to ineffective hacks flooding the space and fucking things up.

There’s a lot of news out there about menopause these days. And a lot of “news.” The conversation is so noisy, in fact, that it can be tough to figure out which information is rooted in actual science and which is just pink sugar water hocked by an influencer.

I read about the topic a lot—new academic research, think pieces on shifting societal attitudes, reddit posts, other substacks—trying to weed out what’s useful. In the past year or so there’ve been a few scientific studies that piqued my interest. Here’s a roundup of recent menopause-relevant work that could someday lead to better experiences—no celebrity side hustles included.

Estrogen & Brain Function:

There’s been a fair amount of discussion and research on the way brains change during perimenopause (I mean, “a fair amount” in terms of what’s typical for menopause research, so, you know, not actually a whole lot compared with other fields). A 2023 article in Nature included information from the University of Arizona’s Roberta Brinton, a neurobiologist who’s studied the brain-related effects of menopause. Brinton found that, as the female reproductive system slowly shuts down, the role of estrogen in cognition inevitably declines. (She’s not the only one who’s discussed this.)

Estrogen, according to Brinton, encourages our brains to take in glucose for fuel and improves energy production. As perimenopause wreaks merry havoc on hormone levels, however, estrogen surges and ebbs. The cycle can feel endless while you’re living through it, but once it’s over, estrogen declines and doesn’t rise again.

Those neural pathways that relied on estrogen are very confused for a while. They expect estrogen and don’t get it. And during perimenopause, the hormonal drops don’t last long enough for the body to figure out how to do without what it’s losing. Instead, we just feel like our brains don’t work anymore.

Eventually, (thankfully) the brain learns how to manage without estrogen, Brinton said. It shifts its fuel from glucose to lipids. Brinton also said that the transition can lead to inflammation, which can make thinking a bit of a foggy endeavor. (A brain fog, one might say.) The shift also brings a higher risk of Alzheimer’s and Parkinson’s, presumably due to inflammation. Fun food for thought.

I first read the Nature article months ago, but one of Brinton’s lines there has haunted me. She was talking about how the brain transitions from getting lots of estrogen to not very much. Because no one should ever be alone in anxiety-riddled nightmares, I’ll give you the direct quote.

“Perimenopause is a very important part of this transition. It really depends on how that perimenopausal transition goes, whether you come out with a heightened risk generated by inflammation or whether you come out and you’re okay.”

Spoiler: The article does not give any advice on how to improve the transition so you’re in the “okay” camp and not the, uh, “not okay” camp.

That said, Brinton and colleagues reportedly are working on brain scans and getting beyond animal models. So…good? And she also said that, after the perimenopause-induced neurological shitshow (I’m paraphrasing) had passed, most postmenopausal brains seemed to figure it out and settle into what she described as a “new normal,” with better cognitive performance.

Another study released this year found that, as people move through the menopausal process, their brains develop more estrogen receptors. The increase in receptors was linked to reduced cognitive function. At this point, it’s just information, not something that can be immediately used for a remedy. But there’s no call for panic yet—and more knowledge is usually helpful.

Personally, I’m left wondering if the boost in receptors comes from the brain being like, Hey, I really need this hormone, so let’s try to develop as many ways to catch it as we can. I don’t know, but I am curious—and I can’t read all this without thinking about caffeine and adenosine.

Adenosine is the molecule that makes us feel tired when we need sleep. If your receptor network is something like a parking lot, caffeine basically blocks the spaces into which adenosine could fit. It also affects dopamine in a way that allows that feel-good chemical to hang around more, at least at first. When you start consuming caffeine regularly, your brain responds by growing more adenosine receptors. I assume this is because we all have to sleep at some point, and because the human body is great at finding new ways to keep you alive even in the face of strong odds.

So the brain grows more estrogen receptors as its estrogen supply dwindles, and the similarities between that and how we adapt to drinking coffee make me suspect those processes might be similar. I have no background in professional science, only a degree in journalism. Maybe adenosine receptors and estrogen receptors are hilariously dissimilar—what would I know? Why do I bother to ignorantly theorize about this stuff? What am I, an influencer?

It’s because this kind of abstract speculation allows me to intellectualize, and thus distance myself from, the possibility that I might not end up with one of Roberta Brinton’s “okay” brains. That, after menopause, things will come apart upstairs.

There’s still so much unknown about the process; I’m not sure what I’ll be like on the other side of this thing. We can’t even be sure of what we don’t know, really, because we’ve neglected even the most basic menopause research for generations. If you stop to think about how little ground we’ve covered thus far, it’s a huge bummer.

All to say, I hope these troubling but vital studies into menopause continue.

Sauna Time Could Prevent Menopause-Related Weight Gain:

Okay, time to bring the mood back up! A study by University of Massachusetts Amherst researchers suggests older women could reduce their risk of obesity and insulin resistance if they spend time in a sauna. Sounds like a legitimate way to budget in spa time.

To be fair, the study only looked at this cause-and-effect in mice. But those older female mice who got a solid half hour of “whole-body heat treatment”—basically a sauna bake—gained less weight than mice of a similar age that didn’t. The research leader, Soonkyu Chung, said the heat therapy could be particularly helpful for menopausal women.

Honestly, I don’t know what to make of this. For every study that encourages one action, there’s at least one other study out there that connects the opposite action to the same effect. For example, earlier studies that focused on keeping off excess weight said the production of “brown” fat—the “good” kind, in that it burns calories and helps control blood sugar—could be encouraged by enduring very cold temperatures.

These studies were looking at different things, of course (the hot-mice study was in no way concerned with brown fat) but the end goal in both cases was the prevention or reversal of weight gain. But whatever. Spend some time hot, some time cold, maybe both work for you. (And if that’s true, perhaps Iowa really is the ideal climate for everyone.)

Some things work for some people and not for others. There’s probably no harm in unwinding in a sauna. At minimum, maybe your stress levels will go down, and that, I’ve gathered, is pretty much the ultimate health win.

Perimenopausal People Are More Likely to Experience Depres—

On second thought, no. We’ll save this for another day. Let’s end on the sauna note! Take some relaxing time in a hot, steamy room. Allow your brain a break. Get some non-optimized hours.

Yours while slightly distracted by researching the history of saunas (dating back to 4000 BCE!),

That Hag

Two Things to Read in the Week Ahead:

1. Fiction. At least one prominent brain doctor (Richard Restak) believes reading fiction and having to keep track of a complicated narrative is good for your memory and your brain. Give it a try. If you can’t cram a novel into a single week, I think short stories are fine. Novellas are also fine. For the latter, I recommend Martha Wells’s Murderbot series, which starts with four quick-to-read novellas. I mean, sure, they’re about artificial intelligence (not a language model, the real kind), evil corporations (the, uh, real kind, like in the U.S.), and a sprawling dystopia (no comment). But they’ll sure take your mind off a looming estrogen deficit.

2. Poetry. This is a recommendation just from me—not a neuroscientist, a biochemist, or an endocrinologist. It took me a long time to get into poetry. I’m a reader who’s focused on what happens next in books and that can be the opposite of poetry in some ways. These days, though, I not only admire the skill in poetry—where no word can be wasted or even be 2 percent suboptimal—but also love the mental space it gives me. You have to slow down to appreciate it. Some poetry is all feeling, no plot. Some is lushly epic and some is painfully spare. Every good composition, though, requires that you simultaneously pay close attention and let yourself melt into the poem. I think it’s great for your brain to both wrestle and drift.