Understanding what is happening in your brain and body during menopause

6minute read

Author: Megan Hayward, The Menopause Concierge®

Our hormones are whole-body messengers.

We have hormone receptors throughout our bodies, including our brain, bones, heart, blood vessels, muscles, skin and reproductive tissues.

And importantly, our hormones do not operate independently. They interact with each other, our nervous system and our neurotransmitters, influencing everything from mood and sleep to metabolism, concentration and motivation.

This is why perimenopause can be a physical, cognitive and emotional experience.

And remember, a temporary change in capacity is not a loss of capability.

ESTROGEN | The whole-body multitasker

In my opinion, estrogen is the high goddess of hormones for women! And for good reason.

• Brain: Influences memory, concentration, mood, temperature regulation and neurotransmitters, including serotonin and dopamine.
• Bones and muscles: Helps maintain bone density, supports muscle health and influences inflammatory pathways.
• Heart and metabolism: Influences blood vessel health, cholesterol, fat distribution, body composition and fluid regulation.
• Reproductive and sexual health: Regulates the menstrual cycle, supports the uterine lining and helps maintain healthy vaginal and urinary tissues, including lubrication.
• Whole-body health: Influences our skin, immune function and numerous other tissues throughout the body.

Good to know: During perimenopause, estrogen does not decline in a lovely neat straight line. It fluctuates, sometimes enormously. And symptoms can fluctuate too!

PROGESTERONE | The calming influence

Often called the pregnancy hormone, progesterone does far more than support reproduction.

• Reproductive health: Supports the uterine lining and pregnancy, while influencing body temperature during the menstrual cycle.
• Brain and mood: Produces allopregnanolone, which interacts with GABA, one of the brain’s major calming systems.
• Sleep and breathing: Influences sleep and respiratory regulation. Hormonal changes during menopause may contribute to sleep disturbances, while sleep apnoea also becomes more common.
• Hormonal changes: As ovulation becomes less predictable during perimenopause, progesterone production can become irregular, while estrogen continues to fluctuate.
• Stress response: Progesterone, stress hormones and the nervous system interact, although the relationship is more complex than one hormone simply increasing or decreasing another.

Good to know: That feeling of being “wired and tired”, exhausted but unable to switch off, may have several contributing factors, including changing hormones, stress and disrupted sleep.

It does not necessarily mean you have suddenly become less resilient.

TESTOSTERONE | Strength, desire and drive

Testosterone is absolutely not just a male hormone!

• Naturally occurring: Women produce testosterone too, and circulating levels can be higher than estradiol levels.
• Sexual wellbeing: Plays an important role in sexual desire and arousal.
• Muscles and bones: Contributes to normal muscle and bone physiology alongside estrogen and other hormones.
• Brain and metabolism: Has physiological roles in multiple tissues, although its effects on women’s cognition, mood and metabolic health are still being researched.
• Ageing: Testosterone generally declines gradually throughout adulthood, rather than suddenly disappearing at menopause.

Good to know: Testosterone treatment has an established role for some women experiencing distressing low sexual desire, following appropriate medical assessment. It is not currently an established treatment for brain fog, fatigue or muscle weakness (although many women report improvements in these areas once they commence testosterone treatment).

And while we often focus on weight in midlife, I would love women to start thinking more about strength, muscle and long-term independence.

Instead of simply asking, “How much do I weigh?”

Perhaps a better question is, “How strong am I?”

CORTISOL | The stress-response system

Cortisol is not a menopause hormone, but it plays an important role in how our body responds to stress.

• Stress response: Helps regulate our fight, flight or freeze response, blood pressure, blood glucose and inflammation.
• Sleep and mood: Prolonged stress and poor sleep can influence anxiety, irritability, concentration and emotional regulation.
• Hormonal interactions: Cortisol and reproductive hormones interact through our body’s interconnected stress and hormonal systems.
• Metabolic health: Chronic stress can influence appetite, metabolism and body composition, but cortisol alone does not explain menopause-related weight changes.

Good to know: Women often have a lot of tabs open in midlife.

When changes in energy, sleep, weight or emotional resilience occur, they deserve curiosity rather than judgement.

SEROTONIN | Mood, sleep and emotional regulation

Serotonin is a neurotransmitter, one of the chemical messengers used by our nervous system.

• Helps regulate mood and emotional wellbeing.
• Plays a role in sleep, appetite and other body functions.
• Interacts with estrogen pathways, potentially contributing to mood changes during perimenopause.
• Works alongside other biological, psychological and lifestyle factors influencing mental health.

Good to know: Not every mental health concern in midlife is menopause. Hormones, stress, sleep, physical health and life circumstances can all intersect.

DOPAMINE | Motivation, reward and focus

Dopamine is another important neurotransmitter.

• Plays a role in motivation, reward and pleasure.
• Supports attention, learning and concentration.
• Interacts with estrogen pathways, although the relationship between hormonal changes and cognitive symptoms is complex.
• Can be influenced by sleep, stress, mental health and neurodivergence.

Good to know: What might look like disengagement, poor motivation or distraction, particularly at work, may have a much more complicated explanation.

A temporary change in capacity is not a loss of capability.

MENOPAUSE | A whole-body transition

Menopause is not simply about hot flushes and changing periods.

Hormonal changes can affect our brain, mental health, heart, bones, muscles, metabolism, sleep, skin and genitourinary health.

And the experience is different for everyone.

How many women experience symptoms?

• Around 20% experience no symptoms or very few.
• Around 60% experience mild to moderate symptoms.
• Around 20% experience symptoms severe enough to interfere with everyday life.

These are commonly cited estimates, and newer research suggests the proportions may vary.

Symptoms can range from inconvenient to debilitating, and nobody should feel they have to simply put up with them.

Some women visit the dentist about their gums, the physiotherapist about their joints or their GP about anxiety and migraines.

But nobody necessarily stands back and asks:

“Could some of these things be connected?”

Not everything in midlife is menopause, and new, persistent or concerning symptoms deserve medical assessment.

But recognising possible connections can be the first step towards understanding what is happening and finding appropriate support.

There is no single menopause experience.

Your symptom pattern is your symptom fingerprint, and your approach to managing it should be just as individual.

Movement. Mindset. Modify. ®

Note: Cover image is estrogen under the microscope.