FOR MORE THAN forty years, women have walked into my office and said some version of the same things. I don’t feel like myself anymore. My brain feels foggy. I’m anxious all the time. I can’t sleep. I’m so irritable, and I don’t know why. I keep forgetting things. I’m overwhelmed, caring for aging parents, my children, my grandchildren, everyone but myself.
As a health psychologist, I’ve always heard those statements through the lens of the health of our brain. Every stressor, every relationship struggle, every experience of trauma, it all gets filtered through our brain’s stress response system. And it works the other way too. Our brain is constantly getting information back from the body, through the vagus nerve, through our gut, through our hormones, and using that to interpret and manage whatever is changing in us.
Estrogen is a good example. The receptors where estrogen does its work aren’t only in our reproductive organs. They’re all through the brain too. So when something shifts hormonally, the brain isn’t a bystander. It’s directly involved. This is exactly why the separation between mental health and physical health has never made sense to me. We are holistic beings, and we need to be cared for that way.
This week I recorded the first episode in a new women’s health series, and I wanted to share some of what came up, because I think it matters for every woman reading this. We’re starting with the brain, because that’s always been my lens, but the series itself moves far beyond it, into hormones, sexual health, and the psychiatric realities of pregnancy and postpartum.
Menopause is neurological, not just reproductive
I leaned heavily on the work of neuroscientist Lisa Mosconi, whose book The Menopause Brain makes a case I wish every woman heard decades before she needed it. Menopause isn’t only a reproductive event. It’s a neurological one. Estrogen protects the brain, helps new brain cells grow, supports memory, and shapes mood through how the brain handles serotonin. When estrogen drops, all of that gets disrupted at once. That’s why so many of us hit this transition and suddenly feel foggy, forgetful, or moody in a way that feels completely unlike ourselves.
Mosconi has the brain imaging to back this up. Actual scans showing this remodeling happening in real time. Not just women describing symptoms, real, visible change. So when your brain feels unrecognizable during this stretch, it’s not because something is wrong with you. It’s because something is actually happening.
Here’s the part that gives me hope. Mosconi is clear this isn’t permanent. For most women, it’s a transition, and with the right support, we come out the other side with brains that are just as sharp, sometimes sharper, than before.
Honestly, when I first read her research, I felt relief and anger at the same time. Relief, because it finally gave language to what I’d been hearing from women for decades. Anger, because so many of these women had already gone to a doctor, described exactly this, and been told it was just stress, just aging, or just menopause. Nobody explained there was a real, measurable neurological event underneath it all. They weren’t imagining it. Somebody just never bothered to tell them what was actually going on.
Women carry two-thirds of Alzheimer’s cases, and a fraction of the research
Alzheimer’s may be diagnosed late in life, but brain health is built decades earlier. Nearly two-thirds of people living with Alzheimer’s in this country are women, and for decades, women have made up only a fraction of the research dedicated to figuring out why. Science studied the brain, and disease, mostly through a male model, and then simply applied it to women, as though our brains and bodies were smaller versions of the same thing. They’re not. That drop in estrogen during perimenopause and menopause appears to play a real role in how vulnerable the female brain becomes to decline later on.
This pattern isn’t isolated to Alzheimer’s. Women metabolize medication differently than men, and most drug trials were built around a male body. Women are roughly twice as likely to be diagnosed with anxiety and depression. Stroke kills more women than men every year, in part because our symptoms present differently than the textbook signs. Autoimmune disease, especially MS, shows up in women at far higher rates. None of this is a pile of unrelated facts. It’s a pattern, and the pattern has a name: for most of modern medicine, the male body was the default, and the female body was treated as a variation on it.
What’s actually in our control
The Lancet Commission recently identified fourteen modifiable risk factors that together account for nearly half of all dementia cases worldwide. Hearing loss, blood pressure, cholesterol, diabetes, weight, smoking, alcohol, movement, depression, head injuries, vision, air quality, education, and social isolation. Not genetics. Not bad luck. Things we actually have some say over.
You don’t have to fix all fourteen this week. Get your hearing checked. Get your blood pressure and cholesterol looked at. Move your body, even if that’s just a walk most days. Treat depression and anxiety like the medical issues they are. Take your social life seriously, connection is protective for your brain the same way managing your blood pressure is.
A word for the women holding everyone else together
Sixty-three million Americans are family caregivers, and sixty-one percent of them are women. That’s somewhere north of thirty-eight million women caring for a parent, a spouse, sometimes a child too, usually on top of a job and everything else already on her plate. The stress that never lets up, the years of bad sleep, the friendships that quietly fall away, all of it is on that same list of risk factors.
So the women holding everyone else together are, without even realizing it, putting their own brains at risk in the process. And the story we tell ourselves, that we just have to live with it, is exactly what keeps the cycle going.
If that’s you, hear this. Taking care of your own brain isn’t selfish. It’s what lets you keep showing up for the people who need you. And you have more say in this than you’ve ever been told.
This is the first episode in a women’s health series I’m genuinely excited about. Over the coming weeks, incredible professionals will join me to talk about pregnancy and postpartum mental health, sexual health and desire, and hormone therapy with the current science behind it. It starts with the brain, but it goes everywhere the brain touches: our hormones, our relationships, our sexuality, our futures. Put time aside to come back and listen. You owe it to yourself.
If this episode hit close to home
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Materials Referenced
The Menopause Brain by Lisa Mosconi, PhD
https://www.lisamosconi.com/the-menopause-brain
