Perimenopause is the period before a woman's final menstrual cycle that can last up to ten years or more, with symptoms often starting in the thirties or forties. It can involve changes such as cycles getting closer together, poor sleep due to decreased progesterone, and increased anxiety possibly related to estrogen receptors. Fascinatingly, Heather Mosconi's research at Cornell points to massive alterations in female brain cerebral metabolism around age 40, with approximately a 20% decline from pre-menopause to post-menopause. Women experiencing significant perimenopausal and menopausal symptoms, such as hot flashes and night sweats, exhibit the most considerable cerebral hypometabolism, a condition almost akin to pseudo-dementia that can map onto Alzheimer's disease risk 1.

Hormonal shifts during perimenopause, particularly the decrease in estrogen around age 40, are believed to drive the cerebral hypometabolism. This is described as having symptoms like brain fog, which has led to women considering hormone therapy to mitigate risks, including declines in brain function. However, there's caution against hormone therapy unless needed for severe hot flashes or night sweats, due to the infamous Women's Health Initiative (WHI) study related concerns 2.

Meanwhile, lifestyle factors also influence the onset of menopause. Behaviors like smoking, exposure to toxins, and untreated chronic diseases like diabetes can lead to earlier menopause. Living a lower-inflammation lifestyle and avoiding toxins can help naturally prolong the time before menopause. Early menopause is associated with increased health risks such as dementia, heart disease, and osteoporosis 3.

Perimenopause and Brain Changes

Sara discusses the perimenopause period and the massive change that happens in the female brain during this time. She talks about the decline in cerebral metabolism and how it can be mapped to Alzheimer's disease. Andrew compares it to a low-level pseudo dementia.

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Dr. Sara Gottfried: How to Optimize Female Hormone Health for Vitality & Longevity | Huberman Lab

Regarding hormone therapy during menopause, it is highlighted that if started within ten years of menopause, typically between ages 51-52, hormone therapy can be very beneficial. The WHI study indicated that premature use of hormone therapy could lead to adverse health effects, but when initiated at the right time, the outcomes are generally positive, leading to decreased cardiovascular disease, improved bone health, and reduced diabetes progression 4.

Lastly, hormone replacement therapy (HRT) for menopausal symptoms has evolved from using only estrogen, which increased uterine cancer risk, to combining estrogen with progesterone to mitigate such risks. The WHI study in the 1990s tackled this with two parallel arms to assess the proper approach for HRT 5.