How do changes in hormonal levels impact the brain?

There’s two general ways that we think the hormonal changes of menopause can influence cognitive performance. One is through the direct effects of estrogen and progesterone on brain systems. We know that the hippocampus and the prefrontal cortex, areas of the brain that are rich in estrogen receptors and are key to our success in remembering, respond differently to fluctuations in estrogen, whether it follows removal of the ovaries, which is done surgically in some women, or across the menstrual cycle. Those brain areas change in their sensitivity. That’s what we would call the direct hormonal effect, so that’s one direction. The second one is through menopausal symptoms. Menopausal symptoms can also affect cognitive performance and the most common symptom is sleep disruption. Sometimes it’s related to hot flashes, and we have some data to suggest that hot flashes may contribute to memory decline in women. We have the direct effects of the hormone plus the effects of menopausal symptoms.