A journey of understanding the effects of the menopause on my partner and link in to my study through Coursera

1. Neurobiology and menopause
Gareth Nicholson - July 2023
Understanding the brain –
The neurobiology of everyday life

2. What is going on?
My partner, a 41 years old woman and has recently begun
showing signs of extreme temperature changes, increased worry
and struggles sleeping through the night. After going to the GP
she was prescribed Anti-depressants without explanation. I
wanted to find out what was happening and suspected she was
experiencing peri-menopause, I decided to research further and
piece together how I could support her more effectively as she
flat out refused to take SSRi’s as she wasn’t “Depressed”

3. • Perimenopause (‘around menopause’) is defined as the years leading up to menopause, and it
can start 5 to 10 years before you will have your last period.
• If you have your last period before the age of 40 you’ve experienced premature menopause,
sometimes this is referred to as primary ovarian insufficiency.
• Early menopause is when your last period happens before the age of 45.
• Menopause is defined as 12 consecutive months without a menstrual period.
• Every day that follows is post-menopause, a phase that can make up a third of your life or
more.
What is menopause? – A natural transition

4. What is going on?
1.identify the parts of the nervous system that are active in
your example,
2.describe the functions of the nervous system that are
apparent and/or impaired in your example, and
3.explain in detail the ways in which this course has
allowed you to better analyze the events and phenomena
around you.

5. The body and function
• Oestrogen or Estrogen is responsible for female physical features & reproduction
• The chemical is responsible for:
• Growth of the breasts
• Growth of pubic and underarm hair
• Start of the menstrual cycle
• It also:
• Keeps cholesterol in control
• Protects bone health
• Helps with brain function (including mood) bones heart, skin and other tissues

6. The body and function
• Oestrogen or Estrogen works alongside another chemical or hormone called Progesterone
• Progesterone works as a counterbalance by:
• Using fat for energy
• Working as an anti-depressant
• Facilitating thyroid hormone action
• Regulating blood clotting
• Invigorating libido
• Regulating blood sugar levels
• Protecting from cancers

7. Chemical circuitry
• BS, Brainstem;
• CB, cerebellum;
• CC, corpus callosum;
• FC, frontal cortex;
• HIPPO, hippocampus; HYP,
• hypothalamus;
• PIT, pituitary;
• THAL, thalamus.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6674699/

8. The body and function
Increase body fat
Depression
Headache, migraine
Interferes with
thyroid
Decreases libido
Impairs sugar control
Increases risk
of cancer
Using fat for energy
Working as an
anti-depressant
Facilitating thyroid
hormone action
Regulating blood
clotting
Invigorating
libido
Regulating blood sugar levels
Protecting from cancers
Oestrogen/Estrogen Progesterone

9. The body and function
• During periods of our lifespan, both Oestrogen and Progesterone peak and trough
Age 20 Age 30 Age 35 Age 40 Age 50 Age 60 Age 70 Age 80
Menopause
Oestrogen/Estrogen level Oestrogen/Estrogen deficiency

10. The body and function
• During periods of our lifespan, both Oestrogen/Estrogen and Progesterone peak and trough
What's Estrogen Dominance & 18
Reasons You Should Care -
MenoMe® - (meno-me.co.nz)

11. The body and function
Depression
Impairs sugar control
Using fat for energy
Facilitating thyroid
hormone action
Regulating
blood clotting
Regulating blood
sugar levels
Oestrogen/Estrogen Progesterone

12. Spotting the signs and symptoms
• Weight gain
• Night sweats
• Heart palpitations
• Pain
• Hot flashes/flushes
• Dry skin
• Itching
• Tingling sensations
• Sore or stiff joints
• Bladder control
• Dryness of vagina
• Dizziness
• Trouble sleeping
• Increased worry
• Poor memory
• Inability to concentrate
• Brain fog
• Low mood
• Irritability
• Low sex drive
• Additional vaginal
bleeding
• Painful intercourse
What's Estrogen Dominance & 18 Reasons
You Should Care - MenoMe® - (meno-
me.co.nz)

13. Are we all doomed?!
20% of women will have
severe symptoms
20% of women will have no
symptoms
60% of women will have
moderate symptoms
https://www.jeanhailes.org.au/health-a-
z/menopause/menopause-symptoms

14. What determines if we sail through or
suffer?
• Your genes
• Biological resilience
• Previous experience of mood problems
• Cultural expectations
• Exposure to stressful life events
• Social support
• Whether your menopause is natural, surgical
or chemotherapy-induced all impact the
experience
• Your age
• Your stage of life and whether you have done
the things you wanted to, like have children or
all the children you wanted to have
• How you view your body and feel about the
changes that are happening to you
• Are you as healthy as you can be and taking
care of yourself?
Like most things to do with our health and wellbeing it’s a combination:

15. Biopsychosocial model
EQ
https://pubmed.ncbi.nlm.nih.g
ov/35114695/

16. Biopsychosocial tools
Genetics – Ask parents/grandparents about their experience
Friends – Talk about your experiences, share stories and have a laugh!
Window of focus – Work out when you are at the best and focus your attention around these times
Isolate to concentrate – Book a room to reduce distraction
Research – Look for tools to help, lavender pillow spray, wear a wrap
Plan – Pull together a list of coping tools & share with your partner
Ask for help – Self audit, see your GP or Gynaecologist, speak to friends or family members

17. It’s all in your head
Oestrogen-receptor rich brain regions.
• Hypothalamus — regulates temperature & regulates sleep
• Hippocampus — learning and memory, emotion processing
• Amygdala — emotion and motivation
Other areas Oestrogen boosts:
• Brain Stem— mood (serotonin hub) & attention, arousal and anxiety
(norepinephrine hub)
• Prefrontal cortex — executive function and working memory
Alongside the symptoms of menopause there is also the risk of co-morbidities of anxiety
and depression
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628183/

18. Loss of efficiency
Perimenopause as a neurological
transition state - PMC (nih.gov)

19. Body temperature
Normal body temperature within a few tenths of
a degree above or below 37C.
37°C
37°C
Tolerance threshold
Pre-menopause
During
menopause
• During menopause, your upper ‘hot’ threshold
level moves down
• The lower ‘cool’ threshold moves up
• Your neural thermostat narrows.
• You become much more sensitive to even tiny
variations in core temperature — you’ll sweat
and shiver more easily
• These symptoms could last up to 7 years!
• If you are hot, our body sweats to regulate
• If you are cold, you will shiver to regulate

20. • Make a sleep schedule whereby you wake at the same time each day regardless of plans
and have a set bedtime.
• Eliminate long daytime naps (this is hard but only necessary if you haven’t mastered the
fine art of the strategic 20-minute power nap)
• Limit anxiety-provoking or stimulating activities before bed.
• Establish that bed is for sleep and sex.
Body temperature – making life bearable
46% of women going through the menopausal transition will have problems with
sleep

21. HRT – What exactly does it do?
Hormone replacement therapy (HRT; also called menopausal hormone therapy, MHT) is a drug combination
of oestrogen and progesterone, and sometimes testosterone.
HRT comes in different forms, talk to your GP or nurse specialist about the pros’ and con’s of each
Tablets
Skin patches
Oestrogen gel
Implants
Vaginal oestrogen
Testosterone gel
The 2 types of routines are cyclical (or sequential) HRT and continuous combined
HRT.

22. HRT – What exactly does it do?
• It is most commonly used to treat symptoms of perimenopause such as hot flashes.
• Does hormone therapy fix brain fog? Sadly, the evidence is mixed and leans towards
menopausal hormone therapy (MHT) not clearing brain fog.
Side effects:
Oestrogen supplement
• Bloating
• Breast tenderness/swelling
• Body swelling
• Sickness
• Leg cramps
• Headaches
• Indigestion
• Vaginal bleeding
Side effects:
Progesterone supplement
• Breast tenderness/swelling
• Body swelling
• Mood swings
• Depression
• Headaches
• Tummy pain
• Acne
• Vaginal bleeding
Side effects will usually pass after a
few weeks, if they persist see your GP

23. Hot flushes & Brain fog
‘Brain fog’ is an umbrella term used to describe problems with memory or concentration.
Symptoms may include:
• Slow or fuzzy thinking
• Problems finding the ‘right’ word or remembering names
• Difficulty focusing
• Confusion
• Forgetfulness.
“You can’t dissect out hot flashes and sweats from sleep disturbance. We know sleep is really
important for consolidation of memory. But is brain fog due to disturbed sleep, anxiety, or
hormones? We just don’t know.” Sue Davis from Monash University
https://drsarahmckay.com/the-
brain-fog-of-menopause/

24. • Temporary changes with memory, attention, and the feeling of brain fog are typical
symptoms of the menopause transition, and while they feel alarming, they aren’t a
cause for alarm. This isn’t a sign that there’s a steep memory cliff ahead.
• Consider asking your GP for help with depression, anxiety, and sleep disturbance: these
affect cognitive performance and when treated memory may improve.
• Exercise: at least 150 minutes a week of moderate activity is the goal. Moving your body
is the best exercise you can provide for your brain.
• Consider stress: there’s no easy fix here, but a psychologist may be able to help reframe
life stressors, give support, and provide strategies for coping.
Your toolkit - limits
Exercise doesn’t necessarily reduce the number of hot flashes but being fit and healthy does make
them much more bearable

25. Your toolkit
A holistic approach provides better results than medication alone
Trouble sleeping - Bedtime routine
Heart palpitations - Mindfulness
Sore or stiff joints - Yoga/Supplements
Dry skin - Bedtime routine
Itching - Bedtime routine
Dizziness - Meditation
Increased worry - Social group
Weight gain - Exercise/Diet
Poor memory - Exercise
Hot flashes/flushes - Exercise/Diet
Trouble sleeping -Exercise/Routine/Diet
Brain fog - Exercise/Mindfulness
Low mood - Exercise/Social/Diet
Irritability - Exercise/Social/Diet
Mood swings - HRT
Low sex drive - HRT
Night Sweats - HRT
Hot flashes/flushes - HRT
Bladder control - HRT
Dryness of vagina - HRT
Inability to concentrate - HRT/GP
Additional vaginal bleeding - GP
Irritability - GP (anti-depressants)
Low mood - GP (anti-depressants)
Poor memory - GP (anti-depressants)
Increased worry - GP (anti-depressants)
Brain fog - GP (anti-depressants)
Pain - Paracetamol/Ibuprofen

26. Managing symptoms
Change
Your situation
Yourself
Physical – Noise, telephones, environment
Social – Support systems
Work – Amount, pressure, demands
Active coping
Rest/habituation
Assertiveness, social skills, communication
Habits – Eating, drinking, sleeping, exercise
Time – Priorities, Look for a good balance
Control – Self-monitoring, feedback – Ask others
Cognitive – Realistic thinking, perception, interpretation,
Relaxation - Yoga, meditation, book reading
Break - Leisure time, holidays, lunch?
Exercise – Walking, green-scapes, blue spaces
Distraction – Grounding techniques, PMR, Jigsaws!

27. Your toolkit - Apps
Health & Her Menopause
Cost – Free
Helps tracking symptoms, identifying
triggers and providing exercises to
relieve symptoms
Luminosity
Cost – Free
Helps with brain fog and memory loss,
memory training games to keep focus
Her spirit
Cost – £4.99 per month
Helps with fatigue, mood issues and
weight gain
Swimmo
Cost – Free
Helps with sea dips and benefits for
joint aches, hot flushes, energy issues
Intimately us
Cost – £3.99 a month
Helps with low libido, mood issues and
intimacy problems
Gousto
Cost – depends on recipe
Helps nutrition, weight gain and
energy issues

28. So, on reflection do SSRi’s work??
My partner, a 41 years old woman and has recently begun
showing signs of extreme temperature changes, increased worry
and struggles sleeping through the night. After going to the GP
she was prescribed Anti-depressants without explanation. I
wanted to find out what was happening and suspected she was
experiencing peri-menopause, I decided to research further and
piece together how I could support her more effectively as she
flat out refused to take SSRi’s as she wasn’t “Depressed”
The answer is that yes, they can help but are not enough alone, think bio-psych-
social.
The GP should explain more to patients exactly why they are prescribing but
also other factors that can help with the menopause journey.