Perimenopause is typically treated as a reproductive transition, but the symptoms women experience during this period tell a different story. A review in Nature Reviews Endocrinology argues that many of these symptoms are neurological, pointing to estrogen’s role in regulating the brain’s energy production. As estrogen declines, the brain’s ability to use glucose may change, potentially contributing to hot flashes, insomnia, depression and memory problems. Research also links hot flashes with higher blood sugar and insulin resistance, raising questions about how metabolic health influences the transition.

The implications extend beyond symptom management. For some women, perimenopause may represent a critical window for long-term neurological health, potentially influencing vulnerability to cognitive decline later in life. The evidence does not establish that impaired brain energy causes these symptoms, nor does it mean that most women will experience lasting harm. But it does suggest that we should look beyond reproductive hormones alone. Understanding the relationship between estrogen, glucose metabolism and brain function may offer a more complete picture of what women experience during this transition.

https://letsstartwiththetruth.substack.com/p/perimenopause-is-all-in-your-head