Opinion: Not ‘just stress’ – How hormonal changes affect women’s brain function

By Dr Louise Newson BSc(Hons) MBChB(Hons) MRCGP FRCGP DHealth

Over years of studying the health of women there’s one key thing that I’ve come to realise; clinicians have often been missing a crucial piece of the puzzle in understanding women’s mental health and brain function.

It all comes down to three hormones that deserve far more attention for their powerful influence on the brain — progesterone, estradiol, and testosterone.

As an example, I consulted with a 46-year-old woman last week in my clinic. She’s clever, accomplished, always been on top of things.

But recently she has been forgetting words mid-sentence, she can’t remember where she parked her car and finds herself having to read the same page three times and still nothing sticks.

Terrified that she has early-onset dementia, she visited her GP who told her it’s “just stress” or “normal ageing.”

But here’s the thing – it’s neither. It’s her brain responding to a dramatic hormonal shift, and we need to start talking about it.

Women’s mental health, and especially brain health, is deeply influenced by our hormones – progesterone, estradiol and testosterone – all three having fundamental roles in how our brains function.

However this connection is often overlooked in medicine and public conversations.

When levels of these hormones fluctuate and reduce (as they do during perimenopause and menopause) then this can have negative effects on our brain metabolism and function leading to symptoms such as memory problems, brain fog, poor sleep, low mood, anxiety, irritability and fatigue.

Menopausal women have an increased risk of developing dementia due to these hormone levels being low.

These vital hormones work to improve glucose metabolism, which provides the fuel our neurones (nerve cells) need to function and connect with each other.

They also work to reduce inflammation and improve the function of our mitochondria (the powerhouse of our cells) which all work to keep our brains healthy and working well.

Progesterone, estradiol and testosterone also increase neural growth, strengthen synaptic connections between nerves, and regulate levels of neurotransmitters such as serotonin for mood, acetylcholine for memory, melatonin for sleep and dopamine for motivation.

The presence of these hormones is linked to lower rates of memory loss and can reduce risk of Alzheimer’s disease, which affects women at nearly double the rate of men.

Importantly, “brain fog” and forgetfulness commonly reported during perimenopause and menopause are real and measurable phenomena linked to hormonal fluctuations, not just “normal ageing” or stress.​

Testosterone is commonly misconstrued as “just a male hormone,” but women’s brains require it for optimal functioning.

Produced by ovaries and adrenal glands, as well as in the brain, testosterone supports cognitive sharpness, energy, and drive.

Emerging evidence links lower levels of testosterone in women to poorer performance on memory, processing speed, and even greater Alzheimer’s risk, especially among those with certain genetic risk factors.

Like estradiol, testosterone boosts dopamine activity, which is crucial for focus, motivation, and pleasure.

Many women report that restoring testosterone improves concentration, energy, and overall mental clarity.

Women’s mental health is closely associated with these changing hormone levels.

Rates of depression, psychosis and anxiety in women are more common at times of hormonal flux such as puberty, the premenstrual phase, postpartum, perimenopause and menopause.

Therefore, clinicians should certainly be assessing for hormonal factors when cognitive and mental health concerns arise in women.

Women represent nearly two-thirds of all Alzheimer’s patients, and much of this is likely driven by the neurological impact of hormone loss.

Understanding estradiol, progesterone, and testosterone as master regulators of brain metabolism and cognition should then lead to better clinical treatment.

This must take the form of more personalised approaches by clinicians, prescribing the right dose and type of hormone treatment, which when combined with a healthy lifestyle offers the best prospects for safeguarding and improving brain and mental health for women.​

One of the reasons I developed the Balance app is to empower women with evidence-based information so they can make the choices that are right for them about their hormonal health.

Using technology to both monitor symptoms and learn more is so important – the response from our users has been so positive and inspiring.

Femtech has the ability to reach a global audience and transcend national borders and cultures which is really exciting for me to witness through our Balance app.

It has also enabled us to provide communities with large scale pools of information and support which are not so readily available in other ways.

Also, Balance is used to support and empower women, privately, who are too scared to communicate in the physical world.

We’ve ignored women’s brain health for too long.

Clinicians have too often dismissed symptoms, failed to account for the profound impact of these hormones on brain function, and have frequently accepted cognitive decline as inevitable.

It’s time for that to change.

Because understanding the hormone-brain connection and replacing the missing hormones isn’t just about preventing disease, it’s about helping women thrive, with their minds sharp, their memories intact, and their full cognitive potential realised.

Image Credit: Andrew Crowley