By Deborah Lethby, Nutritionist at attend2health

There are many well-known physical symptoms of perimenopause, such as hot flushes, night sweats and insomnia.  However, hormonal changes at this time can also have a huge impact on mental health.  Women commonly suffer from many issues related to brain health such as brain fog, headaches, forgetfulness, as well as difficulty concentrating and focussing.  Psychological symptoms such as loss of confidence, motivation, feeling overwhelmed and loss of self- esteem can also be present, leading to anxiety and depression. 

These feelings are often put down to pressures of life, before considering that they may well be connected to the fluctuating hormone levels during perimenopause.  Of course, often at this time of life we may have many challenges such as a stressful job, relationship difficulties, and pressures of looking after older parents or teenage children.  However, these life stresses can be much harder to cope with when our hormones are unstable.

What is the link between hormones and mental health?

Oestrogen helps to maintain serotonin, noradrenaline and dopamine – our ‘happy hormones’.  So, when we feel low or emotional, it can be that oestrogen levels are taking a dip.  Among its many benefits in the brain, oestrogen also seems to prevent or delay cognitive decline.  If levels are too low, we can experience low libido, difficulty concentrating, mood swings, breast tenderness, hot flashes and irregular periods.  If oestrogen is too high, this can cause sleep problems, weight gain, hair loss, headaches, memory problems and changed in appetite (slower metabolism).

Progesterone stimulates GABA receptors in the brain (the same receptors that anti-anxiety medications act upon), producing a calming effect and helping with sleep.  It can regulate cognition, mood, inflammation, neurogenesis, and regeneration.  Levels of progesterone can drop by up to 75% after the age of 35. 

Testosterone is produced by the ovaries – it contributes to mental sharpness by strengthening neurons as well as helping with energy levels and confidence.  Testosterone can also lower stress levels and give a more positive sense of well-being.  The hormone also depletes as we age, therefore leading to lack of motivation, irritability, low moods, fatigue and lack of sex drive.

Cortisol, our stress hormone – high levels can affect serotonin, dopamine, and GABA (the ‘calming’ hormone).  Someone with higher stress levels can therefore experience more severe symptoms of perimenopause. Stress levels (cortisol) can also affect thyroid function (see below) as well as increasing carb cravings.

Thyroid hormones – The thyroid regulates cell activity, metabolism, controls mood and our sensitivity to other hormones like cortisol and oestrogen.  If levels of thyroxine are too high (hyperthyroidism), we can experience difficulty sleeping, irregular heartbeats, anxiety, thinning hair and weight loss.  When levels are too low (hypothyroidism), it can lead to weight gain, slower metabolism, fatigue, anxiety, difficulty concentrating, short term memory loss and depression.  Therefore, it’s important to check thyroid hormone levels (it’s preferable to check all the thyroid markers to get the full picture).

Insulin regulates the amount of glucose in the blood.  High blood sugar (hyperglycaemia) can cause poor concentration, ADHD, depression, anxiety, and insomnia.  When blood sugar levels are low (hypoglycaemia), the brain can be starved of energy, so it’s no wonder it can have a serious impact on how we function mentally, with symptoms such as brain fog, anxiety, irritability or depression, as well as poor concentration, dizziness and insomnia. 

• A recent study of over 2,000 post-menopausal women in Denmark found that risk for developing cognitive dysfunction was 44% greater in those with impaired fasting glucose

• In women diagnosed with Insulin Resistance there was a 47% increased risk for cognitive dysfunction.

So, what can we do to help these symptoms?

Eat the right foods:

  • keeping your blood sugar balanced will lower the risk of insulin resistance (eating too many refined carbs and high amounts of sugar can create too much insulin, resulting in brain inflammation).  Include healthy fats such as avocados, oily fish, nuts and seeds at each meal, with good quality protein such as eggs, chicken, pulses.  Lots of veggies and fibre are important, and limit processed foods and sugar.  If you can avoid snacking between meals this will also help, and if you do feel you need a snack make sure it contains protein.
  • Include eggs, turkey, quinoa, brown rice, oats, dark chocolate, nuts/seeds, oily fish and green leafy veggies – these are all great brain foods.
  • Phytoestrogens such as flaxseeds, chickpeas, lentils, organic soy are great for balancing hormones as they act like oestrogens.  Cruciferous veg like cauliflower, broccoli, kale and brussels sprouts can help detoxify excess hormones from the body.
  • Vitamin D rich foods such as salmon, mackerel, eggs, mushrooms, milk, yoghurt, cheese, oatmeal, tofu, pork.  It is quite common to have a deficiency as many of us do not get enough sunshine for large parts of the year.  Studies have shown that this vitamin is thought to be neuroprotective and there is a link between low vitamin D levels and depression.
  • Good fats – omega 3 containing foods such as oily fish, nuts/seeds, avocados, olive oil.  Our brains are 60% fat, so we need it!

Exercise – this will improve mood and help with stress.  However, over-exercising can put extra strain on the body.  Aim for 30 mins/day.

Gut health – Optimising our gut health is key to keeping our hormones in balance. A healthy, diverse gut microbiome helps regulate our hormones and neurotransmitters, facilitates absorption of nutrients, and is an essential part of the immune system.  ‘Eating a rainbow’ of foods will ensure we feed those good gut bugs, as well as plenty of fibre rich foods so that we can eliminate the waste (including removing excess oestrogens).

Intermittent Fasting – eating within a set window of time, for example between the hours of 11am and 7pm, has been shown to improve brain health by stimulating the production of a protein called BDNF, which plays a role in learning, memory, and generation of new nerve cells in the brain. Fasting also triggers autophagy, the body’s way of cleaning out damaged cells to allow for regeneration of new ones – a bit like ‘spring-cleaning’ for the body cells.  

Sleep is essential for the functioning of the brain as well as the necessary repair processes mentioned above.  This is often an issue for women during the perimenopause as the lower levels of oestrogen can cause night sweats and the decline of progesterone (which is a calming, sleep inducing hormone) may also affect our ability to fall asleep.

Managing stress levels – ensure you get time to switch off every day – try deep breathing, meditation, reading a book, listening to music, or just taking a walk which will all help to activate the parasympathetic nervous system (our ‘rest and digest’ system), thereby reducing stress levels (our ‘flight of flight’ response, controlled by the sympathetic nervous system). Therapies such as EFT (emotional freedom technique) or ‘tapping’ as well as practicing mindfulness can also help. The Hypnotherapist Amanda Lonergan at Attend2Health can also help with managing stress.

Limit alcohol – Excess drinking can raise the levels of oestrogen produced while lowering your progesterone levels.

Look into the possibility of body identical HRT – replacing oestrogen and progesterone can be helpful.  Not just to improve symptoms, oestrogen is neuroprotective so can reduce risk of dementia (as well as being protective against long-term health risks such as osteoporosis, cardiovascular disease, and diabetes).

Consider getting tested – tests are available to check hormones, gut health and nutrients – all of these can have an impact on our mental health and brain function.  Testing will help to pinpoint any imbalances which may then be addressed through either hormone replacement and/or nutrition, supplements, and lifestyle recommendations.

If any of these symptoms sound familiar and you’d like to find out how Deborah can help, why not book in a free 30-minute (no obligation) call with her here: