Nearly every woman who lives long enough will experience menopause. Menopause begins with perimenopause, a transition that can last 2 to 8 years (average 4). During this time, levels of estrogen and progesterone change and decrease. Perimenopause typically begins in a woman’s mid to late 40s, though the timing can vary. For example, Black and Latina women often begin perimenopause about two years earlier compared to white women. Perimenopause is marked by symptoms such as difficulty sleeping, irregular periods, and hot flashes. Menopause is officially confirmed after a woman has gone a year without having a period.

Although education and resources around menopause are increasing, perimenopause is still often a confusing experience. Many women experience disruptive symptoms for years without adequate medical guidance or support.

Perimenopause is more than a reproductive transition—it is also a time of neurological and metabolic change and may represent an important window for brain health awareness and prevention.

Women are nearly twice as likely as men to develop Alzheimer’s disease. Researchers once assumed this was mainly due to women living longer, but newer evidence suggests additional biological and social factors may be involved. One key area of investigation is menopause and the decline of estrogen, a hormone that supports brain energy metabolism and cellular function.

Alzheimer’s disease begins developing in the brain decades before symptoms appear, meaning midlife transitions like menopause may be a critical period for understanding risk. Social determinants such as access to healthcare, education, and economic opportunity also contribute to long-term brain health disparities.

Women of color face additional systemic barriers, which may further influence risk and outcomes over time.

During perimenopause and menopause, declining estrogen levels can affect how the brain uses energy. Estrogen helps the brain utilize glucose efficiently, and its decline may lead to reduced metabolic efficiency.

Some researchers describe this as an “energy shift” in the brain. These changes have been associated with early biological markers of Alzheimer’s disease, including amyloid accumulation and structural brain changes.

Many women report symptoms such as brain fog, forgetfulness, or difficulty concentrating. While common, these changes reflect underlying neurological transitions and highlight an opportunity for earlier brain health awareness.

Estrogen plays an important role beyond reproduction, including supporting brain function and energy regulation. This has led researchers to study whether hormone replacement therapy (HRT) may influence Alzheimer’s risk.

Findings so far are mixed. Some studies suggest potential benefits depending on timing, formulation, and individual risk factors. Research continues to explore whether starting HRT closer to the onset of menopause may have different effects on brain health compared to later use.

Researchers are increasingly focused on understanding why women face higher Alzheimer’s risk beyond longevity alone. Studies now examine interactions between hormones, genetics, lifestyle, and social factors.

Women are increasingly included in clinical research, improving understanding of sex-specific differences in brain aging. Organizations focused on women’s brain health are also helping drive awareness and research progress.

If you notice changes in memory, attention, or thinking during perimenopause or menopause, it is important to discuss them with a healthcare provider. These symptoms are often dismissed or attributed solely to stress.

You may want to ask about:

• Cognitive screening
• Hormonal changes
• Menopause-related cognitive symptoms

Your concerns are valid and deserve clinical attention.

Menopause is still under-discussed in many communities, despite being a universal life stage for women. Talking about it helps reduce stigma and improves awareness of its impact on brain health.

Sharing experiences can help normalize symptoms and encourage earlier conversations about cognitive health and prevention strategies.