Everyday Neuro 026: Why Menopause Matters – Brain Science, Symptoms and Strategies to Create Equitable Workplaces

Introduction to Menopause

0:00Hello, and welcome to the Everyday Neuro podcast series. I'm your host, Dr. Janine Cooper, and I'm aiming to provide you with the knowledge and inspiration to understand the fascinating world of the human brain. Today, we're talking about a topic that affects the lives of millions globally, yet is still too often misunderstood or overlooked, and that's menopause. In this

0:36episode, we are exploring how we understand this life stage and the evidence that menopause begins in the brain. Yep, that's right. While we often associate menopause with hormonal shifts in the ovaries, cutting-edge neuroscience reveals that many of the symptoms, like hot flushes, sleep issues and insomnia, anxiety and brain fog, are actually neurological in origin.

1:04The symptoms of menopause can have dramatic effects on health and well-being, as well as cognition, and these things include memory, planning and overall productivity. Many women living with the symptoms find that it affects their confidence in and out of the workplace. So what exactly is there to support women in this transitional life stage? To answer this question and provide insight into menopause, we are really fortunate today to be joined by Linda Engels, a chartered organisational

1:38psychologist who will share her passion for advocating and raising awareness about menopause, especially in the workplace, and why it's important that all people understand the impact of menopause, and also recognise ways to manage this transition to help support women to continue to work with productivity and also well-being. But before we talk with Linda, let's understand what menopause is and the effects it can have.

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Defining Menopause

3:39Medically, menopause is the stage in life when the female has gone for 12 consecutive months without a menstrual period. And this is due to a significant decline in the production of ovarian hormones. And these are primarily oestrogen and progesterone. This transition typically happens in a woman's 40s or 50s, but it varies from person to person and it depends on a number of factors like genetics and also lifestyle. However, for some people, this can occur rapidly due to being

4:14medically induced or from surgery. Menopause is often recognised to have three phases, with the first being perimenopause. And this can occur somewhere between the 30s or 40s, when the ovaries start to gradually produce less oestrogen and some symptoms may occur.

4:36This is followed by menopause. And this is the stage when ovaries stop the production of oestrogen and release the remaining eggs. And as I mentioned earlier, menopause is when there's been 12 consecutive months without menstruating. This is followed by what some people term as post-menopause, when the menstrual cycle has stopped for more than one year. However, some experts believe it might be time to rethink how we use the term post-menopause. So let's have a look at that now before we investigate

5:06the evidence that menopause begins in the brain. Post-menopause is commonly used to describe the time after a woman's periods have stopped for good, but it's a bit of an umbrella term and that's where the problem lies. Not all menopause experiences are the same and some people go through it naturally over time, while others experience it suddenly due to surgery, medical treatments or conditions like early ovarian failure. Yet often, all of these very different experiences are put under one label,

5:41post-menopause. So it's as if they're all the same and they're not. So why does this matter? This matters because the type of menopause someone goes through can affect their brain, mood, memory and overall health in very different ways. For example, someone who's had their ovaries removed might experience more intense, rapid symptoms than someone going through a more gradual, natural transition. On top of that, researchers have found that many studies don't even specify what kind

6:17of menopause they're looking at. And that makes it harder to understand what's really going on in the brain and body during this very important time and how to best support people going through it.

6:29So when we talk about post-menopause, we need to start being much more specific. Are we talking about early post-menopause when symptoms are still intense or later stages when things have settled somewhat? Are we considering how someone reached menopause in the first place? And does post really reflect things accurately? After all, this is an ongoing transition that will endure rather than end. That's why being more precise with our language will hopefully improve research, healthcare and most

7:03importantly, help people feel understood and supported during this powerful life transition, an area that we're going to discuss shortly with our wonderful guest, Linda.

Menopause Starts in the Brain

7:13So let's unpack why menopause starts in the brain. Well, evidence for this can be found in the work of Dr. Lisa Moscone and her team. Lisa is the director of the Women's Brain Initiative and reveals that the brain and ovaries are part of the finely tuned neuroendocrine system. When estrogen levels drop, it's not just the reproductive system that's affected. Our brain's energy, mood regulation, memory and sleep cycles are all impacted as well. So let's look at some of the cognitive symptoms that

7:49occur with menopause, an area that I'm becoming increasingly fascinated with. Many women report difficulties with memory, word retrieval and concentration and it's often described as brain fog. And these symptoms are most prominent during the times of menopause when hormone fluctuations are greatest. And this can often be around the time of perimenopause and early postmenopause. Estrogen plays a key role in modulating neurotransmitters like serotonin and dopamine and

8:23supports synaptic plasticity in brain regions such as the hippocampus and prefrontal cortex. Areas that we know from this podcast are critical for memory and executive function? And they also include abilities such as planning, multitasking and working memory. So that's holding things in your mind. This is supported by a comprehensive review of executive function research by Diamond and Ling in 2020.

8:53And this research highlighted that hormonal changes, particularly the decline in estrogen, may impair cognitive flexibility and working memory. So that's your ability to really start to think with a little bit of variability and also to hold things in mind. Other aspects of cognition that are affected are attention and processing speed. Some studies show a decline in sustained attention and slower cognitive processing during the menopausal transition.

9:27And although such changes are often subtle, for some people, they can really impact daily functioning, especially when people are under stress or doing many things at once. So multitasking demands are high. Another impact of menopause on cognition is sleep disruption. Now you've heard from the wonderful Dr. Michelle earlier in this podcast series about the effects of sleep. And just to reiterate here, sleep disturbances, which are common in menopause due to night sweats and insomnia,

10:00are strongly linked to poorer cognitive performance and poor sleep quality has really been shown to exacerbate memory and attention issues. So it makes it much harder to focus and sustain your attention on a task at hand. And often that can lead to this kind of foggy feeling that many women experience. Brain imaging has shown structural and functional changes during menopause. And these include reduced connectivity in memory related networks, and also really changes in the gray matter. So your neurons in

10:35terms of volume. It's amazing to think that menopause has such huge effects, and yet we don't discuss it or give it the weighting it requires to really support those living with the symptoms and going through this huge transition, which all females will go through.

Study of Women's Health Across the Nation

10:55But let's not just take my word for it, because really where the evidence lies is in a huge study called the Study of Women's Health Across the Nation. Its acronym is SWAN. And it's one of the largest longitudinal studies on menopause. And it's been based in the United States. And it's provided robust data linking vasomotor symptoms, so things like hot flushes, and sleep issues to cognitive complaints. And should you like more information, then you can visit the SWAN website. That's

11:26www.swanstudy.org. And there you'll find so many pieces of information and resources. Also, for more information about sleep and insomnia, as I alluded to earlier, then please listen to my interview in episode 20 of the Everyday Neuro podcast with Dr. Michelle, who is an NHS trained insomnia specialist, and also a cognitive neuroscientist. Now, another area that menopause

11:57affects is mood. And this often results in feelings of depression and anxiety, which can emerge or worsen during menopause. These are also associated with cognitive difficulties. And neuropsychological evaluations often reveal that mood disorders can mimic or amplify cognitive decline. And that makes accurate assessment really crucial. So it could be that a woman is going through the transition of menopause

12:28and may feel that they have this kind of brain fog and that their memory is really affected, thinking that it could be some kind of cognitive issue. Well, it is a cognitive issue, but it's related to menopause rather than perhaps a neurodegenerative disorder. In fact, the symptoms of menopause on mood and cognition can be so severe that many people actually start to become concerned that they might be in the early stages of dementia. And this makes us question how we label the symptoms. So this kind of idea of brain fog might

13:04not place enough emphasis on the severity that menopause can have on the brain. And indeed, the American Psychological Association, or APA, their guidelines for the evaluation of dementia and age-related cognitive change, emphasize the importance of really distinguishing between normal menopause cognitive changes and the early signs of neurodegenerative conditions. So something really important to think about along with the terminology that we use and this kind of idea that we kind of

13:38clump all these symptoms together and don't even know when it's starting or how it started under the term post-menopause. So from the information that I've shared with you in this starting point, I hope it's clear why it's so important to know how menopause affects the brain. But if it's affecting our brain to such a degree, what can be done to support the symptoms, especially on how this affects the abilities and productivity of people going through this life transition in the workplace? To answer these

Interview with Linda Engels

14:14questions, I'm delighted to introduce our guest today, Linda Engels, who is a Chartered Organisational Psychologist and also Chair of the Menopause Network at the University of Aberdeen. Hello Linda, thank you so much for joining us today. Hi Janine, thank you so much for inviting me along to join your podcast. I'm really excited about speaking about my passion subject on menopause. That's wonderful. Okay, I'd like to start with the observation that recently there's been a lot more

14:50talk about menopause, for example, in social media, on the news and such like. Linda, why is it so important to talk about menopause? Why does it matter so much? Menopause matters because it affects 50% of the population and it's really important to raise awareness around that for that very reason. There's often a lot of stigma attached to menopause as well and often talking about it can make people

15:20feel really uncomfortable. But that is something I believe that needs to happen in order for change to occur. I think we need to be uncomfortable with it because it will actually help us to grow. Yes. But I also know that one in ten women leave the workplace due to menopause, which results in a huge talent drain. We lose a lot of women in senior roles. So women are often at the peak of their

15:52career because it happens to women in their, tends to be in their 50s. And so it also has those financial implications as well, such as pension income or access to pension income. But there's also a greater risk to women's physical health. So there's an increased risk of cardiovascular disease, diabetes, dementia and osteoporosis. But there's also a greater risk to women's mental health as well.

16:27Wow. There's just so many impacts when you put it so succinctly like that, Linda. I suppose I've just talked a little bit earlier about the cognitive symptoms, but could you explain what are some of the other main symptoms of menopause? There are so many menopause symptoms. Some statistics tell us that there's between 40 and 100, which is quite a lot of symptoms. So some of them I wanted to just kind of touch on briefly are

16:59vasomotor symptoms. So what I mean by that is it's a bit like our internal dermostat and it's a bit wonky. It doesn't work in the way that it did before. That's such a good way to describe it. So it can make it really challenging for women to regulate their temperature, for instance, which means that they can experience things like night sweats and hot flushes as well. And these can be really debilitating. Night sweats, disturbing sleep can then impact on how effective that person will

17:35be when they come into work the next day. Yeah. I mean, I was just talking about that earlier. I mean, it's such a big impact, isn't it, your sleep, on your wellbeing, your productivity. So absolutely. And then there are things like weight gain, genital sleep disturbances as well, changes in mood. I mean, this is not an exhaustive list by any stretch of the imagination. But it's really important to recognise, I think, that every woman will have her own experiences of menopause

18:09and have her own set of symptoms. And they're not necessarily going to be that everyone will have those exact same symptoms. I think that's such an important point that you raise, that everybody's got a different story, perhaps. You know, no one woman is going through the same sort of set symptoms. So in terms of how those symptoms affect you, you know, what's the impact on women's capacity to perform, for example, in the workplace? So some of these symptoms that I've referred to

18:42can negatively affect women's experience in the workplace. It can negatively impact their overall job performance and their levels of job satisfaction as well. I mean, and that matters because we know if people have increased job satisfaction or high levels of job satisfaction, they're actually more likely to remain in that job. There are decreased levels of productivity, increased levels of stress as well.

19:16Linda, for women who are experiencing the effects of menopause on their thinking and cognitive skills, how might this feel for them? How might it affect their wellbeing? That can often lead to increased stress levels for those affected and then have a negative impact on their mental health as well. And the reason for that is generally around this decline in confidence. So women feel much less confidence in their ability and how they are perceived by other people in the

19:48workplace. And as a result of that, we might start to see increased absence rates within the workplace as well. And also evidence of presenteeism. And that is when women attend work. So they actually show up, but they are unable to perform effectively. So that in itself has very negative implications around the impact on productivity, performance and job satisfaction as well.

20:23Oh, okay. I actually wasn't aware of presenteeism. So thanks so much for highlighting that. I think it brings me to my next question, really. So you've explained how many things are actually affecting women in the workplace due to menopause. What is exactly being done to support women in, you know, at work? Finding ways to be financially savvy is a smart move and knowing you could be saving money for the things you really want. Like that dream home or new ride is a great feeling. That's why the state farm personal price

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21:46Some organizations have implemented menopause policies, for instance, which are a really positive step. So it basically gives guidance to menopausal and perimenopausal women to understand what sort of reasonable adjustments they could apply for within the workplace. So do they need to have a change in uniform because the fabric of their uniform isn't breathable? Can they have increased breaks, more frequent opportunities to go outside and to kill down, have access to a desk

22:21fan, that type of thing. And there are networks as well. So we have a network at the University of Aberdeen, of which I'm chair. And the aim there is to make sure that people have access to that social support, because we know that that is really important for women who are going through menopause. So understanding that they're not alone can really help them with that sense of isolation and help them to understand that there are sources of support out there. There are lots of sources of support within

22:52the university as well, as well as externally. And I try to organize events. And these are just held online, usually an hour over a lunch time. We've had yoga sessions, we've had Pilates, we've had dieticians, we've had people speak to us about the use of herbs during menopause. So there's lots and lots of different things, really a really broad range. And we also, what I tend to find is that we see this a lot in larger organizations, that the policies are in place, the networks are in place,

23:27the social support is there, the training is there. But it can often not be seen as much within smaller businesses as well. So they perhaps don't have the resources, they might not have access to human resources department, for instance, to be able to put these kinds of things in place. And I think a lot of the time as well, organizations don't really know what to do. Which means, unfortunately, they don't do anything at all. And whilst there is training and awareness

23:58raising sessions, these can sometimes feel like they're a bit of a box ticking exercise. Yeah, I mean, hopefully, it's a lot less, you know, box ticking and on a lot more action now that you've actually shared what can be done. But you know, also where to start, perhaps, for those smaller organizations that you've talked about. One of the things that's really sticking in my head, Linda, is the stat that you mentioned previously, that one in 10 women are leaving the workplace due to symptoms of menopause. And I think my last question for you really is,

24:31what more can be done to ensure that women don't leave?

Supporting Women in the Workplace

24:35So I believe what needs to happen within workplaces to ensure that women don't leave, is there needs to be an increase in awareness. And this needs to happen across all employees, not just women, for instance. It needs to be across all employees at all levels within the organization as well. It's important that menopause isn't seen as just a women problem, but as something that all employees should be educated on. And as something that has the impact, potential impact of

25:10affecting other people within the workplace and not just those women themselves. So I feel very passionately about the need for training for line managers and particularly to support them having difficult conversations. You know, going back to what I said at the beginning, there's still a lot of stigma around menopause and it can feel really uncomfortable having those conversations. So we should be training our line managers to make sure that they actually have the skills, the knowledge and the confidence to have these difficult conversations. Networks within

25:48organizations are a great source of support, but obviously it's not necessarily always practical for smaller organizations. But it is something to think about. And then at the moment, the employment rights bill implementation plan has been released and from April 2026, menopause action plans are voluntary. However, from 2027, these menopause action plans will be mandatory for larger organizations. So lots of positive things

26:28things happening. But it's not necessarily having that impact on the reduction of women leaving. So there's still a lot more to be done. Even though we might not be there just yet, Linda, it certainly gives me hope knowing that there are people like you advocating, you know, to give support to women who are living with the symptoms of menopause. And I can't thank you enough for sharing your insights and also giving us some, you know, real workable ways to improve life for women in this life stage in the workplace. And so we don't see one in 10 women

27:05leaving. So thanks ever so much, Linda. It's been a pleasure talking to you. And yeah, I'm looking forward to looking into this a lot more. So I just want to say a huge thank you to you for having me inviting me along. I've really enjoyed it. Thank you so much.

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28:22So today we've really dug deep into the topic of menopause and the fact that, as Linda says, it affects half the world's population. So really, a lot more awareness is required. And also, when you start to realize just how much it affects our thinking, our physiology and overall mental health, then more and more needs to be done, especially in the workplace. So on that note, thanks again for listening. And I hope you'll join me for another episode of the Everyday Neuro Podcast.

28:57In the meantime, continue to look after that amazing brain of yours. Until then, take care. Finding ways to be financially savvy is a smart move. And knowing you could be saving money for the things you really want, like that dream home or new ride, is a great feeling. That's why the State Farm

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