Your Brain on Perimenopause: Why Anxiety, ADHD, and Brain Fog Suddenly Show Up

We talk with Michigan State University researcher Dr Kristen Colbert about how perimenopause hormone fluctuations may shape the brain and mental health, and why “it’s just menopause” can feel so dismissive. We break down how daily symptom tracking and hormone testing could finally connect the dots so women can get taken seriously and supported. 
• the harm of minimizing language and why symptoms deserve attention 
• the research gap in perimenopause compared with puberty, menstrual cycle and postpartum 
• why women and providers are asking about psychotic symptoms and hormonal change 
• how daily assessments capture mood, sleep, anxiety and brain fog alongside saliva hormone data 
• why some women may be more hormone sensitive and what biology might explain it 
• how to talk with a provider when anxiety, depression or ADHD shifts in midlife 
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Transcript

Welcome And Research Focus

SPEAKER_01 0:00

Welcome to The Pause, the Menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn't see coming, and the hilarious moments midlife can bring. I'm your host, Val Lego, and I've been a dedicated health reporter for 25 years, and I wanted to normalize something that every woman goes through: menopause. Hi friends, Val Lego here. Welcome back to the pause for part two of Hormones in Flux. We are talking with Michigan State University researchers about the work they are doing when it comes to hormones and the effect they have on our brains as we move through perimenopause. I'm talking with Dr. Kristen Colbert. We're digging into another area of this amazing research that MSU is doing. Dr. Colbert is a research specialist at Michigan State and co-principal investigator in this study. Thank you so much for your time, Kristen.

SPEAKER_02 0:58

Thank you.

Why “Just Menopause” Hurts

SPEAKER_01 0:59

Thank you for allowing us to come on the podcast and speak about this work. Oh, of course, because it's it's fascinating. It really is. You know, one of the things that I read is that part of your motivation for this research really came from hearing women say that they just felt dismissed, which I hear all the time on the podcast or when I'm out talking about this, you know, when they're like, I've got mood changes or I've got this, you know, they're being told. It's just menopause. So you really put thought into that in shaping the study's design.

Study Gap And Psychotic Symptoms

Daily Symptom Logs And Saliva

SPEAKER_02 1:30

Yeah, I mean, I yeah. So first let me just comment like that phrase, you know, it's just menopause. It really can feel, you know, incredibly invalidating or dismissive. And it may not be the intentional, right? But it minimizes like the real and substantial changes that, you know, many women can experience. Um, those words, like it's just menopause. Um, you know, really just kind of essentially uh, you know, can convey the symptoms are expected or they're, you know, not worth further expiration or you know, treatment and relief. So um I do think that's important to just kind of say and get out there. But um, you know, I I think about the motivation um for the work in two parts kind of the motivation that initiated the research and then motivation that's um kind of kept it evolving and they've kind of grown together over time. So, you know, the motivation for initiating the research, I would say, like really did stem from prior research showing ovarian hormone influences on mental health and behavioral outcomes at other stages of life. So um, for example, puberty across the menstrual cycle, um, postpartum, just that there's this, there is robust evidence that when there are these hormonal shifts, emotional behavior changes can follow. Um, but really what stood out to us um was you know how little work had actually examined those same types of hormonal questions during midlife, especially perimenopause, despite the fact that this is this period um marked by substantial hormone fluctuation. And so that gap is really what you know motivated us to dig deeper, um, seek the grant funding, um, and design a study that could really answer um questions. And so as we you know prepped that grant, um, you know, we simultaneously pulled together a review paper. And that review paper aimed to highlight, you know, what was known and importantly also what's not known. Um, and it was actually after that paper was published in Psychological Medicine, um, where we started to just get email messages hearing directly from women as well as healthcare providers around the world. Um, they had found the article as they were searching for answers. So they or their patients were experiencing new or unfamiliar kind of mental health outcomes, um, in particular, psychotic symptoms. And the women and the providers were essentially questioning whether psychotic experiences or symptoms could be connected to the hormonal changes of perimenopause. Um, and what we were hearing in these communications is essentially like they were feeling largely dismissed and unsupported as they searched for the answers and whether or not there was there or there could be some connection to hormonal status. And um they were often being, you know, kind of told by their treatment providers that there's no evidence or it's an unlikely possibility. Um, and because it didn't sit with them, that's why they were diving into the science themselves. Um, so I mean, it was devastating to hear those stories, but um, in a way, you know, it's made the work that we're doing come alive. Um, and you know, reinstates kind of that commitment to the research. Um but I'll say, you know, by the time those stories then reached us, our study um was already in place, data collection was underway, but the experiences that were being conveyed really validated the approach that we were taking in the study design we had developed. So our use of um daily assessments really does help capture like a real-time ebb and flow of symptoms alongside daily hormonal changes. Um, do the changes in the hormones predict changes in symptoms? Like that's what we're interested in trying to understand. Um, and weekly or monthly types of check-ins as a study design would miss that dynamic picture kind of entirely.

SPEAKER_01 5:22

I think I really, really like the fact that you're saying, you know, daily check-ins, write down your mood. How did you sleep? Where's your anxiety? Are you having brain fog? You know, making sure that you're documenting all that and then overlapping that with the saliva test, with where you are with your hormones. Such an important part of research that I think sometimes um those are separately looked at, but never together in an overlapping way where you can really have that aha moment of what is happening in a woman's life.

SPEAKER_02 5:52

We're assessing their current symptoms, but we're also assessing for lifetime history of symptoms and other conditions. Um, you know, we're taking a population level approach that will help us, you know, capture natural individual or kind of, you know, between person types of differences in risk, because just like other stages of life, you know, not every woman is going to be experiencing the hormone symptom effects or um experiencing it to the same degree. Um, but then like I would say, like the one other aspect of how, you know, just hearing from women and thinking about it really critically and kind of informed the design is that um we did want women to also be able to communicate or disclose, you know, other challenges they face that aren't captured in our standardized questionnaires or assessments. You know, most of what we're doing, we are using validated questionnaires that don't have open-ended responses. But we've added open-ended questions. Um, so even though it's not a large component of the study, we do have some qualitative data that gives them this opportunity to share a little bit more and hopefully, you know, we'll be able to dive into that aspect of the data as well and see if we see any, you know, unique patterns there as well.

Hormone Sensitivity And Possible Biology

SPEAKER_01 7:00

Yeah, I think that's great because women like to share, they like to tell you what's going on. And I think that's wonderful that you leave that there to say, maybe not for this study, but definitely going to possibly let us go down a road in a future study. I do want to ask you, so um are you able to correlate yet, like why some women might be more sensitive to um the these hormone fluctuations that that deal with mental health issues?

SPEAKER_02 7:29

Yeah, I mean, it's the sensitivity question. Um it's an interesting one and it's you know another important question. Um, but that there's just not that much research. There's evidence that suggests, right, that we know women differ and how sensitive they are to hormonal fluctuations. But why those differences exist, you know, is really unclear at this point. One thing that we're doing in our study, I would say, you know, is um tapping into differences in the experience of menopausal symptoms, like, you know, night sweats and hot flashes and um the severity of those to capture um variation. Um and we're thinking a lot about the hormone sensitivity aspect. Um, and you know, one strong possibility um that we hope to be able to explore more directly is whether or not there are underlying kind of biological differences. Um, you know, we're thinking about it in terms of, you know, genetic differences or how the central nervous system has been organized, um, kind of structured at other hormone-sensitive periods of life, like prenatally or pubertally, um, puberty, um, that may make women more responsive to hormones um and hormonal change than others. Um, but we don't have, we haven't run analyses um, you know, in particular at this point to be able to, you know, start answering those questions, but we do hope the study itself um will be able to dive into that in the future.

Talking With Providers About Mental Health

SPEAKER_01 8:59

Yep. That's the next chapter, right? Yep. Um, so if you're a woman who's currently managing um a mental health condition like anxiety or depression or or ADHD, as they move into perimenopause, what would be your advice for them? What kind of conversation should they have with their provider?

SPEAKER_02 9:16

Yeah, I mean, I think first and foremost, um, it's important to be open and make sure the provider's aware of, you know, the mental health symptoms of, you know, whether it's depression, anxiety, or, you know, anything else that you're feeling, um, and to express the concerns that you do have. Um, so, you know, if you're noticing or, you know, think you're noticing like changes or some sort of exacerbation of symptoms, um I would just say, you know, aim to have that open collaborative dialogue so that the provider can provide the appropriate information, guidance, referrals if needed. Um and, you know, if if you've noticed any change in mental health symptoms, you know, as your cycles become irregular, for example, um, or it feels as though symptoms seem more variable or unpredictable. Again, letting the your provider know. Um, you know, thinking about um if there's then any changes in other medications, even, you know, prescription hormone meds, um, whether you know start them or thinking about starting them, just kind of monitoring any new kind of signs or symptoms or side effects. Um, and again, then speaking up and having those conversations. I mean, I think it is that the dialogue part of it and not being, you know, afraid to convey or have those conversations so that your provider can support you in the ways that are necessary.

SPEAKER_01 10:35

Yeah, and just being educated and knowing that this research is out there, and hopefully, you know, those that are listening that might be, you know, navigating the their their mental health uh along with perimetopause, they know that there now might be a connection and they can take that information to their physician and and and have a different kind of conversation, other than I'm feeling this way, or I've got brain fog or what have you. Um, and that's what I really love, even though there's so much more for the study to discover, and so many other arms of the study that may go on for decades. Um, what it does right now is give women another layer of information of like, I'm not crazy. This is happening. What can we do? How can you help me? And that's what I love about the work that you're doing. Thank you. You're welcome. I just want to wrap this up by saying I thank you so much for your time. I can't wait to hear more about the study um and all that it brings for women's health. You're moving the needle, you're moving us forward into the 19th century, I feel like.

SPEAKER_00 11:39

Someday we'll get to the 21st century, right? Someday we want to be in that 21st century for women's health, but we're still that far behind. But we're moving it.

SPEAKER_01 11:47

Yes. So thank you so much for um all the work that you're doing, and it was a pleasure having you on the podcast.

You’re Not Alone Plus Next Steps

SPEAKER_02 11:53

Yes, thank you so much for speaking with us.

SPEAKER_01 11:55

You know, every time I talk to scientists, I'm reminded how much we still don't know about women's health and how powerful it is when we start to ask the right questions. So if you're listening and you're thinking, hmm, this kind of sounds like me, here's what I want you to know. You're not broken, you are not imagining it, and you are not alone. Hormones can influence our brains in real, measurable ways. Write down what you're noticing. Why am I suddenly so anxious? Why do I feel detached? Why am I more sensitive? Or why is my mind racing? Write these down. Make a note, then bring it up with someone. Talk to someone about it. You can talk to your doctor, your therapist, your friend, your sister, your mom, your neighbor. Every woman is going to be going through this in their lifetime. Every woman deserves to be supported in their journey and talk through it. And that's what I want for you. So if today's episode resonated with you, come join me in our private Facebook group, The Pause Diaries. This is where we keep these conversations going with other women through perimenopause and menopause. And don't forget to follow the pause wherever you listen to podcasts so you don't miss a new episode. Until next time, take good care of your body and your mind, and we'll talk soon. The Pause Podcast is for informational purposes only and not intended as medical advice. Always talk to your healthcare provider about any questions or concerns. Views shared by hosts and guests are their own and don't replace personalized care from a qualified professional.