When it comes to estrogen, one of the greatest things it does for our brain is protecting it by creating extra connections so it becomes more able to adjust to different environmental situations as they arise. So when estrogen levels decline, our brain takes a big hit. No wonder brain fog becomes our new superpower!

Today we know that the drastic hormonal decline in P&M is tied to memory lapses & forgetfulness. No wonder why there’s actually a valid reason (a hormonal but totally valid one) behind moments where we easily lose the train of thought by just reaching for a glass of water or…wait, what was I saying?...oh, right…or a glass of wine.

Today we also know that diseases like Alzheimer’s start with adverse changes in the brain chemistry in midlife. Not a coincidence that, according to the Alzheimer’s Association, “about 2/3 of Alzheimer’s patients in the US are women.”

So for each and every one of us to pay attention to cognitive changes even when not all of us will get Alzheimer’s or any other form of dementia.

Menopause does affect our brain’s optimal functioning as it affects the optimal functioning of our entire body.

Hormonal imbalances in general impact gut health and estrogen is no exception. Estrogen helps maintain our gut lining healthy by regulating and increasing the helpful bacteria within the gut.

However, according to Orlando Health the decline of "estrogen and progesterone during menopause can slow down the processes of food passing through the GI system."

The gut (a general term for our gastrointestinal system) is composed of a diversity of bacteria that breaks down foods that cannot be digested in the small intestine. The cluster of bacteria is known as the gut microbiome and without a healthy one we are prone to digestive conditions that can worsen without adequate health care.

With the decline of estrogen in menopause, the diversity of the microbiome is reduced and causes, for example, complications as the slowing down of the processes needed to help move food in our intestines.

Among some common issues triggered by the slow down are more water retention, constipation, acid reflux, general indigestion and my personal favorite, bloating like a freaking hot air balloon. Estrogen decline also contributes to food sensitivities and keeping cortisol (stress hormone) levels high which negatively affect beneficial bacteria and the optimal absorption of food nutrients.

When in menopause, low levels of estrogen make us lose more bone mass than before we reach this moment, increasing our risks of osteoporosis. Of course, it could not leave the bones alone!

Osteoporosis is a bone disease that occurs when bone density (minerals) and bone mass drop making our bones more susceptible to becoming brittle; easy to break.

In fact, as stated by the International Osteoporosis Foundation, “osteoporosis is the most common bone disease affecting 1 in 5 women worldwide and in women over 45, it accounts for more days in the hospital than many other diseases.”

But there are things we can do to address bone health and work around maintaining good posture at any age. Doable things that allow us to protect our bones which are the living tissues that support the structure of our body.

Bone health can actually be improved and shielded with a healthy nutrition and exercises that promote balance and strength. Also avoiding heavy drinking as well as smoking come handy when considering reducing the risk of osteoporosis.

Because osteoporosis become such a real possibility in menopause, consider the seriousness of fractures as a threat to your mobility, independence and quality of life.

According to Harvard Health, “women are twice as likely to have an autoimmune disease compare to men.” And estrogen may have something to do with it although more research needs to be done to pinpoint the exact reasons behind the connection.

We know that estrogen boosts our immune system by reducing the inflammatory response to viruses and bacteria. But with its decline, the adequate response changes. It is believed that in menopause, the hormonal imbalances stimulate the immune system’s production of more antibodies which could predispose us to autoimmune diseases.

Autoimmune diseases happen when the immune system starts to attack its own organs and tissues and some of them include multiple sclerosis, ulcerative colitis, lupus, rheumatoid arthritis and even the thickening of the skin (scleroderma). And these, according to the Autoimmune Association "are only some in over 100 known autoimmune diseases."

So even as we don’t have a definite understanding of hormonal imbalances and the immune system, we do know that the changes in our organs that are triggered by menopause could contribute to suffering from autoimmune diseases later in life.

And just when we thought that the list of risks could be shorter, menopause keeps adding to it!

The way estrogen regulates mood is by the effect it has on neurotransmitters (chemical messengers that carry signals in the brain). Estrogen also influences other hormones.

For example, out of a variety of neurotransmitters, two very well known ones are dopamine (pleasure) and serotonin (happiness). A well known hormone influenced by estrogen is cortisol (stress hormone). When estrogen levels are optimal, it enhances the release of these neurotransmitters. When it comes to cortisol, optimal estrogen regulates stress.

So with drastic hormonal imbalances in P&M we end up with an alteration of the chemical balance in our brain and how we feel. No wonder mood fluctuations are experienced throughout the menopausal journey and have nothing to do with waking up in the morning “deciding” to be a crabby bitch.

Adding to this reality is the fact that, according to the National Institutes of Health, "with a higher life expectancy, we will spend a long time of our lives experiencing the effects of estrogen shortage" in our mood once we reach this moment and beyond. For all of us, it’s critical to understand the fact that menopause increases the risks of mood disorders so that we don’t ignore its impact in the quality of our lives.

Visualize this cycle: hormonal imbalances affect our emotions, trigger physiological symptoms that negatively alter how we have lived our entire adult lives which as a consequence, intensify already awful feelings.

So please try to consider incorporating movement, improving the quality of sleep, managing stress, meditation and/or therapy as tools to alleviate the severity of these emotions.

Everything from what we eat, how often we move or don’t, the amount of personal or work responsibilities, social connections or the lack of, smoking, how often/how much we drink, medications, access to green areas, food deserts and even how far or close we live from environmental pollution factor our lifestyle.

And when these sources contribute to an unhealthy one, our bodies become targets of issues that will corrode our physiological function. For women in menopause, lifestyles become critical as the list of risk factors keeps adding up, especially for those whose lifestyles revolve around the wellbeing of others...which is probably every woman in the planet!

Whether as caring for children, entire families or vulnerable adults, these are the women who never put themselves first, but still will be impacted by risk factors along the bumpy road of menopause.

Per NYU Health, lifestyle changes "help relieve symptoms and improve your quality of life during perimenopause and menopause."

Today we know, that lifestyle risks can be mitigated by creating routines of healthy habits. These can start with small changes around what contributes to endless cycles of unwell. A sedentary lifestyle aligned with symptoms such as chronic stress, sleep difficulties, high blood pressure and/or body aches can be eased by incorporating movement. An all processed diet can be modified by slowly introducing nutrient dense foods.

Think of small healthy habits as the driver of every effort we put in preventing as much diseases as we can. It is this one and only opportunity we have to minimize the chance of defining a journey full of illnesses but not full of life.

Hopefully one day a quality of life beyond menopause can become a collective expectation.