Why I'm Low-Key Panicking About Something We're All Ignoring

Let me ask you something: How much time did you spend this week thinking about your health?

I'm willing to bet it was a decent amount. Maybe you checked your sleep score this morning, tracked your steps, scrolled through your health app to see how your HRV looked. We live in this era where we can quantify almost everything about our bodies, and honestly? I'm weirdly into it.

But here's what's been nagging at me lately—for all the tracking and optimizing we do, there's one organ we're basically ignoring. The most important one, actually. The one reading these words right now and making sense of them.

Your brain.

The Stats That Knocked Me Sideways

Okay, I need you to sit down for this one. Or if you're already sitting, maybe grip your chair a little.

Women are twice as likely to develop Alzheimer's disease as we are to develop breast cancer.

Read that again. Twice as likely.

When I first came across this statistic, I had to check it multiple times because—how did I not know this? We've all seen the pink ribbons, done the walks, shared the awareness posts. Breast cancer awareness is everywhere, as it should be. But Alzheimer's? It's been lurking in the shadows of women's health conversations, and I can't figure out why.

Two-thirds of all Alzheimer's patients are women. And before you go where I went—"well, women just live longer, so of course"—researchers have already thought of that. Even when you control for age, women are still at significantly higher risk. This isn't just about longevity. Something else is happening, and we don't fully understand what.

Here's where it gets personal for those of us in perimenopause or approaching it: during this transition, women lose brain volume up to 30% faster than men. Thirty percent! And these aren't just random brain regions—we're talking about areas critical for memory and cognition. The parts that make you, you.

But it gets worse, and I'm sorry about this because I wish I had better news.

Women experience cognitive decline symptoms earlier than men, but we're diagnosed later. Want to know why? Because for decades—literally decades—when women went to their doctors saying "I can't focus like I used to" or "I'm forgetting things," they were told it was stress. Or hormones. Or my personal favorite dismissive phrase: "just getting older."

Meanwhile, we refuse to accept "just getting older" when it comes to literally every other part of our health. We fight it, optimize around it, biohack our way through it. But our brains? Apparently those we're just supposed to let decline quietly.

The Perimenopause Problem No One's Talking About

Here's something that makes me want to shake people: Between 44% and 62% of women going through the menopausal transition report problems with their memory and thinking. Nearly half. And yet when these women bring it up with their doctors, they're often dismissed or told it's "just menopause" as if that's not a legitimate medical concern deserving of attention and intervention. I actually experienced that first hand just a couple weeks ago. 

But the research tells a different story. A really concerning one.

Studies tracking thousands of women through menopause found that verbal memory—your ability to learn and recall information—specifically declines during perimenopause. It's not your imagination when you can't remember that word or where you put your keys (spoiler: they’re almost always in my hand). A UK study of over 15,000 women found that psychomotor speed—how quickly your brain processes information—is particularly sensitive to the menopausal transition. For most women, these changes stabilize after menopause, but about 11-13% of women show clinically significant impairment during this time.

And here's what's wild: Recent research from 2024 found that women who experienced specific symptoms during perimenopause—particularly brain fog, mood changes, and weight changes—showed significantly worse cognitive and behavioral symptoms later on. The brain fog you're experiencing right now? It might not be as temporary as we've been led to believe. Which honestly, given my forgetfulness right now really freaks me out. 

What's Actually Happening in Your Brain

During menopause, the brain experiences significant hypometabolism—meaning it's getting less glucose, its primary fuel source. Think of it like your brain suddenly running on fumes.

As estrogen drops during perimenopause, the brain's ability to use glucose efficiently falters. In animal models that replicate the human menopausal transition, researchers found declines in key enzymes needed for glucose metabolism, along with reduced mitochondrial function—the power plants of brain cells.

But the brain isn't helpless. It adapts by shifting to alternative fuel sources including ketone bodies, fatty acids, and amino acids. This sounds good, yes? Adaptive! …Except this metabolic shift may come at a cost, potentially increasing vulnerability to conditions like Alzheimer's disease later in life.

Imaging studies show that postmenopausal women have lower gray matter volume in multiple brain regions and reduced glucose metabolism in areas critical for memory, including the temporal and parietal cortices. The same regions that light up as problematic in Alzheimer's disease. That's not a coincidence.

Here's the part that really gets me: The hippocampus—the brain region absolutely critical for learning and memory—becomes hypersensitive to injury after surgical menopause in animal models. It's like losing estrogen removes a protective shield, making the brain more vulnerable to damage.

The Critical Window We Keep Missing

Research shows that the timing of hormone therapy matters enormously. Starting estrogen therapy in perimenopause or early menopause appears to have positive effects on brain activity and memory function, though systematic trials haven't been conducted during perimenopause specifically.

This is what researchers call the "critical period hypothesis." Recent fMRI studies found that women who started hormone therapy during perimenopause and continued it showed enhanced verbal memory and better hippocampal function at age 60, compared to women who never used hormone therapy. The window matters, and as a woman in my early 40s, I’ll tell you I’m spending a lot of waking hours thinking about it. 

Unfortunately there’s a catch of course - current guidelines from the North American Menopause Society don't recommend hormone therapy at any age specifically for cognitive concerns or dementia prevention. Despite the evidence suggesting early intervention could help, we're not doing the trials. We're not collecting the data. Women are left in limbo, experiencing real cognitive symptoms, while the medical establishment shrugs.

Why This Has Been Ignored for So Long

Until very recently, research on cognitive problems during the actual perimenopausal transition was essentially nonexistent. Most studies focused on postmenopausal women—after the transition was already complete. It's like studying the aftermath of a hurricane without ever measuring what happened during the storm itself.

And when women did report cognitive problems? Researchers initially assumed it was just due to menopausal symptoms like hot flashes, sleep problems, anxiety, and depression. But the landmark Study of Women's Health Across the Nation (SWAN) found that objective cognitive changes weren't fully explained by these symptoms. Something else was happening—something directly related to the hormonal changes themselves.

The characteristic of early menopause is a diminished level of estrogen that increases risk of dementia, as well as cardiovascular disorders, osteoporosis, depression, and parkinsonism. For women who experience early or surgical menopause, the risks compound significantly. But even for women going through natural menopause at the typical age, the transition represents a vulnerable period that we're largely ignoring.

So How Are We Tracking Brain Health? (Spoiler: We're Not Really)

Here's the thing that's been bothering me. We have all these incredible tools now. Wearables that track everything from our heart rate variability to our REM cycles. I have three of them. I love them! But when it comes to brain health, we're basically trying to measure it by... not actually measuring it.

Your HRV tracker tells you about stress—which is genuinely useful—but it doesn't tell you anything about how your brain is actually performing cognitively. Are you focused? Processing information quickly? It has absolutely no idea.

Your sleep tracker confidently informs you that you slept 7 hours and 23 minutes last night—but did your brain actually recover during that time? Did it do the critical cleanup work it needs to do? The tracker is just making educated guesses based on movement and heart rate.

And those meditation apps we all downloaded during the pandemic? They ask you "how do you feel?" which is lovely and mindful, but also... completely subjective. Yesterday I felt like I had the most profound meditation session of my life. Today the exact same session felt scattered and useless. What actually happened in my brain during those sessions? Your guess is as good as mine.

Don't get me wrong—I use all these tools and find them valuable. But they're measuring brain health the way you'd measure your fitness level by looking at your sneakers. Sure, worn-out shoes might suggest you've been running, but they're not actually telling you about your cardiovascular capacity, are they?

‍

What If We Could Actually Measure Our Brains?

You know how we don't just rely on "feeling healthy" to assess our cardiovascular health? We get our blood pressure checked. We do cholesterol panels. If we're concerned about bone health, we get a bone density scan. We want numbers. Data. Something concrete to either worry about or feel smug about.

What if we could do that for our brains?

The technology actually exists—it's called EEG (electroencephalography), and it's been used in research labs and hospitals forever. What's changing now is that this technology is starting to become accessible outside of clinical settings. No wires, no lab coats, no feeling like a science experiment.

Modern brain-sensing technology can track things like:

• Focus: Is your brain actually performing at its peak, or are you just really good at looking like you're concentrating?
• Calmness: Are you managing cognitive stress, or is your brain secretly screaming while you smile through another Zoom call?
• Physical stress response: What's your nervous system actually doing right now versus what you think it's doing?
• Cognitive processing speed: This is the big one—it's basically a marker of how well your brain is aging.

Think about this: You might be spending hundreds of dollars a month on supplements, hormone optimization, maybe some NAD+ treatments because someone influential posted about them. You meditate daily. You bought the fancy magnesium. You're doing ALL the things.

But... are they working?

Right now, you're kind of just hoping they are. Maybe you feel better? Or do you? It's genuinely hard to say. Our subjective experience is notoriously unreliable, especially when we've invested money and ego into something working.

But what if you could actually see the data? Like, "Oh, my cognitive processing speed improved 15% since I started that protocol." Or "Hmm, that meditation retreat I spent three weeks planning and a small fortune attending didn't actually move the needle on my brain's stress response. Interesting and mildly devastating."

I'm not saying we should reduce everything to numbers—there's absolutely value in subjective experience and how things make us feel. But for those of us who are already tracking everything else, doesn't it seem strange that we're flying completely blind on the one organ that actually runs the whole operation?

The Window of Opportunity (Or: Why Waiting Is a Terrible Strategy)

Here's something I think about a lot, probably more than is healthy: We don't wait until we break a bone to start caring about bone density, right? We get screened. We take our calcium and vitamin D. We do weight-bearing exercise. We're proactive because we know that by the time there's an actual problem, we've lost precious time and bone mass that we can't get back.

But with cognitive health? Most of us wait until we or someone we love starts showing serious symptoms. And here's the part that makes me want to shake people: research suggests that interventions for cognitive decline—hormone therapy, lifestyle changes, cognitive training—work better when you start them early during perimenopause, not later when problems have already emerged.

The window matters. A lot.

Brain imaging studies show that changes in brain structure and metabolism during the menopausal transition often stabilize in the postmenopausal period, but by then, some of the damage may already be done. It's like saying that the best time to plant a tree was 20 years ago, the second best time is now—except with your brain, and with significantly higher stakes than shade coverage.

Plus, and this feels important to mention, when we track our cognitive health proactively, we're not just helping ourselves. We're creating data. We're participating in a larger understanding of how women's brains age, what works, what doesn't, what interventions might actually move the needle. Given how historically understudied women's brain health has been, every data point matters more than you might think.

Let's Talk About Why This Took So Damn Long

Can we just pause for a second and acknowledge why we're even having this conversation in 2025?

For decades, women were systematically excluded from clinical trials. In 1977, the FDA created a policy that barred women of childbearing potential from early-stage clinical trials. The rationale? Protecting potential fetuses. The result? Decades of medical research based primarily on male bodies.

It took until 1993—1993!—for Congress to pass a law requiring that women be included in clinical research. That's barely a generation ago.

And brain health? Even worse. While other areas of women's health were fighting for recognition, cognitive health was sitting way back in the corner, largely ignored and underfunded.

Even now, large-scale randomized controlled trials testing whether hormone therapy improves cognitive problems in perimenopausal women simply don't exist. When data does exist, it's often only for postmenopausal women—a direct legacy of those exclusionary policies.

But something's shifting, and I can feel it. I see it happening with women I know, women in my communities online and off. We're done accepting "that's just how it is." We demand data-driven approaches to our health. We ask uncomfortable questions. We compare notes. We advocate for ourselves and each other, loudly and persistently.

When we take cognitive health as seriously as we take everything else—when we track it, talk about it openly, refuse to let it be dismissed as "just stress" or "just hormones" or "just aging"—we contribute to a much larger change in how women's brain health gets prioritized and funded.

That feels important to me. Not just for us, but for our daughters, our younger colleagues, the women coming up behind us who hopefully won't have to fight as hard to be taken seriously when they say something feels off.

So Where Does This Leave Us?

Look, I'm not here to fear-monger or send anyone into an anxiety spiral. We have enough of those on our own without my help, thank you very much.

But I do think we need to have an honest conversation about brain health. Not in a "someday when we're older" way, but now. Today. This week.

Because here's what I keep coming back to: The future of wellness isn't just about living longer. I mean, yes, longevity is great—sign me up for those extra years. But what we really want is to live those years sharp, clear, vibrant. Still ourselves. Still able to engage fully with the world, with our work, with the people we love. Still making memories, not just existing.

If you're already someone who tracks aspects of your health—and if you're reading this, you probably are because this is not content for the casually health-curious—I want you to ask yourself: Does your brain deserve the same attention?

The organ that's making it possible for you to have a career, maintain relationships, learn new things, experience joy, remember your entire life—shouldn't it get the same investment in monitoring and maintenance that you give to literally everything else?

As technology makes brain health measurement more accessible (and it is, rapidly), we have this kind of unprecedented opportunity to shift from reactive to proactive cognitive care. To move from "I hope my brain's okay" to "I know my brain's okay, here's the data, and here's what I'm doing about the parts that aren't optimal."

The question really isn't whether we can afford to measure our brain health.

It's whether we can afford not to.

And maybe, more importantly: Why are we still asking permission to prioritize this?

‍