Understanding the Changing Mind: Improving Brain-Health and Cognition during Perimenopause, Part 1

Imagine this: You’re a high-achieving professional, excelling in your career, but suddenly, in the middle of a crucial meeting, you find yourself struggling to stay focused and remember key details. This isn’t an isolated incident but a growing concern for many navigating perimenopause. As the body adjusts to shifting hormonal levels, one of the most common and unsettling symptoms is brain fog, characterized by sudden lapses in concentration, forgetfulness, and impaired verbal recall. A 2019 study revealed that up to 59% of women experience such severe symptoms that they significantly impact their work performance. So, what’s behind these cognitive challenges, and more importantly, what can those going through perimenopause do to ease this transitional phase and regain their mental clarity?

When I set out to research how estrogen and progesterone impact brain function and health, I had no idea just how deep that rabbit hole would take me. The topic really deserves a book onto itself. For now, let me try and break it down into three subcategories. First the chemical changes that happen, especially involving some of the most important neurotransmitters for focus and cognition: serotonin, dopamine, and acetylcholine. Second, the structural changes that take place, most prominently in an area of the brain called the hippocampus that is the site of our memory formation. And lastly overall brain health, inflammation, and repair processes. Of course all of those processes are interrelated and do not function in isolation but this grouping should make the information a bit easier to process and make suggestions for interventions a bit more targeted.

In this first post, I will be focusing on the chemical changes. Let’s begin by meeting our main characters, dopamine, serotonin, and acetylcholine and learn which function they perform, then see how estrogen, progesterone, and testosterone are involved, and finish with looking into what avenues are open to us when those hormones decline to still boost the action of our neurotransmitters.

Our brain consists of a vast network of neurons that communicate through connections called synapses. These synapses are tiny gaps where signals need a way to jump from one neuron to the next. This is where neurotransmitters come in — chemical messengers that carry signals across these gaps. We produce about a hundred different types of neurotransmitters, each responsible for transmitting specific messages. If your brain doesn’t produce enough of a particular neurotransmitter, or if its receptors aren’t functioning properly, those signals can’t be sent effectively, no matter how intelligent or hard working you are. Dopamine, serotonin, and acetylcholine play crucial roles in focus and cognition, and they are all influenced by estrogen, progesterone, and testosterone. There are often significant differences between individuals as to how much influence those hormones exert and we need more research into testosterone, especially in how it affects women, it is an evolving science. But here is a general overview of where it stands right now.

Our first protagonist is dopamine. Dopamine, often referred to as the “pleasure” molecule because of its association with the brain’s reward system, is a crucial neurotransmitter that plays a key role in regulating mood, movement, motivation, focus, and cognition. It is made from the amino acid tyrosine and primarily produced by neurons (nerve cells) in areas of the midbrain called the substantia nigra and the ventral tegmental area (VTA), as well as in the hypothalamus. The areas of interest to us for cognition and focus are mostly the VTA, that is our famous reward circuit responsible for motivation and focus, and the hypothalamus, responsible for mood regulation.

While its reputation is of hedonistic pleasure, dopamine is in reality a lot more involved with hard, often mentally challenging work. It is dopamine and its close cousin, norepinephrine which is derived from dopamine, which allows us to undertake goal oriented pursuits by enabling executive function. Dopamine helps us regulate attention by modulating how we process information. Higher levels of it in certain areas of the brain, like the prefrontal cortex, are associated with improved attention and the ability to concentrate on tasks. It also plays a vital role in working memory which is the ability to hold and manipulate information in your mind over short periods of time. It is also crucial for tasks that require planning, decision-making, and problem-solving. It helps prioritize actions and thoughts, making it easier to focus on and achieve goals. Dopamine levels tend to be higher in the morning and then remain relatively stable until mid afternoon, dropping just before evening. Ever noticed how you lose motivation to do things like go to the gym after work even though you were looking forward to it earlier in the day?

Now let’s look at how our sex hormones impact dopamine. Estrogen plays a crucial role by not only increasing dopamine production but also enhancing the sensitivity of dopamine receptors — tiny structures that dopamine binds to in order to transmit its signals, in certain brain regions, particularly in the prefrontal cortex and the striatum (the area of the brain most associated with reward based learning). Estrogen is also neuroprotective and plays an important role in maintaining the health of dopamine producing neurons.

Testosterone has also been shown to increase dopamine levels, particularly in areas of the brain associated with motivation and reward, such as the nucleus accumbens. Higher testosterone levels are associated with increased motivation, competitiveness, and focus, largely due to its impact on dopamine pathways.

The story gets a bit more complex with progesterone. This hormone dampens dopamine and enhances the activity of GABA, an other neurotransmitter but an inhibitory one, meaning it slows or stops the sending of signals, which can have a calming effect but may counterbalance dopamine’s stimulating effects, sometimes leading to feelings of sluggishness or reduced drive. So while that should mean that lower levels of this hormone should boost our dopamine, in reality, as sufficient quality sleep is essential for producing dopamine in the first place and the lack of progesterone during the menopause transition is linked to the sleep disturbances many face, it can still have an overall negative effect.

And with that, let’s move on to the next of our co-stars. Serotonin. Pop-science often refers to this neurotransmitter as the “feel good” molecule, but just as with dopamine, the story is far more interesting and complex. Serotonin is not just a “mood molecule”, it also plays a pivotal role in cognitive functions, including memory, learning, focus, and attention. The majority of the brain’s serotonin is synthesized from the amino acid tryptophan in an area of the brain called the raphe nuclei, a very ancient group of nuclei located in the brainstem. From here, serotonin is distributed throughout the brain. You can imagine it like a sprinkler system in your garden. That should already give us a clue as to how important this molecule is.

Serotonin plays a key role in synaptic plasticity, which is the ability of synapses (the connections between neurons) to strengthen or weaken over time. This plasticity is fundamental to learning and memory formation, as it allows the brain to adapt and store new information. We will look more into this in the next post when we examine the structural changes that take place during this time.

In the prefrontal cortex, the site of our executive function, serotonin helps regulate attention. It does so by enhancing our impulse control so we can stay focused on goals rather than being distracted by irrelevant stimuli. Serotonin also interacts with its co-stars in cognitive performance, dopamine and acetylcholine. By modulating the activity of these neurotransmitters, serotonin helps fine-tune cognitive processes, ensuring that information is processed efficiently and accurately. Since serotonin also influences mood, its impact on cognition is interconnected with emotional states. For instance, higher serotonin levels can lead to a more positive mood and reduce stress, which in turn can enhance our ability to learn and recall information.

Estrogen has been shown to boost the production of serotonin by increasing the expression of tryptophan hydroxylase, the enzyme responsible for serotonin synthesis. This can lead to higher levels of serotonin in the brain. Estrogen also increases the sensitivity and density of serotonin receptors, particularly in the brain regions involved in mood regulation, such as the prefrontal cortex and hippocampus. This means that the brain responds more effectively to the available serotonin. Estrogen also inhibits the activity of monoamine oxidase (MAO), an enzyme that breaks down serotonin. By slowing this breakdown, it helps maintain higher levels of serotonin in the brain.

Testosterone has also been found to increase serotonin levels in the brain by enhancing the activity of serotonin-producing neurons. Higher testosterone levels are often associated with greater emotional resilience and stability, partially due to its positive impact on serotonin. This effect may be more pronounced in men, who generally have higher testosterone levels, but it also occurs in women, albeit to a lesser extent.

Progesterone has a more nuanced and less straightforward effect on serotonin. Just as with dopamine, it can modulate serotonin activity indirectly by interacting with GABA, which can alter the balance of serotonin’s effects. Some research suggests that high levels of progesterone, particularly during the luteal phase of the menstrual cycle, might reduce serotonin receptor sensitivity or influence serotonin transmission in ways that can lead to mood disturbances, such as irritability or depression. So again, during menopause, the most impactful side effect of low progesterone on serotonin levels might be down to sleep deprivation.

The last, but by no means less important, of our protagonists is acetylcholine. Acetylcholine is made from the precursors choline and acetyl-CoA. In the brain, one of the main areas where acetylcholine is produced is the basal forebrain, specifically in groups of neurons known as the cholinergic nuclei. These neurons project to other regions of the brain, including the hippocampus and cerebral cortex, which are involved in memory and cognition. Acetylcholine binds to nicotinic receptors which mediate a very fast synaptic transmission, which is crucial for rapid cognitive processes. Those are the same receptors that nicotine binds to and why nicotine is a stimulant that can help you focus. But smoking will not be part of our mediating interventions.

Like serotonin, acetylcholine supports synaptic plasticity, the process so critical for memory formation and learning. It plays a key role in the prefrontal cortex, where it helps regulate higher cognitive functions like problem-solving and decision-making as well as enhances attention and the ability to focus on tasks. Acetylcholine also promotes arousal and wakefulness. Ever felt dopey and sleepy after a stretch of intense focus? That is in part due to acetylcholine depletion.

Estrogen helps us increase the production of acetylcholine by promoting the activity of the enzyme responsible for making it, choline acetyltransferase. You can look at it like the morning coffee for those enzymes. And again, estrogen has neuroprotective effects, helping us to maintain the health and function of cholinergic neurons (neurons that release acetylcholine). This protective role is crucial for preserving cognitive function, especially during aging.

Testosterone, like estrogen, has neuroprotective properties. It can help protect cholinergic neurons from age-related degeneration, potentially reducing the risk of cognitive decline associated with conditions like Alzheimer’s disease. Some studies suggest that testosterone can enhance cognitive function, partly by influencing acetylcholine pathways. Higher testosterone levels are associated with improved spatial memory and other cognitive abilities, which may be linked to acetylcholine’s role in these processes.

Again, progesterone has an indirect effect via its role in promoting GABA, this inhibitory neurotransmitter, slightly reducing the amount of acetylcholine.

So now that we know where and from what those neurotransmitters are made and what they do, let’s start exploring our options. Before we begin, it goes without saying that consulting your healthcare provider should be your first point of call to see if hormone replacement therapy is a viable option for you. But regardless if you chose this intervention, making lifestyle adjustments that will improve your long-term brain health should always be a priority.

Let’s begin with what is termed big rocks. Big rocks are actions or behaviors that have a much greater overall impact. In our case, that means it has the same positive impact on all three neurotransmitters we are looking to boost.

The rock-star of our big rocks is exercise. Consistent exercise habits lead to an increase in the production of all our neurotransmitters in question as well as increases in receptor sensitivity so they function better. This has been confirmed with more studies than there are Starbucks cafes on London streets. But exercise is an umbrella term that covers many forms of moving. So let’s take a closer look at how individual training modalities stack up.

While all forms of exercise will increase our levels of dopamine, serotonin, and acetylcholine, cardiovascular, also termed aerobic exercise, has by far the greatest impact. For dopamine specifically, a form of cardiovascular training called HIIT is the most effective. The term HIIT gets thrown around a lot these days, but most workouts marketed as such aren’t really HIIT. HIIT, or high intensity interval training, is a form of training that intersperses short periods of very high or near maximal exertion with adequate rest and recovery periods. If the workout you are doing includes the likes of biceps curls, lunges, crunches, and so forth, you are not doing HIIT, you are doing a strength-circuit class. A good example of a HIIT workout would be sprinting or cycling at near maximum or even maximum for a minute and then taking two or even more minutes to fully recover and repeating this a number of times. There are many different protocols, but the important part is the all out effort and the recovery in between.

Serotonin seems to get the greatest boost by running at a steady pace. That isn’t to say that other forms of steady state cardio like swimming or cycling don’t boost serotonin levels, it just means as the research stands right now, running is the most efficient way to do so. But do what you enjoy and what makes you happy! They all work.

Acetylcholine appears to respond slightly differently to either HIIT or steady state training. With HIIT, the intense bursts of exercise can stimulate rapid increases in acetylcholine, which might be beneficial for tasks that require quick decision-making and cognitive flexibility. However, the cognitive effects of HIIT may be more acute and focused on short-term benefits. The continuous nature of steady state aerobic exercise supports sustained increases in acetylcholine, which is beneficial for long-term cognitive health, including learning, memory, and attention.

Let me restate that all forms of cardiovascular training have a big impact on dopamine, serotonin, and acetylcholine. I am giving you this more precise breakdown so you can pick your prescription for what you need at any given moment. Have a presentation due or a high pressure deadline and your brain isn’t playing ball? Throw in a quick HIIT workout, can be as short as 10 minutes. Need to boost your mood and de-stress? Go for a run or even a brisk walk.

I have used the term prescription because we are using exercise to change the chemical environment of our brain. As with any prescription, dose is important. Taken too far, exercise can lead to central fatigue and a depletion of serotonin, dopamine, and acetylcholine. So how do you gauge what is enough and when is it too much? This is where learning to pay attention to your body becomes critical. After a good workout, you should feel tired at the end but energized and focused after. You should sleep better, not worse. If you start noticing mood disturbances you didn’t have before such as increased irritability, or if you are feeling more exhausted than usual yet are unable to sleep, there is a good chance you are overtraining and not getting the recovery time you need. How much training you can sustain without overtraining depends on your current health and fitness levels as well on your overall stress and mental load and sleep quality and thus can vary immensely not just from person to person but also day to day. If you want to make sure you are getting it right, it can be very helpful to enlist the help of a qualified professional to assess your current levels and help you develop a routine that is perfect for you.

Now let’s move on to big rock number two. Diet. We can not build anything, including neurotransmitters, unless we procure the building blocks for it. We have established that dopamine is made from tyrosine, serotonin from tryptophan, and acetylcholine from choline. Those are all amino acids and amino acids are found in protein. So step one will be to make sure we get enough protein containing the amino acids we are after. We need a lot more of this macronutrient than previously thought, especially as we get older. Dr Stacy Sims, an expert in female physiology, recommends between 2–2.4 g of protein per kilogram of body weight for people in their menopause transition. All animal products as well as some plant sources like soy contain all the essential amino acids, but I will give you a break down of the best sources for the amino acids we are after.

Let’s begin with tyrosine, this amino acid that can also be synthesized from another amino acid called phenylalanine. Therefore, consuming foods rich in either of these will be beneficial. If you eat meat or animal products, chicken and turkey are excellent sources of tyrosine, as are salmon and tuna. In the dairy category, cheese is particularly high in tyrosine, with hard cheeses like parmesan, cheddar, and Swiss being especially rich. For plant-based options, tofu and tempeh are top choices, though nuts, lentils, and chickpeas also provide a good amount.

When it comes to phenylalanine, the meat products with the highest concentrations are beef, pork, mackerel, and cod. Cottage cheese is also a great source. Plant-based sources for phenylalanine are similar to those for tyrosine.

As for tryptophan, some of the richest sources include turkey, chicken, salmon, and tuna, with cheese once again being an excellent option. Among plant sources, seeds, nuts, and legumes like soybeans and chickpeas are your best bets. It is important to have some complex carbohydrates with it, such a sweet potatoes or beans, as those are needed to make serotonin out of tryptophan.

Finally, we have choline. This amino acid is most abundant in eggs, particularly in the yolk, and in liver meat. However, this is where vegans and vegetarians have an advantage: soy contains significantly higher amounts of choline than meat and dairy products.

Starting to see why a varied diet is so important? But there’s more to it than just getting the right building blocks. To produce neurotransmitters, we also need the tools and energy to make them, which come from vitamins and other compounds that we obtain or synthesize from food.

Pyridoxine (B6) and folate (B9) are essential for producing dopamine and serotonin. You can find vitamin B6 in poultry, fish, legumes, nuts, bananas, and fortified cereals. For vitamin B9, leafy greens, legumes, asparagus, Brussels sprouts, avocados, oranges, and beets are particularly rich sources.

Pantothenic acid (B5) is crucial for synthesizing acetylcholine, and it’s mostly found in meat, poultry, fish, and legumes, with smaller amounts in nuts, seeds, whole grains, and vegetables.

Another important nutrient is magnesium, which is essential for converting amino acids into functioning neurotransmitters, especially serotonin and acetylcholine.

Iron is also key, particularly for dopamine production. While both magnesium and iron can be found in leafy green vegetables, it’s worth noting that plant-based iron is not easily absorbed by the body. If you’re a vegetarian, you might need to consider taking a supplement, but be sure to consult your healthcare provider first.

Omega-3 fatty acids, especially DHA and EPA, play a crucial role in neurotransmitter synthesis and function. DHA is a key component of neuronal membranes, helping to maintain their fluidity. This fluidity is essential for the optimal functioning of receptors and for efficient signaling of serotonin, dopamine, and acetylcholine. You can think of it like a well-oiled door that opens smoothly.

Omega-3s also help reduce neuroinflammation, which supports overall neuron health and promotes better neurotransmission. This is particularly important for serotonin, as EPA can increase the availability of tryptophan, the precursor to serotonin, by reducing the activity of enzymes that divert tryptophan away from serotonin production. This is one reason why omega-3s are being explored as a potential treatment for depression.

The best sources of omega-3 are fatty fish such as salmon, mackerel, and sardines, but there are algae based supplements available if you do not consume animal products. Other plant sources of omega-3 are not converted into its active form in sufficient amounts to make much of a difference.

Probiotics and fermented foods can also positively influence neurotransmitter synthesis through their effects on gut health. By enhancing the gut-brain axis, these foods improve the availability of neurotransmitter precursors and support a balanced microbiome, which is crucial for optimal neurotransmitter production. For dopamine, probiotics can help by increasing the availability of tyrosine and reducing inflammation, which supports dopamine synthesis and receptor function. A healthy gut microbiome also enhances tryptophan metabolism, the precursor to serotonin. The direct impact of probiotics on acetylcholine synthesis is less clear, but as maintaining a balanced gut environment supports overall nutrient absorption, including choline, it certainly doesn’t hurt.

While the effectiveness and quality of probiotic supplements is still a big question mark, fermented foods are easy to come by or even make. Kimchi, sauerkraut, kefir, yogurt are found in most supermarkets or health-food stores.

If sleep is an issue for you, prioritising choices that improve dopamine and acytelcholine early in the day and those that promote serotonin in the evening, could be helpful.

Which brings us to rock number three is sleep. Sleep is crucial for the synthesis and regulation of dopamine, serotonin, and acetylcholine. During sleep, particularly during rapid eye movement (REM) sleep, the brain undergoes essential processes that impact these neurotransmitters. For dopamine, sleep helps to regulate and restore receptor sensitivity, which is critical for maintaining a balanced mood and motivation. Adequate sleep supports the production and release of dopamine, while sleep deprivation can reduce dopamine levels and receptor functionality, potentially leading to mood disorders and cognitive impairments.

Serotonin is involved in maintaining circadian rhythms, which regulate the sleep-wake cycle. Proper sleep helps synchronize these rhythms, promoting healthy sleep patterns and balanced serotonin levels. Irregular sleep patterns can disrupt circadian rhythms and lead to imbalances in serotonin. This is partially why going to sleep and waking up at approximately the same time each day, including weekends, is so important.

Acetylcholine is actively involved during REM sleep. This is the stage of sleep that promotes memory consolidation and supports learning. It does that by enhancing acetylcholine activity in the brain. Inadequate sleep impairs acetylcholine signaling, which can lead to deficits in memory and cognitive abilities. Ever struggled with studying something that just didn’t make sense to you, but then you go to sleep and when you wake up, it suddenly does? Now you know why. That is also one of the reasons why kids need more sleep.

Now of course we have the issue that perimenopause is infamous for bringing with it sleep disruptions and insomnia. I will address this in a post separately, but having a robust sleep routine is crucial here. It is not about performing an elaborate ritual but about doing the same things at the same time to get ready for bed so your brain can eventually get into the rhythm, knowing by your actions that it is time to go to sleep. Binge watching netflix until 1 am is not an effective night time routine, in case you were wondering.

Now let’s move on to our pebbles. Those are still very impactful actions and behaviors, but they would not accomplish a whole lot if the big rocks are not in place.

Stress management is key, I would almost put it with the big rocks. When we experience a pervasive presence of stress, and perimenopause can very often be a stressor itself, and we fail to manage it effectively, the delicate balance of these neurotransmitters is disrupted, leading to a cascade of effects on our mood, motivation, and cognitive function.

We have already covered exercise and sleep, which are effective tools for mitigating stress, so let’s look at some other ways of finding some calm. Mindfulness practices such as yoga and meditation have been well studied and can be very effective for many. There are many different forms and techniques, so investigate which, if any, appeal to you. If going to a class doesn’t work for you, there are a plethora of apps and options on YouTupe or you can hire a coach to teach you some techniques.

Controlled breathing techniques, such as diaphragmatic breathing or box breathing, can activate the parasympathetic nervous system, promoting relaxation. As does progressive muscle relaxation or PMR. PMR involves tensing and then slowly relaxing each muscle group in the body, promoting physical relaxation and reducing mental stress. It can be practiced by following guided instructions or using recorded sessions.

Cognitive behavioral therapy. CBT is a structured, time-limited psychotherapy that helps individuals identify and change negative thought patterns and behaviors contributing to stress.

It is in fact one of the most extensively researched and validated forms of therapy for managing stress, anxiety, and depression.

Effective time management and organization skills can reduce the stress that comes from feeling overwhelmed by responsibilities and deadlines. Research shows that individuals who effectively manage their time experience lower stress and better overall mood.

Spending time in natural environments, such as parks or forests, can also significantly reduce stress. Studies indicate that nature exposure lowers cortisol levels, reduces heart rate, and enhances mood.

And of course social connection. But besides lowering stress, it is a pebble all to itself.

Our relationships and social interactions do more than just enrich our lives — they profoundly affect our brain chemistry. Whether it’s a conversation with a friend or a collaborative project at work, positive social experiences activate the brain’s reward system, leading to increased dopamine release. Serotonin levels increase due to the reduction in cortisol and interacting with others involves complex cognitive processes, this stimulates and reinforces acetylcholine production. Engaging in intellectually stimulating conversations and activities not only enhances cognitive function but also helps maintain cognitive health as we age.

That leads me straight to pebble number three, learning. Yes, learning not only engages but also enhances the production of dopamine, serotonin, and acetylcholine. So sign up for that class you always wanted or see if you still remember your password for duolingo. It doesn’t matter if you are learning a new physical skill or a cognitive task. The impact on brain health is the same. If you have gotten this far in reading this, good chance you are currently boosting your neurotransmitters!

On to our next pebble: Sunlight offers an easy and free way to further boost our neurotransmitter friends. Morning sunlight, in particular, helps regulate dopamine levels by stimulating the retina, which sends signals to the brain to release this crucial neurotransmitter.

UV light from the sun aids in the production of vitamin D in our skin, which is essential for serotonin synthesis. The direct impact of sunlight on serotonin levels explains why we often feel happier and more relaxed after spending time outside, and why a lack of sunlight can contribute to conditions like seasonal affective disorder (SAD).

Lastly, while acetylcholine isn’t directly produced by sunlight, its function in the brain — particularly in learning, memory, and attention — is indirectly supported by sunlight exposure. By helping regulate the body’s circadian rhythm, it promotes better sleep which we have already established is key for this neurotransmitter to fulfill its full responsibility.

Our fived pebble is heating up. I’m talking about sauna use. The therapeutic effects of sauna bathing extend far beyond the immediate sensation of warmth and relaxation, reaching deep into our brain’s intricate network of neurotransmitters. As the body’s temperature rises, the hypothalamic-pituitary-adrenal (HPA) axis is activated, setting off a cascade of biological responses. One of the most significant of these is the release of dopamine.

Serotonin levels can also be significantly boosted by the thermal stress of a sauna. This is one of the reasons why regular use of saunas can help you regulate circadian rhythms, promoting better sleep and contributing to an overall improvement in your mental health.

Acetylcholine is another beneficiary of regular sauna use. The relaxation and stress reduction provided by sauna sessions create an environment in which acetylcholine can thrive, supporting cognitive functions and enhancing synaptic plasticity — the brain’s ability to adapt, learn, and remember. The heat also helps maintain the health and function of cholinergic neurons, which are essential for the production and release of acetylcholine. The result is a brain more primed for clarity, quick thinking, and efficient learning.

That should cover most of our pebbles. Once you have your rocks and your pebbles, you can fill the rest with sand. I won’t go too much into those as their impact is too minor to warrant writing or reading about on a blog, with one exception: Cold exposure.

Cold exposure is close enough to being a pebble, with a bit more research it might even get officially upgraded. At least in regards to dopamine. All the current date does show that cold water immersion or even a cold shower can increase dopamine levels at least shortly after. I would not rely on it to be my main source of dopamine but a cold shower after a morning run, in early sunlight, maybe through nature, maybe with a friend might well give you yet another boost.

Now that we know how to boost our neurotransmitters, let’s have a look at how we can protect them from habits that could damage them. Our big one there is substance abuse. By that I mean recreational drug use, alcohol, and nicotine.

Drugs such as cocaine and methamphetamine cause a surge in dopamine levels, leading to a temporary high. However, as the amount of dopamine released is far greater than what would occur naturally, the brain responds by shutting down dopamine receptors in an attempt to restore balance. Hence repeated use can deplete dopamine stores and damage dopamine receptors, leading to dependence and decreased natural dopamine production. This is why we feel a come-down the days after consuming those substances.

MDMA and its relatives can deplete serotonin. But it is not only illegal substances that will do that. The most damaging drug to our serotonin is perfectly legal and widely consumed. Alcohol. We often choose to indulge in a few glasses of wine to unwind after a particularly stressful day or when we are upset. But while it may temporarily lift your mood, its use will worsen mood swings, cognition, and often leads to depression and anxiety.

Remember how earlier I mentioned how nicotine binds to acetylcholine receptors and in that way can enhance focus? Well besides smoking being one of the worst things you can do to your health in general, nicotine, even consumed in forms that do not require smoking, will over time desensitize those receptors which can impair memory and cognitive function.

Consuming a diet high in sugar, processed foods, and unhealthy fats can also impair dopamine production. These foods can cause spikes in blood sugar, which eventually lead to crashes, reducing dopamine availability and leading to feelings of low energy and depression.

Another habit bound to deplete the chemical resources of your brain is doom-scrolling on social media. Your brain doesn’t differentiate between information that is important and just information. It uses the same neurotransmitters and depletes them in the process.

Navigating perimenopause while striving to maintain peak cognitive performance can indeed be challenging, but I hope by understanding the role of neurotransmitters and hormones a bit better, you can find valuable insights into managing these difficulties. Prioritise your big rocks and then fill your jar with as many pebbles as feels comfortably attainable to you.

This concludes the first of this three part series. See you back for part two.

Sybille Hazward