We often take our mental clarity for granted and don’t notice its importance until it’s gone. But things like brain fog, issues concentrating, and mood swings can impact your day-to-day immensely. These symptoms, along with other emotional changes are more than common in adults going through hormonal transitions. Unfortunately, patients and providers will often chalk these symptoms up to stress, general aging, and burnout, instead of addressing the underlying cause: hormonal imbalance.
Bioidentical hormone therapy, or BHRT, can provide a path to more balanced hormones and therefore better mood and focus. When used under the care and supervision of a healthcare professional, individuals may see improvements in their mental clarity. This article will discuss the unique interplay between our hormones and cognition and how BHRT can help.
Let’s first start by understanding exactly what brain fog is. Brain fog is defined as difficulty remembering things, concentrating, or finding the correct words. It may feel like your mind moves slowly or your memory is muddy. As such, brain fog can greatly impact your ability to function day-to-day, such as with tasks that involve organizing, planning, multitasking, or remembering. Individuals may experience decreased productivity or performance both in their personal life and at work due to brain fog (1).
Brain fog can happen for a number of reasons, including illnesses and conditions, environmental factors, and lifestyle factors (1). However, an often overlooked cause are our hormones. Hormones can affect things known as neurotransmitters, which are naturally found chemicals in our bodies that act as signals within our nervous system. Common ones associated with cognitive functioning and mental health include serotonin, dopamine, and gamma-aminobutyric acid (GABA). We’ll discuss exactly how our hormones influence these neurotransmitters later.
Knowing the intimate link between hormones, neurotransmitters, and cognition, it makes sense that in times of hormonal flux, we may experience things like brain fog and mood changes. That is why certain life stages are associated with symptoms of decreased mental clarity and less emotional stability. In particular, these life stages can include perimenopause, menopause, andropause, postpartum, and periods of chronic stress.
Hormones do more than just control physiologic processes like metabolism, growth, and reproduction. They also play a key role in the operations of the central and peripheral nervous systems. Hormones such as estrogen, progesterone, testosterone, cortisol, and more can have profound impacts on cognitive functioning and mood.
Estrogen is a female sex hormone that has a multitude of functions in the body. When it comes to the brain, estrogen receptors are located in several regions like the hippocampus and prefrontal cortex. These regions of the brain regulate things like memory, mood, and cognition.
There are several ways in which estrogens regulate neurotransmitters and signaling within the nervous system. For starters, estrogens activate an enzyme known as tryptophan hydroxylase, which is key to serotonin synthesis. In activating this enzyme, estrogens upregulate the production of serotonin.
Estrogens also can inhibit monoamine oxidase (MAO), which is an enzyme involved in the breakdown of monoamine neurotransmitters such as serotonin, dopamine, and norepinephrine. By inhibiting MAO, estrogens prevent the breakdown of these neurotransmitters so that they exist for longer, influencing things like mood, motivation, pleasure, and reward (2).
Because estrogen can greatly impact neurotransmitter levels, estrogen levels may correlate with mental and cognitive symptoms. For example, low or fluctuating estrogen can be associated with things like mood swings, brain fog, and anxiety.
These mechanisms have been substantiated in animal model studies. In rats, learning capabilities improved with increased estrogen levels, which investigators attribute to increased dopamine activity. Additionally, when estrogen activity decreased, learning capabilities were diminished (3). One study in humans found that estrogen exposure during adulthood, from birth control and hormone therapy in particular, led to increase cognitive functioning in later adulthood (4).
Progesterone is another sex hormone implicated in brain function. Progesterone generates a metabolite known as allopregnanolone, which impacts the GABA receptors. GABA is important to mood, as it is the main inhibitory neurotransmitter receptor located in the brain. When GABA is bound to its receptor, it causes sedative effects. Because progesterone increases transmission of GABA, progesterone thereby induces relaxation, which can have mood and cognitive effects (2).
As such, progesterone deficiency can be detrimental. Cognitive impacts include:
Testosterone is a male sex hormone, but it is found in both the male and female bodies. It plays a key role in the synthesis and function of the dopamine neurotransmitter. In fact, it increases dopamine production and dopamine receptor sensitivity. In doing so, it can impact things like mood regulation, motivation, and the reward system within the brain (2). Common signs and symptoms of low testosterone levels include things like:
It is also hypothesized that low levels of testosterone in older men are correlated to worse performance on cognitive tests. Although results in randomized controlled studies tend to be mixed, there are some positive results indicating that testosterone supplementation can improve cognition (7).
The final hormone we’ll discuss that can impact the brain is cortisol. You may have heard of cortisol, as it is commonly referred to as the stress hormone. The hypothalamic-pituitary-adrenal (HPA) axis releases cortisol when the body experiences stress. When someone experiences persistent levels of stress and thus increased cortisol, they may experience dysregulation of neurotransmitters such as dopamine, serotonin, and norepinephrine.
For example, cortisol can decrease the expression of serotonin receptors, change transmission of norepinephrine, and minimize dopamine signaling. As a result, individuals with chronic stress may experience symptoms such as depression, decreased pleasure, and withdrawal (2).
The role of BHRT
It’s pretty clear that if you’re experiencing decreased mental clarity and mood changes, you may have an underlying hormonal balance. If confirmed by a healthcare professional, you may want to consider hormone supplementation, particularly with BHRT.
Bioidentical hormones are structurally the same as the endogenous hormones in our bodies, but they differ in that they are derived from plant sources. Bioidentical hormones are available in several personalized dosing and delivery methods, including creams, pellets, and patches, making them adaptable to many conditions and patient preferences.
Which BHRT is right for you will depend on what types of hormone imbalances you are experiencing, which can be identified by a healthcare professional. This is typically done through lab work, where your provider can gather your exact hormone levels and develop a personalized treatment plan as a result.
For example, many women experiencing perimenopause or menopause may have symptoms of mood swings and irritability as the result of decreased estrogen and progesterone. In these cases, women may benefit from BHRT, specifically formulations with estrogen and progesterone.
By restoring hormone levels at the right amounts, you may experience changes such as:
BHRT should not just be for anyone experiencing symptoms of brain fog and mood changes. A careful lab workup and medical history is required to identify individuals that are candidates for BHRT. However, common reasons to take BHRT include individuals that are:
Regardless of the scenario, BHRT should always be coupled with a holistic strategy that further augments cognition and mental health. This will involve combining BHRT with lifestyle changes such as:
We often attribute issues such as brain fog and mental health to personal failures. However, it is important to recognize that these symptoms and changes can sometimes be because of biological causes. Oftentimes, our hormones are out of whack, particularly during life transitions, which can have downstream effects on neurotransmitters and thus the overall functioning of our nervous system.
Thankfully, hormone replacement therapy such as BHRT can be used as a tool when we find our hormones in flux. BHRT, when used appropriately and under supervision of a healthcare provider, can enhance your cognitive health and emotional wellbeing.
