Understanding Your Brain Through Perimenopause and Menopause with Dr.

An estimated 7.2 million Americans age 65 and older are currently living with Alzheimer's dementia. The part that should alarm every woman listening is this: almost two thirds of them are women.

In this episode, Dr. Mary Claire Haver sits down with neurophysiologist and Alzheimer's researcher Dr. Louisa Nicola to unpack what's really happening to women's brains during perimenopause and menopause and what we can do about it. Louisa Nicola is a neurophysiologist, human performance coach, and founder of Neuro Athletics, a consulting firm that works with elite athletes and high-level professionals to optimize brain health and performance. A former world class triathlete, she transitioned into neuroscience and earned her Master of Medicine in neurophysiology from the University of Sydney. Dr. Nicola is currently pursuing her doctorate studying the effects of resistance exercise on brain health. She focuses on optimizing brain function and longevity, particularly in women, through sleep, nutrition, and exercise interventions.

Dr. Nicola reveals how Alzheimer's disease doesn't suddenly appear at 70 but starts quietly in our thirties and forties, building up over a 30-year progression. She explains what's happening in the brain as amyloid beta proteins and tau tangles accumulate, why the hippocampus is the first area to go, and the critical role that sleep plays in clearing these proteins through the glymphatic system. The conversation explores why women are more predisposed to tau protein accumulation than men and how estrogen, progesterone, and prolactin inhibit the enzyme that causes tau proteins to become hyperphosphorylated and toxic. Dr. Nicola explains the connection between declining estrogen during perimenopause and increased Alzheimer's risk, including how estrogen helps mediate glucose metabolism in the brain, supports synaptic connections, and why the loss of this hormonal scaffolding leaves women vulnerable to cognitive decline.

Dr. Nicola breaks down the difference between brain fog and dementia, explaining that brain fog is a symptom that can be caused by hormonal changes, stress, or sleep deprivation, while dementia is a medical diagnosis that includes multiple forms including Alzheimer's disease, vascular dementia, and Parkinson's dementia. She discusses the window of opportunity for hormone replacement therapy, referencing Scandinavian studies showing that women with one copy of the APOE4 gene have a two-to-four-fold increase in Alzheimer's risk but can lower that risk with early estrogen replacement. The discussion covers why one night of sleep deprivation can raise amyloid beta levels in the brain, why sleep regularity matters more than sleep duration, and how hot flashes and night sweats disrupt the critical deep sleep stages needed for brain waste clearance through the glymphatic system.

Dr. Nicola explains why exercise is the single best thing women can do for brain health, revealing that women with high cardiovascular fitness measured by VO2 max can lower their dementia risk by 80%. She breaks down aerobic exercise that releases BDNF and grows the hippocampus by 2%, resistance training and strength training that releases myokines and improves frontal lobe function, and high intensity interval training that produces lactate as fuel for the brain. The conversation explores why muscle health and bone health matter for longevity, why larger leg muscles correlate with larger brains, and how exercise can reverse age-related heart decline. Dr. Nicola shares her supplement recommendations including omega 3 fatty acids, EPA and DHA for brain health, creatine for cell energy metabolism and recovery from sleep deprivation, and why most women have omega indexes below 4% when they should be at 8% or higher for cardiovascular health and reduced mortality risk.

The conversation explores nutrition for brain health including the Mediterranean diet and MIND diet, managing LDL cholesterol and APOB, and the importance of adequate protein, green leafy vegetables for magnesium, and omega fatty acids. Dr. Nicola explains how glucose metabolism affects cognitive function and memory, how cortisol and chronic stress impact sleep quality and brain health, and why social connection and self-compassion matter for longevity and mortality risk. This episode provides women with evidence-based strategies for protecting their brains during perimenopause, menopause, and midlife, emphasizing that Alzheimer's disease and dementia are not inevitable parts of aging and that lifestyle interventions can make a profound difference in long term brain health and quality of life.

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