13 Steps to Maintaining a Healthy Menopausal Female Brain

Dr Felice Gersh
5 min readFeb 1, 2019

Every woman wants to live a wonderful and joyous long life, yet the prospect of getting old is both frightening and distasteful. And the thought of aging poorly is typically viewed as a far worse fate than is dying at a younger age.

The worst images of aging conjure up grim visions of disability, frailty, infirmity, and dementia and cause alarm for people — particularly when there is no real guidance about how people can improve their chances of ongoing cognitive wellness. After all, what’s the point of living to a ripe old age if you’ve no notion of whether you’re coming or going?

As women develop Alzheimer’s disease at nearly three times the rate of men, this is no small matter. And, to compound the problem, most therapies for Alzheimer’s disease to date have been far off the mark and do little to nothing to change the inevitable decline.

To understand some basics, Alzheimer’s disease is not the result of just one thing, but rather the gathering of the perfect storm, creating the foundation upon which the brain deteriorates due to a neuroinflammatory state — and along with cognitive decline comes mood disorders.

Cognition and mood are flip sides of the same coin. This fact helps explain why many with dementia are also very emotionally unstable. If we are going to find a way to reduce our risk of dementia, we need to figure out the full array of risk factors, beyond just age, as age is simply not something modifiable.

The underlying promoting factors for dementia vary somewhat from individual to individual, but nearly always include hormonal and nutritional deficiencies, chronic infections, and environmental toxins.

Let’s take a deep dive into exploring these one by one.

The obvious answer to the female preponderance of dementia is the impact of menopause, with its loss of ovarian hormone production. Estrogen is directly neuroprotective and maintains the health of all neurons, including those which produce critical neurotransmitters serotonin and acetylcholine. Estrogen is also indirectly neuroprotective, having a role in maintaining healthy central and peripheral immune systems. The microglia and astrocytes are uniquely adapted immune cells, which are specifically designed to protect neurons. These specialized immune cells are controlled by estradiol, the main estrogen made by ovaries, and by the brain itself!

The loss of ovarian estrogen production with menopause is hugely harmful to cognitive function. Though the brain actually makes estradiol on site for local use, after menopause it doesn’t make more to make up for the loss of ovarian estradiol production. The result is a menopausal female brain deficient in estrogen (estradiol), which ups the risk of neuroinflammation and accounts for the heightened female risk for dementias.

Men’s brains make all their estrogen onsite, somewhere in the order of six to eight times the amount made by women’s brains. There are even studies showing that the brain makes even less estradiol after menopause than before!

Environmental toxicants and nutrient deficiencies make up another clear group of triggers for the onset of Alzheimer’s. Many toxicants can be directly neurotoxic, as well as acting as endocrine disruptors, essentially creating an environment of estrogen deficiency, plus malfunctioning estrogen — which I label as a double whammy! Brain poisons include heavy metals like mercury, lead, and cadmium, as well as pesticides and flame retardants, to name just a few. By interfering with the functioning of “real” estrogen, the reserve some women have for brain health simply vanishes.

Nutritional deficiencies are not insignificant as regards their role in creating neuroinflammation. Key among them is Vitamin B12 deficiency, but deficiencies of other B vitamins are also being recognized as being associated with dementia. As well, any brain deprived of adequate antioxidants and crucial minerals will suffer loss of function. Brain cells require extraordinary amounts of energy to function, and cannot work optimally without an adequate supply of nutrients.

We come now to the final contributing factors — infections. New data shows that people over 50 who experience a severe herpes infection will have increased risk for developing dementia. A study recently published showed that human herpes virus 6 and 7 were found in Alzheimer’s-affected brains at levels up to twice as high as in those without Alzheimer’s. Three additional studies have recently come out, published in 2017 and 2018, which suggested that acute herpes zoster infection creates a dramatic rise in the incidence of dementia, and that aggressive use of antiherpetic medication dramatically lowers dementia risk. In one study which lasted almost a decade, the herpes group had a risk of dementia topping 2.5 times the rate of the control group. Aggressive antiviral treatment reduced the relative dementia risk by an astonishing 10 fold reduction. These antiviral pharmaceuticals truly helped to prevent the long-term damage in the brain that leads to Alzheimer’s disease. Such data provides the first evidence of the link between herpes infection and Alzheimer’s disease.

Given all this new insight, what can a woman do to lower her risk?

Here are my bullet point suggestions, generalized for a basically healthy woman of about age 50:

  1. When you are perimenopausal, begin hormone therapy using physiological doses of bioidentical hormones, and check for low thyroid.
  2. Do all you can to limit exposures to environmental toxicants.
  3. Do all you can to limit exposure to mold and other biotoxins.
  4. Treat herpes and other infections rapidly and aggressively.
  5. Test for Lyme Disease — it can mimic anything. Look for other infections by testing antibody titers — as an example, consider chronic Beta Strep infections, which can lurk deep within the tonsils. Test levels of inflammatory markers.
  6. Test for autoimmunity and gluten/gliadin antibodies.
  7. Get seven to eight hours of sleep nightly. Sleep in a very dark room or with a sleep mask.
  8. Get regular exercise — preferably in the morning. High intensity interval training (HIIT) is best.
  9. Get sunlight regularly and work to keep the proper beat of the circadian rhythm.
  10. Laugh and smile a lot and practice mind/body medicine to adequately control stress.
  11. Replete nutrient deficiencies and maintain a healthy and properly functioning gut.
  12. Take targeted supplements to improve brain health and lower inflammation.
  13. Practice time restricted eating — a 13 hour overnight fast, last meal by 7 PM, no snacks, and utilize regular periodic fasting or (preferred)the fasting mimicking diet.

If you do all these things, you will definitely be much healthier, and most probably … less prone to develop dementia such as or Alzheimer’s Disease.


• Readhead et al. Neuron. 2018;99(1):64–82

• Devanand. 2018; Psychiatry and Neurology: 18(9):55

• Itzhaki et al. J Alzheimers Dis. 2018;64(2):363–366



Dr Felice Gersh

Obstetrician/gynecologist and founder of Integrative Medical Group of Irvine. Author of PCOS SOS. Find her on Twitter at @DrFeliceGersh.