Good Life Project — Menopause Mythbusting: Why Midlife Changes Your Brain and What Helps

Guest: Dr. Lisa Mosconi, PhD
Host: Jonathan Fields
Date: February 19, 2026

Episode Overview

In this insightful episode, Jonathan Fields speaks with Dr. Lisa Mosconi—a renowned neuroscientist and pioneer in women's brain health—about the profound changes menopause brings to the female brain. The conversation busts widely held myths, reframes menopause as a neurological event, and explores the link between midlife changes, brain symptoms, and Alzheimer’s risk. Dr. Mosconi discusses how to better understand, celebrate, and support women through this universal transition—replacing fear and confusion with knowledge and empowerment.

Key Discussion Points & Insights

1. Dr. Mosconi’s Personal and Scientific Journey

• Personal Motivation: Dr. Mosconi's interest in women’s brain health began with witnessing her grandmother and female relatives develop Alzheimer's, while the male sibling remained unaffected.
  • "It was a big red flag. Is it just our family, or is there a bigger lesson?" (03:49)
• Early Challenges in the Field:
  • Pushback in neuroscience due to the prevailing belief that “a brain is a brain,” with little focus on sex differences (06:50).
  • Early discovery: After age, being a woman is the second strongest risk factor for Alzheimer’s disease, which cannot be explained simply by women’s longer life spans (08:47).

2. Midlife and Menopause: Reframing the Narrative

Why There Is a Gender Gap in Brain Health

• Prevalence of Alzheimer’s in women is not solely due to longevity; women are twice as likely to develop Alzheimer’s compared to men, starting as early as age 45 (09:50).

Societal Silence & Stigma

• Menopause is a universal, unavoidable transition akin to puberty, yet lacks ritual, celebration, or communal support.
• Menopause is surrounded by stigma, stereotypes, and silence—unlike puberty and pregnancy (11:54).
  • "...there's so much stigma...stereotypes around menopause and what a menopausal woman is supposed to be or act like that are harmful, are demeaning and really need to be addressed." – Dr. Mosconi (11:54)

3. The Three Major Hormonal Turning Points

Dr. Mosconi compares menopause to puberty and pregnancy:

• All involve shifts in the neuroendocrine system affecting body temperature, sleep, mood, libido, memory, and cognition.
  • “The same exact symptoms come back or may appear for the first time in menopause.” (16:35)

Key Insight:

• 90% of women experience neurological symptoms (e.g., brain fog, memory lapses) during menopause, but there is little formal understanding or expectation set for this variability (16:35).

4. Menopause as a Neurological Transition

• Menopause is not just about reproductive hormones but is fundamentally a neuroendocrine brain event.
  • "It's only in the 1990s that [scientists] realized these [so-called] sex hormones… also serve very important functionalities in the brain." (24:24)
• Estrogen acts as a “master regulator” of the female brain, supporting plasticity, blood flow, antioxidation, and anti-inflammation.
• With menopause, the brain must recalibrate and function without estradiol, leading to a major "rewiring" process (24:24–29:14).

Notable Analogy:

• “It's almost like your CEO that's been there for 50+ years is now gone, and there's a new CEO… but it's not nearly as powerful or as knowledgeable… So things don’t quite work the same way…” – Dr. Mosconi (24:24)

5. The Brain’s Resilience and Rewiring

• With the drop in estrogen, the brain shifts to using new fuel sources (proteins, then fats), but this transition is prone to “glitches” that result in hot flashes, mood swings, brain fog, and increased Alzheimer’s vulnerability (32:13).
• Dr. Mosconi’s theory: Each hormonal transition (puberty, pregnancy, menopause) involves significant brain rewiring, with temporary symptoms but potential for long-term gains like heightened empathy and emotional resilience (35:13–39:41).
  • “Postmenopausal women are by far the most empathic individuals in any gender and age groups globally.” (37:06)

6. The Menopausal Timeline: What Women and Doctors Need to Know

Phases and Symptom Window:

• The transition can last from 2 to 15 years; the average is 7 years just to reach the final period; the brain’s adaptation continues even after (40:10–40:24).
• The standardized clinical model is based on menstrual patterns, but brain changes don’t always align with the reproductive timeline (41:05–44:02).
  • “We are trying to better understand what happens in the brain and when, relative to ovarian function—they’re not hand to hand.” (44:24)
• Blood hormone levels don’t directly measure brain hormone levels; the brain maintains its own balance (44:24).

7. Hormone Therapy: Controversies, Facts & Modern Understanding

Historical Context:

• Hormone therapy (HT) was widely prescribed, then sharply declined due to 2002 studies suggesting an increased breast cancer risk—studies now recognized as flawed (48:57).
• Those studies used older women and outdated, high-dose hormone types, not representative of today’s HT regimens (48:57–53:00).

What We Know Now:

• HT does not cause cancer but can stimulate growth in pre-cancerous/hormone-sensitive tissue; appropriate screening and individually tailored therapy are key (53:00).
  • “Hormone therapy does not magically generate cancer…” – Dr. Mosconi (53:00)
• Modern guidelines (as of 2022) state that, for most midlife women following current protocols, HT carries a rare risk of breast cancer but can be helpful when properly managed (53:00–54:52).

Can HT Interfere With the Brain’s Natural Rewiring?

• No evidence HT impairs the brain’s adaptive process, but research is ongoing. Dr. Mosconi’s team is leading efforts to study estrogen levels and effects inside the brain using advanced imaging (55:52).

8. Alzheimer's Disease: Rethinking Risk and Prevention

• Alzheimer’s is now recognized as a disease that starts in midlife, with menopause as a potential inflection point for increased risk (11:18, 34:13).
• Dr. Mosconi is leading a $50 million international research initiative (“CARE”: Cutting Alzheimer’s Risk through Endocrinology) to uncover:

  • Which women are at greatest risk

  • How menopause drives this risk

  • What types of hormone therapy, genetic factors, and lifestyle interventions may help prevent cognitive decline (58:58–61:43).

  • “We are building the science that women deserve. The awareness has increased, but the science hasn’t quite caught up… It’s a privilege to do this work, and I am quite confident that we’ll get good answers in the next three years.” (62:23)

Notable Quotes & Memorable Moments

• On social stigma:
  • "There is so much stigma… that are harmful, are demeaning and really need to be addressed." – Dr. Mosconi (11:54)
• On empathy after menopause:
  • “Empathy is off the charts. Postmenopausal women are by far the most empathic individuals in any gender and age group globally.” (37:06)
• On modern hormone therapy:
  • “Hormone therapy does not magically generate cancer... What can happen is that you may have precancerous cells... if you add hormones, if those are hormone receptive cells, and you add hormone, that may grow. That's what estrogen does, it makes things grow.” (53:00)
• On brain plasticity:
  • “Women’s brains do have that ability… the human brain has the ability to basically recalibrate itself, rewire itself, and switch gears metabolically so that they can keep going.” (24:24)
• On the need for new research:
  • “If we don’t have a way to measure what these hormones… are doing in the brain, we’re really flying blind when it comes to prescribing hormones for brain health.” (55:52)

Timestamps for Key Segments

• Introduction and Dr. Mosconi’s journey: 00:00–06:50
• Prevalence of Alzheimer’s in women / Menopause as neuro event: 08:47–11:18
• Societal context & need for ritual: 11:43–15:39
• Hormonal transitions compared: 16:35–20:41
• Neuroendocrine system explained: 24:24–32:13
• Brain rewiring in menopause & empathy post-menopause: 34:53–39:41
• The timeline of menopause and what women should know: 40:10–44:24
• Misconceptions and facts about hormone therapy: 48:57–54:52
• HT and the brain’s adaptation: 55:52–58:08
• Alzheimer’s, midlife brain health, and CARE project: 58:08–63:31
• Closing thoughts: what it means to live a good life: 63:41

Closing

The episode replaces fear with clarity about what menopause actually does to the female brain. Dr. Mosconi highlights the immense resiliency and adaptability of the female brain through midlife transition, the importance of supporting women with the right information, and the promise of new, collaborative research connecting menopause and Alzheimer’s risk. Emphasizing both scientific advancement and community understanding, this conversation is empowering for all women—and enlightening for anyone interested in living, and supporting, a good life through every stage.