Home Hormones Expert advice An essential guide to managing perimenopause and menopause

An essential guide to managing perimenopause and menopause

essential guide

From the author of international bestseller Period Repair Manual comes Hormone Repair Manual, an essential guide to understanding and managing perimenopause and menopause.

Dr Laura Briden

With over 20 years’ experience in women’s health, Naturopath Lara Briden’s fresh approach aims to overturn the stigma of perimenopause and menopause and show
women that:

  • many symptoms are temporary and manageable
  • emotional challenges can present an opportunity to thrive
  • a focus on health during this period can bring benefits for years to come

Addressing common symptoms of menopause such as hot flushes, insomnia, depression, mood changes, migraines, weight gain, low libido and heavy periods, Lara offers practical solutions of diet, lifestyle, nutritional supplements and tips for how to speak to your
doctor about hormone therapy.

The average age of those who first experience menopause is 51, with symptoms lasting for an average of 5-10 years.

Hormone Repair Manual is backed by evidence-based research and real-world case studies and is a reassuring guide to soothing, nourishing and strengthening your body, mind and spirit, providing advice on how to overcome symptoms and restore equilibrium.

If you are like me, and experience brain fog (thanks perimenopause) then this extract from the book on Memory should be helpful.


Feel like you’re forgetting things? It’s not your imagination. There’s an 80 per cent chance you’ll notice some degree of menopause related cognitive impairment, which can feel like brain fog, memory loss or trouble concentrating. My example in the Introduction was
forgetting where I parked my car.

Learning about menopause-related cognitive impairment scared me quite a lot. Even the name sounds bad. But then I looked more closely at the research and was reassured to learn that it is usually temporary. ‘During the menopause transition,’ says Dr Gail A. Greendale from the University of California, ‘a woman’s brain may feel a little off, a little muddy, but when the transition passes, the clouds clear and the fog lifts. Sometimes all
a woman needs to know is that this too shall pass.’ And according to neuroscientist Lisa Mosconi, our brains are doing better than we think.

She says that we feel like our cognition is affected, but ‘women still outperform men in cognitive brain studies at any stage of life’. Mosconi is the researcher I quoted in Chapter 1 who proposes that Alzheimer’s disease in women begins with menopause; or rather that the risk of Alzheimer’s begins with menopause. She says menopause is merely the trigger for other underlying factors, such as genetic predisposition, nutrient deficiency, chronic inflammation and insulin resistance.

In her book The XX Brain: the groundbreaking science empowering women to maximise cognitive health and prevent Alzheimer’s disease, Mosconi provides strategies to mitigate
some of those underlying factors and prevent normal menopause-related cognitive impairment from turning into Alzheimer’s or other types of dementia (of which there are several).

Hormone Repair Manual on sale from 23 February

Hormone Repair Manual

We’ll discuss long-term dementia prevention in Chapter 10, but for now, let’s look at what you can do to brighten cognition. Conventional treatment for menopause-related
cognitive impairment estrogen therapy can improve cognition if you start it within five years of your final period. It works by helping the brain to use glucose for energy. As to whether it can also reduce your long-term risk of dementia is another story. On the one hand, there’s some evidence that estrogen can reduce the risk of dementia, especially for women who underwent surgical, medical or early menopause (Chapter 6).

On the other hand, there’s worrying evidence that estrogen therapy may increase the risk of dementia, especially if it’s started too late and outside of the ‘window of opportunity’. According to neuroscientist Roberta Diaz Brinton, ‘estrogen has beneficial effects if taken before or at the time of menopause when neurological health is still intact, but detrimental effects if initiated years after menopause when neurological health may have already begun to decline’. We’ll look more closely at estrogen therapy and dementia risk in Chapter 10.

As always, if you take estrogen, consider also taking progesterone for its many benefits, such as stimulating brain-derived neurotrophic factor (BDNF) and healthy neurogenesis
(formation of new neurons).

Diet and lifestyle for healthy cognition

Employ the basic action plan (page 161), including reversing insulin resistance, soothing your nervous system, getting enough sleep and, of course, movement. Movement is so beneficial for cognition that it deserves special mention. Movement of any kind, including walking, can increase brain size. Resistance or strength training may be particularly beneficial, and you can do it with weights or resistance bands or even just with
your own body weight in the form of lunges, squats and planks.

Exercise is important in helping to manage memory loss.

The goal is to prevent sarcopenia and build muscle, which has been found to improve cognition and reduce the risk of Alzheimer’s and other types of dementia. Building muscle works both by reversing insulin resistance and therefore improving brain energy, and by directly increasing BDNF and neurogenesis.

Supplements for healthy cognition

Once again, magnesium and taurine are my top two supplement recommendations and have been found to be beneficial for brain health and cognition. Beyond magnesium and taurine, other nutrients to consider include vitamin B12, choline and MCT oil (medium-chain triglycerides). Vitamin B12 By the age of 50, you have at least a 40 per cent chance of being deficient in vitamin B12, which is a critical brain nutrient. Symptoms of deficiency include fatigue, brain fog, anxiety, memory problems, tingling or numbness in the hands and feet, and problems with balance.

Untreated, vitamin B12 deficiency can progress to permanent brain damage. Ask your doctor to test your blood levels of vitamin B12 and then ask to see your result.
An optimal level is at least 400 pg/ml, which is higher than the 200 pg/ml cut-off used by some labs. Animal products such as meat are the only source of vitamin B12 but it’s difficult to absorb, especially when you’re older and have lower levels of stomach acid
and intrinsic factor (a protein required to absorb vitamin B12).

The absorption of vitamin B12 from dietary sources is further impaired by alcohol, stomach acid medication and the diabetic drug metformin.
How it works: Vitamin B12 is an essential nutrient for healthy nerve function.
What else you need to know: If your B12 is less than 400 pg/ml and/or you’re experiencing symptoms, speak to your doctor.

Rewiring the brain

A B12 injection or take a B12 sublingual (under the tongue) spray at a dose of 1000 mcg per day. An oral tablet is unlikely to be helpful because of the absorption issues discussed above.


Choline can be important at menopause because a drop in estrogen decreases the activity of an enzyme called PEMT (phosphatidylethanolamine N-methyltransferase), which normally assists with the manufacture of choline in the body. With menopause, your body can’t make as much of its own choline, so you may need to supplement or obtain more from food sources such as eggs, liver, and salmon.

How it works: Choline is the precursor to acetylcholine, the neurotransmitter that supports memory, mood and intelligence. A sufficient intake can support healthy brain function, including better memory and cognitive function. What else you need to know: Unlike vitamin B12, there’s no simple blood test for choline. Instead, you need to gauge whether
you’re eating enough choline-rich foods to obtain the recommended adequate intake of at least 425 mg. If you don’t eat foods such as eggs or salmon, you almost certainly need to supplement. The best type of choline for brain health is CDP-choline (citicoline)
or alpha-GPC (L-Alpha glycerylphosphorylcholine) at a dose of 500 mg.

MCT oil

Medium-chain triglycerides (MCT) are beneficial saturated fatty acids with six to ten carbon atoms per molecule. As a supplement, MCT oil can calm the brain, reduce inflammation and block a receptor in the brain that causes memory loss. How it works: MCT readily converts to ketones and therefore provides a non-glucose source of energy for the brain.

What else you need to know: Small amounts of MCT oil occur naturally in coconut oil, palm kernel oil and dairy fat, but to get a substantial dose, you’ll need to take a supplement.
The therapeutic dose is 1–2 tablespoons in place of (not in
addition to) other oils.

Checklist for memory

• Test for vitamin B12 deficiency.
• Build muscle.
• Take magnesium plus taurine.
• Consider taking choline or MCT oil.

This is an extract from Hormone Repair Manual by Lara Briden. On sale now, RRP $34.99. Published by Pan Macmillan Australia.

The co-founder of 50SoWhat has been in publishing for most of her working life. She was general manager of successful boutique media publishing house in New Zealand for several years and boasts an impeccable sales, marketing and management background. When she’s not road-testing the latest cosmetic procedures, or investigating the hottest lifestyle, travel, fashion and beauty trends for over 45’s, Jo is often back home catching up with family and friends, or working on her golf swing!