Petra M., a woman in perimenopause, experienced balance problems, dizziness, severe anxiety diagnosed as agoraphobia, vision changes, and joint pain. After discovering information about perimenopause and hormone therapy, she began treatment and experienced significant improvement within four months.

Haver explains that the brain frequently responds first to the hormonal instability of perimenopause, producing emotional, psychological, and cognitive symptoms that range from mildly bothersome to severely disruptive. These can include heightened anxiety, depression, irritability, diminished libido, and impaired thinking or multitasking abilities. Surveys indicate that roughly 70% of women notice changes in mood or cognition during this transition.

Estrogen, progesterone, and testosterone function as neurosteroids that regulate critical aspects of brain activity. The field of neuroendocrinology examines how the nervous and endocrine systems influence one another. This process promotes neural pruning and myelination, which are essential for efficient nerve communication.

Estrogen plays a central role in regulating neurotransmitters such as dopamine, serotonin, acetylcholine, and beta-endorphin. It also protects the brain by enhancing blood flow, reducing inflammation, supporting cell growth and repair, and improving glucose metabolism. These effects influence memory, emotional regulation, sensory processing, and higher-order cognitive functions like decision-making and language.

Progesterone also provides neuroprotection by promoting generation of new brain cells and formation of blood vessels.