What If Menopause Is an Energy Crisis?

Many women describe not being able to trust their own minds anymore.

I’ve been a fly on the wall my entire life.

Not because I’m shy or because I have nothing to say. I’ve been a fly on the wall because when I enter a room, I read it first. I read the environment, the system, the people, the tone, the timing, and the energy. I need to know if this place is friend or foe before I say a word.

I’ve been doing that since I was a child. I did it before scrubbing into a surgical case because I needed to tune out the noise around me and find the signal that mattered. I do it now when I sit across from a woman who’s been told her labs are normal and her symptoms are stress, and I watch her face go blank while she tries to find words for something her body has been saying for years.

I do it when I read a research paper. I do it when I listen to a podcast. I do it when I watch influencers and health professionals argue online about who is more credible, who has the latest finding, who has the final word on menopause.

I sit. I listen. I watch the pattern.

And lately, I’ve been sitting with Lisa Mosconi’s brain energetics data.

Not passively. I mean I’ve been inside it, looking at the figures, tracing the trajectories, and asking the questions the paper was not designed to answer, at least not for the women I take care of.

Here’s what the data suggests if you move past the headline: across the menopause transition, brain glucose metabolism declines in key regions, while other systems appear to compensate. Cerebral blood flow increases in some areas. ATP production is maintained or elevated in some regions. Neural networks adapt. The brain is not simply shutting down. It is compensating. It is working harder to hold the line on function while glucose utilization appears less efficient.

That is not a metaphor. That is what the imaging points toward.

But here is the question I keep coming back to:

How much energy reserve does a brain have left to compensate when it has already been compensating for decades?

Because I’m not only thinking about the “healthy” woman in the study.

I’m thinking about the woman who has been hypervigilant since childhood because her nervous system learned early that the environment required constant monitoring. I’m thinking about the woman who has been masking and performing neurotypicality, performing composure, performing strength, and performing “I’m fine” for so long that the mask became invisible even to her.

I’m thinking about the woman whose cortisol rhythm has been shaped by racialized stress, chronic caregiving, shift work, food instability, medical dismissal, and the particular exhaustion of being the person in the room who has to read everything before she can speak.

I’m thinking about the woman whose brain has been running a compensatory load that a healthy research cohort receiving specialty care was never designed to capture.

When that woman enters perimenopause, her brain does not get to start the transition from baseline.

She starts it with less reserve.

The glucose metabolism is shifting. The allostatic load is already high. The nervous system is already spending more energy than it is recovering. The body has already been keeping score, whether anybody measured it or not.

And then the estrogen fluctuates.

And then the sleep fractures.

And then the threat-detection circuitry that has been regulating, protecting, masking, scanning, and bracing for decades loses some of the hormonal buffering it had been relying on.

So what does that look like from the outside?

Maybe brain fog. Maybe word-finding gaps. Maybe emotional dysregulation. Maybe sensory intolerance that gets louder and more uncomfortable. Maybe executive function that worked yesterday and is gone today. Maybe the collapse of masking strategies that held for twenty years and then suddenly, seemingly out of nowhere, do not hold anymore.

Maybe it feels like what so many women describe and so many doctors dismiss:

I don’t trust my own mind anymore.

That is not menopause failing the brain.

That may be the brain running out of energy to buffer the load.

This might make some people uncomfortable.

The current menopause conversation, as necessary and overdue as it is, is still largely organized around one question:

Will hormone therapy restore what was lost?

That is an important question. I’m not dismissing it. I prescribe hormones. I have a hormone pathway. Estrogen matters. Progesterone matters. Testosterone may matter for some women. I am not anti-hormone.

But I do think hormone therapy is a smaller conversation than the one many women are actually living.

Because if the brain is already compensating, already increasing blood flow, already reallocating energy, already adapting its networks to manage a changing metabolic environment, then hormones can only do so much if the rest of the system is still under assault.

Sleep matters. Glucose control matters. Cortisol rhythm matters. Mitochondrial function matters. Gut integrity matters. Histamine matters. Inflammation matters. Neurotype matters. Sensory load matters. The environment matters. Decades of masking matter. Decades of not being believed matter.

And I always come back to this:

The nervous system eats first.

Before cognition. Before mood. Before libido. Before patience. Before executive function. Before the ability to find your words in the middle of a sentence. Before the ability to feel the music the way you used to.

If the nervous system is spending everything it has just to maintain baseline function in a body that has been under chronic load, the menopause transition is going to cost more. It is going to hit harder. And it is going to look different than what the literature, built on a narrower population, was designed to see.

Nobody has studied this as one integrated question.

Not in Black women with weathering.

Not in autistic and ADHD women with masking fatigue.

Not in women with insulin resistance, surgical menopause, chronic insomnia, high caregiving load, flattened cortisol patterns, sensory processing differences, or histories of medical dismissal.

Not with nutritional genomics layered in — the SNPs that may shape how an individual brain handles fat versus glucose as fuel, how mitochondria respond under stress, how inflammatory pathways are tuned, and how much metabolic flexibility a woman actually has when the transition begins.

The data exists in pieces, scattered across silos that do not talk to each other.

Menopause neuroscience in one room. Metabolic medicine in another. Sleep medicine down the hall. Autism research in a different building. Race and weathering research in another institution entirely. Lifestyle medicine somewhere in between.

And the woman is still sitting in the exam room being told everything is normal.

So here is the question I am building toward:

What determines whether a brain can successfully adapt to the menopause transition in the body she actually lives in?

Not the body the study averaged.

Not the body the guideline assumes.

Not the body the influencer describes.

Her body.

The body that has been working, masking, caregiving, bracing, recovering, metabolizing, sleeping poorly, waking at 3 a.m., managing sensory input, and trying to survive a world that kept asking more from her than it gave back.

That is the conversation I want to have.

Not to replace what Mosconi showed us, but to stand on it and look further.

Because when women say, “I feel like I can’t trust my mind anymore,” I do not hear weakness. I do not hear drama. I do not hear a woman who needs to be told to reduce stress and try melatonin.

I hear a system that may be running out of compensatory room.

I hear a brain asking for fuel, rhythm, sleep, safety, and restoration.

I hear a nervous system that has been eating first for decades and is finally asking, “What is left for me?”

That is why I do this work.

Not because menopause is only about hormones.

Not because hormones do not matter.

But because the nervous system was already at the table before the hormones changed.

And if we do not account for that, we will keep calling women complicated when the real problem is that the framework has been too small.

If this is the conversation you want to keep having, I’ll be here.

Dr. Stacey Denise is a board-certified surgeon transitioned into lifestyle medicine specializing in the menopause transition. She sees patients in California, Georgia, Kentucky, Maryland, Ohio, Texas, and Virginia.

If you’ve been told it’s just hormones, just stress, or just aging, start with the Color Archetype Quiz. Let’s see what pattern your body keeps returning to before we decide what support actually makes sense.

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Dr. Stacey Denise is a board-certified surgeon transitioned into lifestyle medicine specializing in the menopause transition. She sees patients in California, Georgia, Kentucky, Maryland, Ohio, Texas, and Virginia.

The full post on alexithymia and the menopausal brain: The Brain Behind Alexithymia