I was asked recently why is that so many women that are approaching menopause or peri menopause suddenly start having so many energy issues and symptoms like brain fog, not being able to think clearly and having symptoms of cognitive decline.

The reason for this has to do with the way your body makes energy and how your hormones impact on that ability. There are numerous hormones involved in normal homeostasis or function and for women this is much more critical than for men purely because there are more fluctuations in hormone production not only through the menstrual cycle but even during the day. Other hormones such as thyroid hormone and insulin also have a big impact on energy production.

Ok lets start at the beginning and look at how your body makes energy this is known as bioenergetics and it describes the process where you take food and then convert this into energy. Obviously digestion and absorption of foods are important but what we are really interested in is what happens at a cellular level in your body. 

Every cell in your body requires energy to function and within every cell there are organelles called mitochondria. If you remember your school biology and the TCA cycle or if you are as old as me the Krebs cycle which describes the process of converting glucose, fats and proteins into ATP (Adenosine-triphosphate). This takes place within the mitochondria of each cell. ATP is the energy source for all functions carried out by your body. Production of ATP whilst essential, also produces by products which are damaging this is called oxidative stress.  In normal functioning mitochondria these by products are cleared away by anti-oxidants¹. So having a low antioxidant level will impact on your mitochondria’s ability to function.

These mitochondria actually have their own DNA separate from the cell nucleus, and they have a number of functions that respond to your environment. In times of physical stress ie. when you exercise, the mitochondria will join together to make bigger mitochondria to produce more energy this is known as Fusion².

So where do the hormones come in? Hormones have effects on every stage of mitochondrial function.: 

· Estrogens promote mitochondrial biogenesis and promote fusion of mitochondria which increases the number of mitochondria and their size which increase their ability to produce ATP and for you to have more energy³. 

· Progesterone and testosterone will upregulate mitochondrial antioxidant activity and help to clear the body of the harmful by products of energy production, this helps you with endurance and slow’s degeneration.

· Thyroid hormones and testosterone have direct effects on the mitochondria’s ability to produce ATP which has a direct effect on your energy.

More important than the three things listed above is to understand that the production of hormones in your body is completely reliant on your mitochondria.

That means that you have to have mitochondria that are functioning well to produce adequate hormones in the first place. 

That is because sex hormones are derived from HDL and LDL circulating in your blood.  Cholesterol is then taken into the mitochondria and converted into pregnenolone. Depending on whether this is happening in the testes or ovaries, pregnenolone is then converted through a complex cascade that ends up with testosterone, progesterone or estrogen.    Or in the adrenal glands cholesterol is converted into cortisol, progesterone and aldosterone⁴.

What does this mean? When women are perimenopausal their ability to produce hormones diminishes especially if their mitochondrial function is already impaired.  You then enter a vicious cycle where less hormone is produced which further effects mitochondrial function. The key to maintaining hormone production is to restore mitochondrial function.

Hormones are not the only factor that have an impact on mitochondrial function.  Issues with circadian rhythm, gut microbiome and insulin all have a roles to play and there are many dietary, nutritional and lifestyle interventions that can impact these pathways and help you to feel better without suffering from energy issues, brain fog and other cognitive symptoms.

References:

1.     How mitochondria produce reactive oxygen species https://pubmed.ncbi.nlm.nih.gov/19061483/

2.     Bioenergetic role of mitochondrial fusion and fission https://www.sciencedirect.com/science/article/pii/S0005272812000692

3.      Mitochondria, Estrogen and Female Brain Aging https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934418/

4.     Estrogenic control of mitochondrial function https://www.sciencedirect.com/science/article/pii/S2213231719309474