A Spotlight on Women’s Brain Health: Mapping In Vivo Brain Dynamics across the Perimenopausal Years.

Most women will transition to menopause, but no two experiences are the same. While some women embrace the end of their reproductive years, many others struggle with the broad system level changes that first emerge during perimenopause; the years leading up to the final menstrual period. Up to 80% of women will experience debilitating symptoms during perimenopause which are largely neurological in nature, including vasomotor symptoms (i.e., hot flashes and night sweats), as well as mood, sleep, and cognitive disturbances. The presence and severity of perimenopausal symptoms have been proposed as warning signs for an increased risk of neurodegenerative disease later in life. Yet, women’s brain health is historically understudied, and current knowledge about the brain during perimenopause is largely based on animal work or underpowered cross-sectional human studies, often comparing women pre- and post-menopause without capturing the transition period.The objective of MappingPerimenopause is to close this critical knowledge gap by mapping the effects of perimenopause on the female brain in unprecedented detail and in a well-powered sample. I propose a multi-level investigation that will provide a mechanistic understanding of the in-vivo temporal dynamics of the female brain across perimenopause and contributing factors. I will test the main hypothesis that how women experience perimenopause matters for their brain and mental health. This will be achieved by the use of big data and by adopting an accelerated longitudinal multi-modal neuroimaging design, following women during their perimenopausal years, together with the rich assessment of biological measures, cognitive and mood symptom profiles, and psychosocial factors. By combining big data mining and comprehensive phenotyping, MappingPerimenopause is a pioneering effort with the potential to transform our understanding of the well-being and brain health of women navigating this critical transitional phase.