By Ann Marie McQueen
I feel we may have hit a new low in discourse about perimenopause and menopause. Last weekend I asked people on Instagram an open question about what new thing they learned recently (I was at a seminar about putting together a crypto portfolio). Someone replied: “that my brain eats itself without HRT.”
I remained in a state of severe confusion about that language for a full day — wondering: was her brain fog that bad? — until someone sent me a viral video of urologist Dr. Kelly Casperson on Louisa Nicola’s podcast The Neuro Experience, saying just that very thing.
This all took some untangling.
Dr. Casperson was referring to something said during a five-minute presentation by Dr. Roberta Brinton Diaz last July at the FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women. (Dr. Brinton Diaz is a neuroscientist in the field of Alzheimer’s, the aging female brain, and regenerative therapeutics, and director of the Center for Innovation in Brain Science at the University of Arizona Health Sciences; she has also worked with Dr. Lisa Mosconi, a neuroscientist and associate professor at Weill Cornell Medicine who focuses on Alzheimer’s prevention and brain health, particularly concerning women.)
Here’s how the conversation in the viral clip went down:
Dr. Casperson: “Did I hear this correctly, that Dr. Brinton said after menopause, when estrogen goes down, the brain can’t utilize glucose, so the brain eats itself? Did I hear that right? Clear that up for me.”
Nicola, who is a neurophysiologist and founder of Neuro Athletics, a consulting firm that optimizes brain performance for athletes and high performers, replies:
“The female brain literally eats itself during menopause if you don’t replace it with hormone replacement therapy.”
Hot on the heels of this clip — which was shared twice and has almost a million views combined — I was sent another. This one featured orthopedic surgeon Dr. Vonda Wright on The Ultimate Human podcast with human biologist Gary Brecka.
In it, Dr. Wright makes some leaps based on another headline-making database study on the protective benefits of starting hormone therapy in perimenopause — a study that hasn’t even been published yet. The research, which found an association between starting hormone therapy in perimenopause and a 60 percent reduced risk of breast cancer, heart attack, or stroke, was presented at The Menopause Society 2025 Annual Meeting in October. (Watch fellow journalist and MenoWars author Fiona Clark speaking to ob-gyn and researcher Dr. Rachel Pope and her student Ify Chidi about their work on an IG live.)
Dr. Wright also refers to “brain death”.
So let’s cycle back to Dr. Brinton’s presentation, which starts at the 43:54 mark.
To sum up what Dr. Brinton’s said about her research: due to hormone-related metabolic changes in the brain, we experience grey matter reductions that are a normal part of aging, but also menopause-specific metabolic changes that coincide with a rise in beta-amyloid deposits in the brain and a decline in white matter.
“That decline in glucose metabolism activates a starvation response that leads to utilization of auxiliary fuels. And that auxiliary fuel is provided by the white matter. The brain will utilize its own white matter, catabolize its white matter lipids to generate ketone bodies.”
Here’s some context: in Dr Brinton’s rodent research, when estrogen drops, the brain’s ability to metabolize glucose — its main fuel — is compromised. In response, it shifts to burning ketones, an alternate energy source derived from fats. In the short term, that includes breaking down white matter lipids. That’s the “auxiliary fuel” she was referring to — a temporary energy adaptation, not some catastrophic brain meltdown.
In re-watching her presentation, I noticed that Dr. Brinton wraps up her five minutes by concluding that the evidence shows something no guiding body in the world — including for the first time The Lancet Commission on Dementia in 2024 — has: that when hormone therapy is “introduced at the time of menopause and for menopausal symptoms, there is a significant reduction in risk of developing Alzheimer’s disease.”
Anyhoo, that’s how “activates a starvation response that leads to utilization of auxiliary fuel” turned into “the brain eating itself”. And now we also have “brain death” – all courtesy of the wellness podcast circuit.
What isn’t mentioned anywhere — not at the FDA, not on podcasts, or on Instagram — is that:
a) Dr. Brinton is talking about research on rats, who don’t live nearly as long as women; and
b) in women, this situation is actually temporary, part of the transition state. Our bodies were designed to accommodate this restructuring of the brain — indeed, it seems that nature designed it to happen — and we often come out of it better, not worse. (Neuroscientist Dr. Louann Brizendine covers this well in her book The Upgrade.)
Of course, when other conditions are present — the APOE4 gene, insulin resistance, unmanaged stress, poor sleep, lack of exercise or mental stimulation, nutritional deficiencies (to name a few) — what might have been temporary, can lead to disease.
Lots of people have jumped in to talk about what’s wrong with this line of messaging. Australian neuroscientist Dr. Sarah McKay did a great roundup in her newsletter and on Instagram, where she points out:
“Menopause hormone therapy (HRT) does not guarantee brain health.”
Here’s what she wrote in her newsletter:
“If you follow me on social media, you’ll see I spent a chunk of my weekend myth-busting a viral claim that the brain ‘eats itself’ during menopause without HRT. This myth arose as a misinterpretation of research by Dr. Roberta Brinton, which found (in rodents!) that the brain needs to find an alternative source of energy during the menopausal transition. But luckily women are not rats and hormone replacement therapy is not there to stop our brains from ‘eating themselves’… If you’ve been confused by this debacle, I debunked this myth in an Instagram Live with Dr. Jen Gunter, as did Dr. Lisa Mosconi on a Live with The Brain Docs.”
I can’t find the link to that Dr. Mosconi live, although I’ve seen it online. Menopause advocate and educator Amanda Thebe did a good breakdown of what was said.
It’s very worth paying for my friend Maryann Jacobsen‘s Substack, Midlife Strong. She makes me feel saner and smarter — a rare thing indeed — which is why I loved the title of her latest newsletter: Why We Need a Saner Conversation About Midlife Health.
She too has noticed how cherry-picking hormone therapy enthusiasts run with “good news” HRT stories — like the ‘60 percent reduction’ study — while ignoring anything to the contrary.
She wrote:
“Meanwhile, it was crickets regarding two other studies: one showing that aging (not menopause) was linked with brain volume loss, and another finding that women on menopausal hormone therapy (MHT) had a small but significant increase in autoimmune disease risk.”
I wrote about the autoimmunity study a few weeks ago, and women’s health expert, ND and author (and fellow MenoClarity founder) Lara Briden posted about it on Instagram. Some of the comments on her post were wild. People are so used to hormone therapy enthusiasm from the biggest voices that they literally can’t bear a contradictory word said about it, even from someone who regularly posts in support of it.
Look, I came up with this current crop of doctor menopause gurus. I was delighted when they appeared. I am in awe of their success. And I remain grateful for the tireless work they did to get this conversation elevated.
But the certainty with which some of them speak about hormone therapy and prevention for brain and heart is very strange, when we know:
- It’s not an option for many women,
- There are risks and side effects,
- The evidence is mixed
- We still don’t have enough of the best-quality kind.
- Mind-bogglingly, most of the research being done still lumps synthetic and bioidentical HT together, making it difficult to conclude anything
Much of the credible research on hormone therapy and brain health focuses on the so-called “critical window” — the earlier it’s started, the more likely it may help. But even then, the science isn’t settled, and it’s not for everyone.
The female brain isn’t fragile — it’s adaptive. The transition through menopause is complex, but it’s not, for most people, a cliff.
At the heart of it, this latest round of fear-mongering feels very much like a Feminine Forever 2.0 hormone therapy hard sell. It’s also great marketing if you don’t know any better.
As I said on Instagram one tired night this week, I spent my entire life talking shit about myself. I didn’t know that internalized soundtrack wasn’t supposed to be there, and I’ve spent a good amount of the last 10 years — while passing through perimenopause and menopause — learning how to get rid of it.
With my life experience, I feel confident saying that it’s demonstrably damaging to speak about ourselves this way.
So I am utterly befuddled that the people who are most famous in this conversation think it’s perfectly fine to do it on the largest stages.
Does anyone really think this is okay?
This article was first published on Ann Marie’s Substack.
Find out more about Ann Marie’s work at HotFlash Inc.