Het mysterieuze menopauzebrein
‘’s Nachts wakker worden, badend in het zweet, continu droge ogen en pijn in mijn gewrichten bij het opstaan, iets wat ik nog nooit eerder had ervaren.’ Aldus mijn mama, 56 jaar een leerkracht in het basisonderwijs, wanneer ik vraag naar haar ervaringen met de menopauze. ‘Ik was ook meer verstrooid en veel gevoeliger. Mijn stemming kon plots omslaan.’
Haar klachten vormen maar een greep uit het brede scala van symptomen dat zo’n 80% van vrouwen plaagt tijdens de menopauze transitie. Veel van deze klachten zouden wel eens letterlijk ‘tussen de oren’ kunnen zitten: tijdens de menopauze ondergaat het brein namelijk grote veranderingen. Het in kaart brengen van deze hersenveranderingen staat echter nog in zijn kinderschoenen.
Daarom bracht ik tijdens mijn thesis de hersenverbindingen van vrouwen voor, tijdens en na de menopauze transitie in kaart door gebruik te maken van magnetische resonantie beeldvorming (MRI). Wat bleek? Bij vrouwen voor- en tijdens de menopauze waren verschillen in de hersenverbindingen zichtbaar.
Oestrogeen, de hormonale dirigent
Oestrogeen speelt hierin een belangrijke rol. Dit vrouwelijke geslachtshormoon, wordt geproduceerd door de eierstokken, twee kleine organen die zich aan beide zijden van de baarmoeder bevinden. Het circuleert in het bloed en orkestreet vanaf de puberteit de menstruele cyclus. Samen met een aantal andere hormonen maakt oestrogeen een maandelijkse eisprong mogelijk.
Vrouwen spenderen één derde van hun leven in de postmenopauze. Toch begrijpen we nauwelijks hoe deze periode hun hersenen verandert.
Rond de leeftijd van 45 jaar begint de productie van oestrogeen bij de meeste vrouwen sterk te schommelen. Deze perimenopauze duurt gemiddeld 5 jaar en wordt gevolgd door de postmenopauzale periode. Wanneer we in ons achterhoofd houden dat een vrouw in België gemiddeld 84,4 jaar wordt, betekent dit dat een vrouw ongeveer een derde van haar leven in de postmenopauzale periode spendeert. Toch begrijpen we nog maar nauwelijks welke invloed deze hormonale schommelingen hebben op de hersenen.
Het hongerige menopauzebrein
De effecten van oestrogeen reiken verder dan de voortplantingsorganen. Zo speelt oestrogeen een belangrijke rol in de hersenen. Het zorgt er bijvoorbeeld voor dat suikers gemakkelijk als energiebron gebruikt kunnen worden. Wanneer oestrogeenlevels dalen, zoals het geval is bij de menopauze transitie, raakt dit energiesysteem tijdelijk verstoort. Het brein heeft moeilijkheden om suikers efficiënt in energie om te zetten.
Toch blijft de vraag naar energie groot, want hoewel de hersenen slechts 2% van ons lichaamsgewicht uitmaken, gebruiken ze zo’n 20% van de alle energie. Daarom zoeken onze hersenen naar andere energiebronnen, zoals ketonen, moleculen afgeleid van vetten. Sterker nog, men denkt dat myeline, de compacte isolatielaag rond onze hersenverbindingen, wordt afgebroken om deze ketonen te maken.
Volg het water!
Voor mijn thesis onderzocht ik de hersenverbindingen bij vrouwen vóór, tijdens en na de menopauze transitie. Hiervoor maakte ik gebruik van een MRI-techniek die de beweging van watermoleculen langs onze hersenverbindingen in kaart brengt. Deze techniek helpt ons inzicht te krijgen in de kwaliteit van deze verbindingen.
In de perimenopauze lijkt de isolatie rond de hersenverbindingen dikker. Mogelijks liggen de isolatielaagjes minder dicht tegen elkaar aan.
Tot mijn verbazing ontdekte ik dat bij vrouwen in de perimenopauze de isolatielaag net dikker lijkt in het voorste deel van de hersenbalk, die de linker-en rechterhersenhelft met elkaar verbindt. Wat dit precies betekent, weten we nog niet. Misschien wijst dit op een afname in de stevigheid van de isolatielaag, waarbij de verschillende laagjes minder dicht tegen elkaar aan liggen. Je kan dit vergelijken met laagjes tape die beetje bij beetje hun kleefkracht verliezen.
Mijn onderzoek voegt een klein puzzelstukje toe aan het begrijpen van het menopauzebrein. Maar er is nog heel wat onderzoek nodig voor ik aan mijn mama kan uitleggen wat er nu echt ‘tussen haar oren’ gebeurt.
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