Tagni: Menopause Impacts Brain, Bladder, and Belly

Dr. Carine-Ange Tagni, a board-certified obstetrician and gynecologist, argues that the conversation around menopause has stayed too narrow. While hot flashes and irregular periods dominate public discourse, she contends that the condition’s impact on the bladder, brain, and metabolic health is equally severe. As October marks Menopause Awareness Month, Tagni is pushing for a clinical shift that treats the end of the reproductive phase as a systemic event rather than a collection of minor nuisances.

The Centers for Disease Control and Prevention defines menopause as the permanent cessation of menstrual periods for at least 12 months. According to the National Institutes of Health, the average age for this transition in the United States is between 51 and 52. During this period, ovaries reduce their production of estrogen and progesterone. These hormonal drops trigger symptoms that can persist for two to eight years, with the specific timing and intensity varying widely from woman to woman.

Tagni’s analysis begins with the urinary tract. She explains that declining estrogen weakens the tissue and healthy bacteria in the vagina and lower urinary tract. This loss of protection increases the risk of recurrent urinary tract infections. Citing the 2025 Genitourinary Syndrome of Menopause guideline, she notes that low-dose vaginal estrogen can help prevent these infections in appropriate patients. She warns that antibiotics treat the bacteria but do not repair the underlying tissue changes caused by menopause.

Beyond physical discomfort, Tagni highlights the psychological toll of genitourinary syndrome of menopause, or GSM. She points to a matched-control study showing that women with vulvovaginal atrophy recorded higher rates of anxiety and depression than their counterparts. Specifically, anxiety rates were 16.6% among affected women compared to 11.3% in the control group. Depression rates were 23.9% for those with atrophy versus 18.9% for controls. Tagni emphasizes that these intimate symptoms affect daily well-being and relationships, not just sexual function.

Recent research is also linking strength training to cognitive health during this transition. A 2026 randomized pilot trial found that nine months of resistance training improved memory and mental flexibility in perimenopausal and early postmenopausal women. Tagni attributes this to myokines, molecules released by skeletal muscle that communicate with the brain. She cautions that this is early evidence for cognitive benefits, not proof that exercise prevents Alzheimer’s disease.

Finally, Tagni addresses the common complaint of weight gain around the midsection. She explains that the so-called menopause belly often reflects a shift in fat distribution rather than a simple increase in total body weight. As estrogen levels fall, fat is more likely to accumulate as visceral fat around internal organs. This type of fat is metabolically active and is linked to inflammation, insulin resistance, and cardiovascular risk. Data from the SWAN Heart study shows that abdominal visceral fat increases rapidly around the menopause transition.

Tagni concludes that a changing waistline can signal metabolic shifts that a standard scale may miss. She advises clinicians to evaluate emotional and sexual well-being alongside physical symptoms. The goal is to recognize that menopause affects the entire body, requiring a more comprehensive approach to patient care.