As if hot flashes, sleep disturbances, mood shifts, and vaginal dryness are not enough to have to contend with when going through menopause, enter memory problems and other cognitive challenges. This so-called brain fog that many women experience during the “change of life” is a very real phenomenon. As annoying, anxiety-provoking, or even frightening as it may be, however, in most cases the symptoms are not progressive or an indication of future dementia; they may even improve over time.
Many women report some degree of cognitive change around the time of menopause, though rates vary by study, ranging from about 60 to 70 percent to as high as 92 percent. Some women do not experience “brain fog” at all, while others have it on the severe side. It’s largely attributed to fluctuating hormones, most notably a drop in estrogen, which plays an important role in learning and memory. Estrogen receptors are found in parts of the brain that regulate memory and executive function, and estrogen itself may protect brain cells. Estrogen may additionally support endothelial (blood vessel) health, which also plays a role in overall cognitive functioning.
Most common are memory problems, but women also report difficulty maintaining a train of thought, trouble finding the right word, increased distractibility, changes in the capacity to remember and recognize faces, and trouble organizing, planning, and concentrating.
Such subjective complaints are hard to measure, and they can also be difficult to separate from the effects of normal aging and psychological factors such as anxiety and depression that can muddle cognitive performance. But a few studies lend some clarity to our understanding of the phenomenon.
For example, a study of 117 middle-aged women, published in the journal Menopause in 2013, found that those in the early stage of menopause (first year of post-menopause) did worse on neuropsychological tests of working memory, verbal learning, verbal memory, and fine motor skills (speed and dexterity) than women in their late reproductive and late menopausal transition years.
Another study, published in the journal Climacteric in 2010, of 120 women in various stages of menopause, established links between subjective cognitive complaints and actual impaired cognitive performance, especially in measures of verbal memory, as well as attention and cognitive processing speed. The associations held up after non-cognitive psychological factors were controlled for. The authors noted that their results “provide empirical support for subjective descriptions of cognitive problems such as ‘foggy thinking,’ ‘loss for words,’ and ‘naming’ difficulties, and suggest that the mechanism underlying the subjective complaints of memory problems and attentional clarity is a decline in attentional processing ability.”
But here’s some comforting news if you are facing “brain fog” in early menopause: The Study of Women’s Health Across the Nation (SWAN), which has been following several thousand women since 1996, found that while the ability to learn new material decreased somewhat during perimenopause, it returned to premenopausal levels after menopause.
Clearing the fog with hormone therapy?
The connection between estrogen and cognitive function has been well described in the medical literature, but research on whether menopausal hormone therapy can help preserve or even improve cognitive functioning has produced mixed results. Some studies suggest that starting hormone therapy before or soon after menopause protects against cognitive decline, but others have failed to confirm this benefit. Meanwhile, other research suggests that taking estrogen later in life (after age 65) could accelerate mental decline and increase the risk of dementia.
Hormone therapy should not be prescribed solely for memory or other cognitive problems (or for the primary prevention of any chronic diseases) because of the lack of evidence of benefits in the face of potential risks, though it is thought to be safer in perimenopausal women who take it for a limited time to relieve hot flashes and other menopause-related symptoms. Any woman considering hormone therapy should thoroughly discuss the risks (such as increased risk of blood clots, strokes, and breast cancer) versus benefits with her doctor.
Countering cognitive changes with lifestyle changes
Though many remedies have been proposed to counter cognitive changes in midlife women—from antioxidants and ginkgo biloba to anti-inflammatory drugs—the evidence is too little, too weak, or nonexistent to support their use. A multitude of studies, however, suggest that adhering to the lifestyle practices recommended for well-being in general may be good for the brain in particular. This includes eating a healthy diet (such as the Mediterranean or MIND diet), maintaining a healthy weight, exercising regularly, getting enough sleep, participating in social activities, and keeping your brain intellectually engaged (by reading, doing crossword puzzles, or playing a musical instrument, for instance). You should also manage underlying health conditions, such as diabetes, high blood pressure, and thyroid disease, as well as stress, depression, and sleep disorders, all of which can contribute to cognitive problems. Lastly, check with your doctor if any medications you take could interfere with memory or cause confusion.
