Menopause brain: the inability to think clearly is not ‘all in your mind’

f you are a woman in your 40s or 50s, you may at times have found yourself standing in a room wondering why on earth you are there, or forgotten the names of people you know well, or started a sentence and forgotten what it was that you needed to say.

A lot of women worry that these are early signs of dementia. But if these experiences coincide with changes in your hormone levels and maybe a few (or many) hot flushes, they are far more likely to be signs of menopause than the onset of dementia.

Menopause brain is not “all in your mind”. The physical and emotional symptoms related to the changes in your hormone levels are very real, and can be debilitating.

Menopause often coincides with other significant life events, such as adult children leaving home, the arrival of grandchildren, the development of chronic diseases such as diabetes or heart disease, ageing parents requiring care, planning for transition to retirement or, 逆に, having the time to take your career up a gear. したがって、, any symptoms related to menopause, including the effects on brain function, have to be seen in the context of everything else that is going on in your life.

There is a lot of speculation about why some women suffer more from menopause brain than others. It may be related to oestrogen levels, or to the interaction between hormone levels and neurotransmitters in the brain in individuals. It is also suggested that lifelong brain health habits (intellectual activity or physical exercise) provide some protection of brain function.

In perimenopause and the early stages of menopause, women describe changes in their ability to think clearly, make decisions and function well mentally. Some describe this as “brain fog”. They may experience difficulty assimilating and making use of new information.

We now know that this form of brain fog affects around two-thirds of menopausal and perimenopausal women. The cause is related to the effects of changing hormone levels on the female brain. The first hormone level to drop is usually progesterone, and this can be related to irritability, mood swings and brain fog. The drop in progesterone can also cause sleep disturbance. Sleep disturbance in itself can affect the brain’s ability to function optimally.

Dips in oestrogen levels cause the well-recognised symptoms of menopause, including hot flushes, mood changes, irritability, mental confusion and decreased energy. These things can all further contribute to hormone-related brain fog.

There is an association between loss of verbal memory skills (being “lost for words”) and the severity of hot flushes. One study showed that the women who experienced the most hot flushes in a day also had the worst scores for verbal memory performance. しかしながら, even if there are no other menopausal symptoms, memory can still be affected by the drop in hormone levels.

Many of my patients are enormously relieved when I tell them that their problems with brain function are most likely caused by the state of their hormones, and that it is likely to be temporary and not linked to any increased risk of dementia or Alzheimer’s disease.

One study at the University of Rochester in New York looked at 117 middle-aged women and conducted a battery of neuropsychological tests for cognition.

Researchers assessed their menopausal symptoms and measured their hormone levels, finding decreases in attention/working memory, verbal learning, verbal memory and fine motor speed may be most evident in the first year after the final menstrual period.

It has been shown that women who had a hysterectomy and their ovaries surgically removed at a younger age were more prone to the effects on the brain of the absence of hormones produced by the ovaries. Women who had their uterus and ovaries removed and then took hormone replacement therapy had a slower rate of cognitive decline than women who did not take hormones.

You have to consider all of the other problems related to menopause that could contribute to brain fog. Women going through the changes around menopause experience disturbed sleep, hot flushes and night sweats, and a depressed mood, all of which can contribute to difficulties with thinking and memory.

The first year of menopause brain is likely to be the worst, and memory and learning ability generally rebound to normal after the menopause process is complete.

While you are waiting for menopause to run its course, there are things you can do to manage the situation. Bear in mind that menopause is also a time to reflect on all of your health habits and make adjustments that will take you into healthier middle and older age.

Menopause hormone therapy MHT (also known as hormone replacement therapy or HRT) refers to a range of treatments that can reduce menopausal symptoms. MHT can be taken as pills, applied as patches or injected as an implant. If the main problem is vaginal dryness, oestrogen can be used topically as a cream. MHT is not routinely recommended for menopause brain, and certainly not as an initial response. There is no strong evidence that hormone therapy benefits brain function around menopause, and it is important to consider the risks as well as the benefits. The decision really depends on how severely cognitive problems and other menopausal symptoms are affecting your quality of life and your work performance, and what else you have tried. Hormone therapy tends to be most useful for brain function in the perimenopausal stage.

This is an edited extract from How to Keep Your Brain Young by Kerryn Phelps AM, Pan Macmillan, out now

This article first appeared in Tonic Mag

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