Menopause and Brain Fog: Why You're Forgetting Things and How to Get Your Mind Back
You are half a sentence into the sentence and the word you need has disappeared. You enter the kitchen and stand there, really confused as to why you entered the kitchen. You read the same paragraph three times and it does not stick. You have always been sharp, organised, on top of things. And now this.
The cognitive changes of menopause are the least discussed and the most troubling symptom of menopause to many women. Not because they are the most physically uncomfortable, but because they contribute to the loss of confidence in a manner that hot flushes do not.
The good news and researchers are very emphatic on this is that it is real, it is common, it is caused, and in most cases it is temporary in women. This post describes what is going on and what is really useful.
Brain fog is not a medical term, it is a phrase that has become so because it has been used to describe the experience so well. Some sort of low-level mental fog which hangs over all. Words that are more difficult to retrieve. Concentration is less reliable. The feeling that your brain is operating a bit slower than it used to operate.
These experiences are confirmed to be real. The research during the menopause transition has always found that women experience slight decreases in processing speed, the rate of how quickly the brain processes information, and in verbal memory, the capacity to remember words and language. These are not fancied or overdone.
What is also quite clear is the fact that that majority of the women with their concerns about their brain during this age yet still perform in totally normal ranges based on formal cognitive tests. There is a huge discrepancy between the subjective sensory experience of the brain and its objective performance in test situations. The fog is real. The fear that something serious is wrong is not usually.
Oestrogen receptors are distributed within the brain, even in the locations that have been described as the most involved in memory and learning. Oestrogen has effects on the production of major brain chemicals such as serotonin, dopamine and acetylcholine among others that affect mood, motivation, attention and storage and retrieval of memories.
When oestrogen levels become erratic during perimenopause, instead of keeping to the comparatively stable rhythm that they had been keeping during decades, the brain must adapt. Imagine the brain re-calibrating. The feedback it has been trained to obtain is now discontinuous and reduced and it requires time to adjust to that new norm.
A particular result of the research that is worth knowing: oestradiol, the most active form of oestrogen, has a direct effect on verbal memory. That is the reason why word-finding difficulty is the most frequent complaint of brain fog in menopause. It is not random. The neuronal system that is most engaged in language retrieval undergoes a specific hormonal change.
That is why the woman who had never in her life had a problem with finding words suddenly finds herself in the middle of the sentence, gesturing with her hands, and attempting to tug a word out of thin air and she knows it perfectly well but fails to access it. It does not indicate that there is something wrong. It is a highly idiosyncratic hormonal action on a highly idiosyncratic brain activity.
Oestrogen and progesterone are also not the only causes of brain fog in menopause. The impact of sleep deprivation on the cognitive functioning is immense. The sleep debt accumulates rapidly when night sweats are causing one to rise at least two or three times a night over weeks or months, and poor sleep makes all elements of brain action feel more difficult: attention, memory retrieval, verbal fluency, decision-making.
Cognitive performance is also directly influenced by mood changes, especially anxiety and low mood which is typical of perimenopause. Specifically, anxiety maintains the brain in an alert mode of monitoring that cannot be compatible with the receptive and relaxed mode of learning and memory retrieval.
That is why the brain fog of menopause is usually stratified: the hormonal alteration is the baseline, and the sleep disturbance and an emotional shift are on top of it and enhance all the factors.
Talking about brain fog in the menopause years would be incomplete without mentioning something that has seldom found its way into the clinical descriptions; the sheer cognitive burden that many women are bearing at this stage of life.
It is usually the decade when sandwich generation reality strikes the hardest, as they are expected to take care of adult children or adolescents dealing with their problems of their own at the same time taking care of ageing parents, typically at their full time jobs. The psychological burden of keeping up with the lives of all other people, their appointments, needs, and crises is tremendous. Put in hormonal ups and downs, impaired sleep, and increased anxiety and the brain is being required to do a massive job with a poorly-maintained toolkit.
It is the question that lingers in the minds of many women and very few of them do bring it out. And then when I continue forgetting things, is everything really bad? Is this where it all starts and it will not improve?
This is encouraging as evidenced. Mid life dementia is truly uncommon. Most women even those with significant brain fog during perimenopause still work within normal ranges on the formal cognitive tests that are used to screen dementia. The type of forgetting which occurs at menopause, the loss of words, the forgetting of the purpose of entering a room, the forgetting of the details which normally stand out, is different in nature to the type of forgetting that occurs in dementia.
Certain symptoms are those that do justify a discussion with a GP, and will be discussed later in this post. In the majority of women, brain fog during the menopause transition is a momentary hormonal phenomenon, and not the onset of cognitive decline.
Since brain fog is hardly ever triggered by a single factor, the best solution is to target the underlying factors, rather than the fog itself.
In case night sweats are causing serious disturbances in sleep, the enhancement of the quality of sleep is likely to generate a substantial change in cognitive clarity within a relatively short period. Most women observe that brain fog is reduced significantly when they begin to sleep better, whether by the process of managing vasomotor symptoms, by sleep-centred behavioural changes, or both.
On the same note, coping with anxiety and mood by whichever means is suitable to the person i.e, exercise, talking therapy or the medical support will tend to ease some of the cognitive burden that makes the fog heavier.
The most reliably beneficial brain health effect of any intervention investigated is physical exercise. It enhances blood circulation to the brain, encourages the development of new neural connections, decreases cortisol (stress hormone of the body, in large quantities, negatively affects memory), and enhances the quality of sleep.
The study particularly recommends a mix of aerobic workouts and exercises that need coordination or learning like dancing, swimming, yoga, or a novice sport as especially beneficial to the brain. They are not idle activities: the brain has to be actively involved in them, which is precisely what keeps it sharp.
Sleep is the time that the brain consolidates memories. It actually processes the information and experiences of the day and transfers them to the long-term storage while you are sleeping. This process is directly interfered with by consistent poor sleep, and that is why sleep deprivation can lead to such conspicuous cognitive effects in such a short period of time.
One of the most immediate things that a woman can do to her cognitive functioning is to treat her sleep issues during menopause as a priority and not something to grit teeth. The last blog of this series discusses the particular methods of sleep disruption in menopause.
Memory aids through tools are not an indication of cognitive impairment especially in a time when the brain is already being unduly burdened. It is an intelligent adaptation. Menopause cognition experts actively suggest the following strategies:
There are no coping mechanisms of a person whose brain is failing. They are reasonable instruments of a brain that is going through a difficult transition.
It is repeatedly found that a diet can have a long-term effect on the brain, and the Mediterranean diet, which is predominantly vegetarian, with a large proportion of fruits, vegetables, wholegrains, fish, olive oil, and legumes, with little processed food and red meat, has one of the most successful studies of brain health in the middle of life.
It does not result in dramatic overnight changes in cognitive functioning. However, as a component of a more extended strategy of brain health at and beyond the menopause transition, it is a low-risk, supported intervention.
Social bond and mental challenge are both safeguarding to the brain as individuals get older. Being socially active, having friends, and keeping on doing anything that requires learning and mental activity, be it a new skill, a difficult book, innovative activity, or a thought-provoking discussion, all contribute to the resilience of the brain.
The majority of the brain fog during menopause transition does not need medical investigation. However, there are certain circumstances which justify a discussion:
In women where brain fog is unequivocally connected with other menopause symptoms, including poor sleep and hot flushes, medical management of these conditions is a logical initial treatment that commonly has a direct positive impact on cognitive clarity.
The International Menopause Society, which has issued a comprehensive white paper on brain fog and menopause in particular, is straight to the point: these cognitive changes exist, they are generally mild and they tend to improve as the hormonal transition subsides.
The brain is not fractured. It is adapting. The fog usually clears in most women. And in the meantime, comprehending why it is occurring, attending to sleep, maintaining physical activity, sustaining mood, and applying practical aids to counteract transient deficits, makes it much easier.
You used to be quick in the past. You shall be keen as ever. This stage is not a state but a stage.