Brain Fog and Menopause – Everything You Need to Know

It is quite usual for most of the women in middle age to report forgetfulness, memory declines, deficient vocabulary and concentration difficulties. 1 If this fact seems to relate to you, then you are not alone. Studies report that one-third to two-thirds of women in perimenopausal age group experience one or more of these cognitive dysfunctions. 2 Being aware of brain disorders like Alzheimer’s disease, that affect cognitive function, women with these symptoms tend to doubt that they are developing dementia. How many would know that this cognitive dysfunction or simply this ‘foggy brain’ is yet another embarrassing and frustrating symptom of their reproductive aging?

Is brain fog one of the symptoms of menopause?

Though there is considerable variation in the reports of studies attempting to derive a correlation between brain fog in middle-aged women and menopause, some studies have come out with a positive association stating that these memory lapses are a part of the myriad symptoms experienced during the menopausal transition. 3 Brain fog in menopause is expressed in the form of defective verbal and working memory, attention deficits, spatial skill changes, altered sense of time and place, etc. 4

What causes a foggy brain in menopause?

Researchers vary in their reports about the cause of brain fog in menopause. To date, there are not so many studies that correlate a strong background to this subjective memory decline in perimenopausal women.

The proposed organic cause of foggy brain in middle-aged women is the estrogen hormone imbalance (more on it here and here) that occurs around menopause. This hypothesis is supported by the studies that have proved the effect of estrogen on the cognitive functions of the brain. 5, 6 A decrease in the levels of estrogen during menopause is found to have got a deteriorating effect on the functions of the brain especially of those parts which are responsible for memory and concentration. 7

A low performing thyroid (hypothyroidism) which is found to be associated with the low levels of estrogen hormone in post-partum and perimenopausal women, could present with mood changes, depression and cognitive-deficit symptoms. 8 While some scientists have given a biological background to the foggy brain in menopause, a few propose that the disturbing symptoms of menopause themselves, at least in part, have a detrimental effect on memory and cognition. Hot flushes, night sweats, sleep disturbances and mood swings are blamed to be the culprits behind memory lapses. 9

Organic Causes Other Causes
Hormonal Imbalance Vasomotor Symptoms of Menopause
*Low Estrogen Levels *Hot Flushes
*Low Thyroid hormone levels *Night Sweats
Other menopause-related symptoms
*Sleep Disturbances
*Mood Swings
*Depression

Studies show an association between brain fog and menopause

Various studies have been done to analyze the cognitive changes in midlife women. Scientists have also shown evidence for the effect of estrogen on brain functions and the effect of estrogen therapy on cognitive performances. But only a few studies have analyzed the changes in brain functions during menopause and compared them with the subjective cognitive perception of women in middle age. One such study was conducted by the researchers at the University of Rochester Medical Center. Dr. Miriam Weber, the neuropsychologist at the University reported that actual cognitive changes occur in the brain of a woman during her menopausal transition. 10

It is a well established fact that cognitive performance tends to deteriorate with age. However, this fact could not serve a satisfying reason for the memory lapse of women who have just entered their late 30s or early 40s. A more consoling explanation for such women would be the reports of studies that have established a menopause-associated detriment in certain cognitive functions. 11

Brain fog in perimenopause

A foggy brain is found to establish itself at different phases of the reproductive life of a middle-aged woman. The stage at which the symptoms show up and the severity of symptoms differ from woman to woman. Unlike other menopausal symptoms that improve in the post menopausal phase, the cognitive disturbances do not show a linear deterioration or improvement. Women report high cognitive disturbances in the late perimenopause when compared to the early phase. These symptoms further get worse after menopause and improve in the late postmenopausal phase. 12

Brain fog in post-menopausal women

It is evident that brain fog does not just disappear after menopause. It continues into the post-menopausal phase. However, a reassuring fact is that these memory lapses do not last forever after menopause.

How long does brain fog last in post-menopausal women?

Cognitive dysfunctions have been reported to reduce after menopause and the cognitive performance of women in late post-menopausal phases have been found to improve up to the premenopausal levels. 13 Research shows that women in the first year of postmenopause have significant deterioration in cognitive functions and then they tend to show improvement in functions especially verbal memory, motor function and working memory after the first year of postmenopause. 14

Surgical menopause and brain fog

Having said about the effects of natural menopause on memory and other cognitive performances, the effects of surgical menopause warrants a strong mention. While women who undergo a natural menopausal transition experience these symptoms in a gradual manner, those who undergo a hysterectomy associated with oophorectomy (removal of one or both ovaries) will have to face the cyclone of myriad physical and cognitive symptoms in a limited time frame (usually within 48 hours of surgery) and with more severity.

A recent study by the researchers at Brigham and Women’s Hospital in Boston suggests that a woman undergoing surgical menopause at an early age is likely to experience more severe cognitive dysfunction especially in terms of time and place when compared to a woman who undergoes surgery at an older age or who undergoes natural menopause. 15 Later, at the end of the year, the researchers reported that earlier age of surgical menopause had an increased association with neurological disorders like Alzheimer’s disease. They could find evidence for this association through brain autopsies. 16 This particular association between surgical menopause and brain fog and the age-dependent effect has been reported in earlier studies also. 17, 18

How to treat brain fog in menopause?

Some natural ways to treat brain fog in menopause

Unless an organic cause like thyroid dysfunction, which needs an appropriate treatment, exists, a foggy brain needs nothing more than certain lifestyle changes to improve the cognitive problems.

  • Healthy food habits – A healthy food rich in vitamins, minerals and other nutrients that include omega-3 fatty acids are found to offer help in improving concentration and memory.
  • Regular physical exercise – This increases the blood supply to the brain and helps to keep your brain active.
  • With studies pointing to mood and sleep disturbances as causes of brain fog, it is a better option to try on regulating sleep cycles and maintaining a good mood by relieving stress than worrying about your memory deficit.
  • Regular brain training exercises that are found to help improve memory and concentration in old age could also extend support to women in menopausal transition to keep their brain active and working.
  • Alternative medicine: Estrogen imbalance been stated as the primary reason for a hazy brain, natural supplements to cope up with this hormonal deficiency can prove helpful.

Pharmaceutical grade medications that can help

  • Treating hot flushes and night sweats with estrogen and progesterone medications and over-the-counter drugs (of course, after consulting your doctor) can help rebound your memory to a good extent if these were the reasons for your brain fatigue.
  • Literature studies 19and preliminary research 20 show that Hormone Replacement Therapy has been found to slower the rate of cognitive decline and reduce the risk of dementia in postmenopausal women 21 and women who undergo surgical hysterectomy and oophorectomy. 22 However scientists suggest that this aspect of HRT use needs more extensive research before implementing it in clinical practice.
  • Use of HRT in treating memory and mood disturbances has been controversial and studies suggest that the decision regarding this therapy needs a personalized approach. 23
  • HRT is the lastly sort remedy like for any other menopausal symptom and your doctor will definitely advise you if your symptoms really demand hormone replacement and if your benefits seem to outweigh risks.

Dr. Ryan Shelton one of the leading experts on topic of HRT has written an extensive article about everything you need to know regarding hormone replacement therapy which you can read by clicking here.

Memory lapses and concentration difficulties are very frustrating to cope up with. The fear that this would be the case for the rest of the life will add more haziness to your brain. Fortunately, brain fog related to menopause is time-limited and addressing this difficulty with courage, like you would do for any other symptom of menopause, is all that is necessary when you reach this milestone of your reproductive age.

Notes:

  1. Mitchell ES, Woods NF. Midlife Women’s Attributions about Perveived Memory Changes: Observations from the Seattle Midlife Women’s Health Study. J Womens Health Gend Based Med. 2001 May; 10(4): 351-362. Available from: http://online.liebertpub.com/doi/pdf/10.1089/152460901750269670
  2. Weber M, Mapstone M, Staskiewicz J et al. Menopause. 2012 Jul; 19(7): 735-41. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773730/.
  3. Devi G, Hahn K, Massimi S, Zhivotovskaya E. Prevalence of memory loss complaints and other symptoms associated with the menopause transition: A community survey. Gend Med. 2005 Dec; 2(4): 255-264. Available from:  http://www.sciencedirect.com/science/article/pii/S1550857905800555
  4. Warga C. Menopause and The Mind. 1st ed. New York. Simon and Schuster: 2000. 416 p. Available from: http://books.google.ae/books?hl=en&lr=&id=rN1YVdUcFcIC&oi=fnd&pg=PR9&dq=brain+fog+and+menopause&ots=wPIbhUnBzm&sig=qoKMVjjP93jxuAiLvpWePY3MGZs&redir_esc=y#v=onepage&q=brain%20fog%20and%20menopause&f=false 
  5. Genazzani AR, Spinetti A, Gallo R, Bernardi F. Menopause and the central nervous system: intervention options. Maturitas. 1999 Jan 4; 31(2): 103-10. Available from: http://www.sciencedirect.com/science/article/pii/S0378512298001121
  6. McEwen B. Estrogen actions throughout the brain. Recent Prog Horm Res. 2002; 57: 357-84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12017552/.
  7. Thompson RL. Menopause and brain function. Neurol. 2003 Sep 23; 61(6): E9-E10. Available from: https://www.neurology.org/content/61/6/E9.full
  8. Warga C. Menopause and The Mind. 1st ed. New York. Simon and Schuster: 2000. 416 p. Available from: http://books.google.ae/books?hl=en&lr=&id=rN1YVdUcFcIC&oi=fnd&pg=PR9&dq=brain+fog+and+menopause&ots=wPIbhUnBzm&sig=qoKMVjjP93jxuAiLvpWePY3MGZs&redir_esc=y#v=onepage&q=brain%20fog%20and%20menopause&f=false
  9. Greendale GA, Wight RG, Huang M-H, Avis N, Gold EB, Joffe H, Seeman T, Vuge M, Karmlamangla AS. Menopause-associated symptoms and cognitive performance: Results from the study of women’s health across the nation. Am J Epidemiol. 2010 Jun 1; 171(11): 1214-24. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915492/.
  10. University of Rochester: ‘Brain Fog’ of Menopause Confirmed. 2012. Available from: http://www.urmc.rochester.edu/news/story/index.cfm?id=3436
  11. Epperson CN, Sammel MD, Freeman EW. Menopause Effects on Verbal Memory: Findings From a Longitudinal Community Cohort. J Clin Endocrinology Metabolism. 2013 Sep 1; 98(9). Available from: http://press.endocrine.org/doi/abs/10.1210/jc.2013-1808
  12. Weber MT, Rubin LH, Maki PM. Cognition in perimenopause: the effect of transition stage. Menopause. 2013 May; 20(5): 511-7. Available from: http://journals.lww.com/menopausejournal/Abstract/2013/05000/Cognition_in_perimenopause___the_effect_of.7.aspx
  13. Greendale GA, Huang M-H, Wight RG, Seeman T, Luetters C, Avis NE, Johnston J, Karlamangla AS. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurol. 2009 May 26; 72(21): 1850-7. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690984/.
  14. Weber MT, Rubin LH, Maki PM. Cognition in perimenopause: the effect of transition stage. Menopause. 2013 May; 20(5): 511-7. Available from: http://journals.lww.com/menopausejournal/Abstract/2013/05000/Cognition_in_perimenopause___the_effect_of.7.aspx
  15. Brooks M. Medscape: Early Surgical Menopause Linked to Early Cognitive Decline. 2013 Jan 15. Available from: http://www.medscape.com/viewarticle/777672
  16. Anderson B. Medscape: Confirmed: Surgical Menopause Linked to Cognitive Decline. 2013 Dec 18. Available from: http://www.medscape.com/viewarticle/818037
  17. Mitchell ES, Woods NF. Midlife Women’s Attributions about Perveived Memory Changes: Observations from the Seattle Midlife Women’s Health Study. J Womens Health Gend Based Med. 2001 May; 10(4): 351-362. Available from: http://online.liebertpub.com/doi/pdf/10.1089/152460901750269670
  18. Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M, Melton III LJ. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy befor menopause. Neurol. 2007 Aug 29; 69(11): 1074-83. Available from: http://www.neurology.org/content/69/11/1074.short
  19. Yaffe K, Sawaya G, Lieberburg I, Grady D. Estrogen therapy in Postmenopausal Women Effects on Cognitive Function and Dementia. JAMA. 1998 Mar 4; 279(9): 688-95. Available from: http://jama.jamanetwork.com/article.aspx?articleid=187297
  20. Bove R, Secor E, Chibnik LB et al. Age at surgical menopause influences cognitive decline and Alzheimer pathology in older women. Neurol. 2014 Jan 21; 82(3): 222-9. Available from: https://www.neurology.org/content/82/3/222.abstract
  21. Yaffe K, Sawaya G, Lieberburg I, Grady D. Estrogen therapy in Postmenopausal Women Effects on Cognitive Function and Dementia. JAMA. 1998 Mar 4; 279(9): 688-95. Available from: http://jama.jamanetwork.com/article.aspx?articleid=187297
  22. Bove R, Secor E, Chibnik LB et al. Age at surgical menopause influences cognitive decline and Alzheimer pathology in older women. Neurol. 2014 Jan 21; 82(3): 222-9. Available from: https://www.neurology.org/content/82/3/222.abstract
  23. Mott NN, Pak TR, Estrogen Signaling and the Agng Brain: Context-Dependent Considerations for Postmenopausal Hormone Therapy. ISRN Endocrinol. 2013 Jul 7, 2013: 814690. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725729/.

Comments

  1. Valerie says:

    I had a total hysterectomy 2 months ago. Feeling like my memory is going. Forgetfulness and problems sleeping. I am sure it does not help that I work nights. I am a Registered Nurse and I am finding this quite troublesome.

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