Jennifer Lovejoy, Arivale Chief Science Officer, PhD
During the menopause transition – which occurs roughly between the ages of 45 and 55 – women’s fluctuating hormones can wreak havoc both physiologically and psychologically, making it a rough time to say the least.
In addition to the well-known symptoms of perimenopause (such as hot flashes, mood changes, difficulty sleeping, and decreased libido), there are the issues of weight gain and increased risk of cardiovascular disease, diabetes, and depression – all related to declining levels of sex hormones.
Being incorrectly diagnosed with early-onset dementia on top of the above issues would almost certainly make this transition worse.
A case study published in the December 2018 issue of Obstetrics and Gynecology describes two extreme cases where women experiencing menopause-related cognitive decline were incorrectly diagnosed as having early-onset dementia – undoubtedly a very scary experience, and one the author of the case study hopes she can help other women avoid.
There’s a significant amount of published literature on cognitive changes during perimenopause. Studies have shown measurable impairments in various aspects of cognitive function – including verbal memory, processing speed, and learning – that correlate with hormonal changes during the menopause transition. A recent New York Times article does a nice job of describing perimenopause-related cognitive changes, or “brain fog.”
While one might predict that the cognitive changes could be related to other menopausal symptoms, such as sleep difficulty, interestingly this doesn’t seem to be the case in most studies. In other words, women who reported worse hot flashes or insomnia don’t necessarily have greater brain fog.
The one symptom that does appear to consistently relate to cognitive function, however, is depression. Several studies have shown that women who report “a more negative attitude toward menopause” or greater depressive symptoms have more complaints about their memory and other cognitive symptoms. What’s really interesting in these studies is that the researchers performed objective measures of cognitive functioning, using well-validated neurological tests, and found that often there was not any evidence of objective decline in cognition, or only a few cognitive measures were impacted while most were fine. Basically, in these studies, the women’s perception of their cognitive function and memory was much poorer than was actually indicated by the standard tests.
So, what’s a woman to do? First, know that cognitive complaints during perimenopause are common and related to hormone changes. Certainly talk to your doctor if your symptoms are severe enough to impact your life, but don’t immediately jump to fears about early Alzheimer’s. Hormone replacement might be a helpful option for severe symptoms if other causes of cognitive change have been ruled out.
And, there is good news. The “brain fog” of perimenopause appears to be transient. Once women are at a stable, low hormone level post-menopause, their cognitive function is comparable to premenopausal women. One study found that decreases in attention, verbal learning, and fine motor speed were most obvious in the first year after the final menstrual period, compared to prior or later years.
There are also a few strategies to consider while you’re waiting for your hormones to stabilize post-menopause.
First, it’s never a bad idea to do brain training – regardless of your age or gender – and doing focused exercises to build cognitive abilities, processing speed, and memory may be helpful to combat “brain fog” during the menopause transition. Several online brain training programs have shown to be effective in published clinical trials, including BrainHQ and Lumosity.
Second, don’t overlook the power of your attitude. If much of your daily mind chatter is devoted to a litany of all the miserable things menopause is doing to your life, you’re likely to experience all your symptoms – including the cognitive ones – more severely. Of course, if you consistently feel sad or depressed, you should seek professional help since untreated depression can itself be a risk factor for cognitive decline.
Proactively taking care of your mental and emotional health is important even if you aren’t depressed. Cognitive Behavioral Therapy is very effective for hot flashes and, while it hasn’t been directly studied for menopausal “brain fog,” some of the cognitive strategies may help with this as well. In addition, making a concerted effort to focus on things you’re grateful for, enjoying the small joyful moments throughout the day, and maintaining a sense of humor about the whole process may help ease you through the menopausal transition.
[Arivale Hot Topics address health stories currently in the news. The Arivale Clinical Team’s commentary on these news articles is not a review of the scientific evidence, nor an endorsement of a specific study, and is not meant as official medical opinion.]