How Menopause Affects Your Brain
If 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, conversely, having the time to take your career up a gear. Therefore, 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.
How Your Brain Can Affected During Menopause
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. However, 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.
What You Can Do About Menopause Brain
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.
General health check See your GP to make sure your symptoms relate to menopause and not some other cause. Check your blood pressure regularly. Hypertension (high blood pressure) can cause hot flushes and can also increase the risk of cognitive impairment, vascular dementia and Alzheimer’s disease. Women with very high blood pressure have been shown to have a 30 per cent increased risk of developing cognitive impairment.
Exercise Exercise is essential for the prevention of chronic disease and it is also helpful for managing irritability, helping you sleep as well as maintaining a healthy weight, strong bones and muscles. Aerobic exercise and resistance (or strength) training also helps your brain function. Just as all body structures need good blood flow to function and repair, the brain similarly requires good blood flow to maintain optimal function.
Exercise your mind Make lists to help you stay organised. Challenge your mind each day with brain stimulations such as crosswords, reading, studying something new, or learning a new language or a musical instrument. Arrange regular social interactions, too.
Sleep Disturbed sleep or lack of quality sleep impairs normal brain function and contributes to brain fog. Give yourself time to get to sleep. Make sure your bed and pillows are comfortable and your bedroom is quiet and dark. Don’t keep electronic devices in your bedroom that emit light or make noise.
Nutrition Look after your diet. Eat plenty of vegetables and fruit and other unprocessed whole foods. Avoid eating animal fats and trans fats.
Diet drinks Compared with people who say they do not consume diet drinks, people who drink at least one per day have been shown to suffer three times more strokes, and to be three times more likely to develop dementia. Avoid artificial sweeteners such as aspartame and switch to water as a thirst-quencher.
Alcohol Many women find that when they drink alcohol around the time of menopause, it makes hot flushes, night sweats and insomnia worse. Alcohol also increases body weight and increases blood pressure.
Healthy weight Achieve and maintain your ideal weight. A 2013 study showed that memory improved in post-menopausal, overweight women after they lost weight by dieting.
Smoking Tobacco smoking affects cerebral blood flow, which has an adverse effect on brain function. Smoking may also worsen the hot flushes of menopause, and increases the risk of heart and blood vessel disease and some cancers.
Meditation/mindfulness Relaxation practices such as meditation, tai chi, yoga, and breathing techniques can help with anxiety, irritability and sleep problems.
Medication review As you get older, it may be more likely that you are prescribed drugs for chronic health conditions. Some of these – sleeping pills, medications for high blood pressure, antidepressants and statins – may have an effect on your memory and brain function. If you notice your brain function has worsened after starting one of these medications, ask your doctor or pharmacist to review the medication you are taking.
Herbs and supplements Some of the herbs and supplements we use to treat the hot flushes and mood swings of menopause may also help brain fog and memory problems. You will need the advice of a health care professional if you are exploring this option. Some common examples include black cohosh, red clover, ginkgo biloba, Bacopa monnieri, and dong quai. Ensure you have adequate vitamins B6 and B12 to support cognitive function through menopause and beyond.
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.
Edited extract from How to Keep Your Brain Young by Professor Kerryn Phelps AM, Pan Macmillan, RRP $34.99