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Imagine your mind going blank during an important meeting at work when everyone is expecting you to deliver. Or fogetting to take your daughter to her soccer game. Or forgetting the names of everyday items such as shoes, pens, or towels and having to point instead of naming them. Menopause brain fog is the name, and it can be a minor annoyance or significantly debilitating. Thankfully HRT, lifestyle medicine pillars and other strategies can reduce the impact on your life!
I meet many clients in clinic with this problem that interferes with their capacity to function in the workplace and at home, significantly so at times. I'd love to share so tips and tricks to help lift the meno fog.
Menopause is a natural biological process that occurs once ovarian function ceases to make sufficient steroid hormones estrogen, progesterone and testosterone for a menstrual cycle. The transition to menopause is called perimenopause and involves fluctuating and declining levels of these hormones.
One of the less-discussed aspects of menopause is menopause brain fog - the difficulties with cognitive function that many women experience. These cognitive symptoms experienced during perimenopause can impact memory, focus, and overall mental clarity.
In this article, we'll delve into the phenomenon of menopause-related brain fog, its causes, and practical strategies to manage and navigate through it.
Related: More About Menopause & The 3 Stages of Menopause?
Understanding Menopause Brain Fog
Menopause is associated with a significant drop in hormone levels that play crucial roles in cognitive function. These hormonal shifts can lead to a range of symptoms, including hot flashes, mood swings, and, of course, brain fog. Brain fog is characterised by a reduction in mental clarity, forgetfulness, and difficulty concentrating.
In the medical literature it is called impaired cognition and it can be associated with impaired mood. Many of the symptoms we think of as physical are actually neurological in nature.
Dr Lisa Mosconi, PhD, Associate Professor of Neuroscience in Neurology and Radiology at Weill Cornell Medicine (WCM), & Director of Alzheimer’s Prevention Program at WCM/NewYork-Presbyterian Hospital. (How Menopause Affects The Brain)
How Common is Menopause Brain Fog?
During perimenopause, more than 60% of women report memory complaints. This can have significant impacts for women in the workplace, in relationships and family life. Approximately 5% of women meet the criteria for mild cognitive decline (Menopause and cognitive impairment 2021).
Causes of Menopause-Related Brain Fog:
Hormonal Fluctuations
Both estrogen, progesterone and testosterone have direct impact on neurofunction. They are considered neurotransmitters in their function (Surprise: Estrogen as Neurotransmitter) and neurotransmitter receptors in the brain responsible for cognition. As these hormone levels fluctuate and decline during perimenopause, it can disrupt the usual functioning of these neurotransmitters.
They also affect gene expression of neuroprotective chemicals such as brain-derived neurotrophic factor (BDNF), which is induced by the presence of estrogen. BDNF is essential for neuronal growth, learning, and neuroplasticity (Estrogen and brain-derived neurotrophic factor (BDNF)).
Progesterone is metabolised to allopregnanolone which has beneficial anti-seizure, anxiolytic and antidepressant effects in the brain.
Testosterone likely also play a role in menopause-related brain fog. Although the decline in testosterone can occur more gradual, it certainly plays a role in memory and organisation and reward and pleasure systems.
The decline in estrogens, progesterone, and androgens during perimenopause also contribute to structural changes in the brain. For example there is a reduction in the size of the hippocampus and parietal cortex volume (Shaping of the Female Human Brain by Sex Hormones).
Neurotransmitters
Hormonal fluctuations during perimenopause not only impact directly on brain receptors but they also impact production and function of neurotransmitters. These chemicals in the brain are essential for transmitting signals between nerve cells. Changes to their levels can disrupt cognitive function and contribute to menopause brain fog.
Key neurotransmitters impacted during perimenopause include:
Noradrenaline plays key roles in:
energy levels
alertness
concentration
impulse control & anxiety
cognition, emotion regulation and mood
Serotonin plays key roles in:
memory
obsession
compulsion,
impulse control & anxiety
cognition, emotion regulation and mood
Dopamine plays key roles in:
Reward-Pleasure systems
Drive
Motivation & Attention
impulse control & anxiety
cognition, emotion regulation and mood
Sleep Disturbances
Low estrogen disrupts the circadian rhythm or sleep/wake cycles. Low progesterone reduces allopregnanolone levels that has a neuro-calming effect and supports sleep.
Additionally many menopausal symptoms, such as night sweats, insomnia, heart palpitations, or urinary frequency can contribute to sleep disturbances. Lack of quality sleep can exacerbate cognitive issues, leading to increased brain fog, especially if you are trying to function with a sleep deficit.
Stress and Anxiety
The hormonal changes during menopause can also influence stress and anxiety levels. As estrogen levels drop, cortisol - your stress hormone increases. Many women experience greater difficulty managing everyday stressors, experiencing greater anxiety and overwhelm and lower resilience to life events. These factors further contribute to cognitive difficulties.
How does the female brain change through menopause?
Recent neuro-imaging studies have demonstrated there are substantial differences in:
brain structure,
brian connectivity, and
brain energy metabolism across menopausal stages from pre-menopause to peri-menopause and post-menopause (Menopause impacts human brain structure).
These brain changes across menopause states correlate to menopausal endocrine aging rather than chronological aging.
This means the aging of the brain in females is directly impacted and accelerated, compared to age-matched males, due to the loss of these neuroprotective brain hormones (Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition).
Strategies for Managing Menopause-Related Brain Fog:
Hormone Replacement Therapy (HRT):
Under the guidance of your healthcare professional, hormone replacement therapy can be considered to alleviate symptoms of menopause, including brain fog. Current HRT formulations are safer when estrogen is used through the skin, and when using body identical formulations.
Estrogen patches, gel or cream is the safest way to use estrogen and it helps even out the peaks and troughs of estrogen that are exaggerated during perimenopause, creating a more stable, consistent estradiol level.
Micronised progesterone supports brain health as it is metabolised to allopregnanolone which acts on GABA receptors, helping you feel calmer.
For those who have ongoing brain fog with optimised estrogen and progesterone, testosterone cream or gel can be a useful addition.
Related: Testosterone use in Menopause
HRT not only supports brain function but it usually also significantly improves sleep, which improves barin functioning.
The evidence on the impacts of HRT on cognitive function is varied but studies indicates there is improved brain function when HRT is started early, either in the perimenopausal or early postmenopausal period ie within 10 years of menopause or the final period (The effect of hormone replacement therapy on cognition & mood).
This is because from menopause, women who do use HRT undergo a prolonged period of low hormones known as menopausal endocrine aging of the brain which predisposes to the development of dementia (Effects of menopause hormone therapy on risk of Alzheimer's disease).
Remember that these changes don't only affect older women. Women who experience early or premature menopause can experience these brain changes at a much earlier age and should replace their hormones to age 50 years at a minimum.
Related: Is HRT funded in New Zealand?
Other Medications
For those with significant brain fog that is not improving with optimised menopausal hormone therapy, or those who cannot use HRT, there is another medication that can be used to support brain function. Memantine at a 20-mg daily dose can be an effective alternative.
It is a medication used for cognitive impairment in Alzheimer's disease . There are no current studies looking at memantine and brain fog during perimenopause. It is used at the HER Centre in Melbourne Australia for this purpose. It has been used in post-menopausal women and showed improvements in executive functioning and language fluency (Cognitive effects of memantine in postmenopausal women).
It is licensed in New Zealand for treatment of moderate to severe dementia but not menopausal cognitive dysfunction/brain fog.
Lifestyle Habits that support Brain Health
These lifestyle habits are important for overall health including brain health and function.
Regular Exercise
Regular exercise improves overall health and well-being, including cognitive function.
Exercise over the short term;
Enhances mood and emotional states in healthy people
Improves mood and wellbeing in people with depression. (Effects of Physical Exercise on Cognitive Functioning and Wellbeing)
Regular exercise over the longer term has additional benefits including;
Increasing neuroplasticity - which is the the ability of the brain to form and reorganize synaptic connections, especially in response to learning, experience and following injury.
Improvement in cognitive function (especially memory and executive functions ie planning, organisation )
Minimises neurodegeneration (prevents/delays cognitive decline)
Improved general wellbeing
Decreasing anxiety and depression (Effects of Physical Exercise on Cognitive Functioning and Wellbeing)
Aim for at least 30 minutes of moderate physical activity at least 5 times per week of 22 minutes daily.
Choose a type of physical activity that you enjoy because it can enhance your mood, reduce your stress, increase enjoyment which can help improve overall cognitive function.
Eating for Brain Health
A brain healthy diet includes eating abundant and diverse sources of
antioxidants,
omega-3 fatty acids, and essential nutrients supports brain healthy foods.
Dr Lisa Mosconi, Female Brain expert recommends the following to optimise brain health at perimenopause/menopause:
"1. Do not eat processed food as much as possible
2. The healthiest diets are diets that focus on plants. Plants are medicine. They are full of vitamins, mineral and phytonutrients.
3. Eat nutrient-dense foods (super-foods) that are really packed with nutrients that are good for your health. In this regard the Mediterranean diet is one of the healthiest dietary patterns in the world.
4. Make sure there is a lot of green on your plate. Include plenty of leafy green vegetables, cruciferous vegetables, cauliflower, broccoli, brussel sprouts and cabbage, kale, spinach and lettuces.
5. Antioxidants in fruit are very important."
Adequate Sleep
We all know the difference between a great and terrible night's sleep. Menopausal brian changes and symptoms are notorious at impairing sleep. Optimise sleep by supporting your hormones and establishing healthy sleep habits.
Our top tips for great sleep during perimenopause are:
Have early morning outdoor light exposure
Avoid caffeine after midday
Ensure your bedroom is quiet, dark and not too hot.
Have a bedtime ritual to support a healthy, calm nervous system such as a lavendar or chamomile tea, some stretches or youga or bedtime reading.
This bedtime ritual also helps you minimise your pre-sleep screen time and bright light exposure to support melatonin production
Establish a consistent bedtime routine.
Support your sleep with melatonin if needed.
Cognitive Strategies
Your brain is a powerful organ made of energy-hungry brain cells (neurones). It needs time-out, via sleep, rest and recovery time where it is not constantly stimulated, overstimulated and up-regulated in a sympathetic stress response.
Practices that create relaxation and safety for the brain
Mindfulness and Meditation: Practices that promote mindfulness can help manage stress and improve concentration.
Yoga: This mind-body practice can improve mental clarity, focus and cognitive function.
Keep you brain healthy and active
Cognitive Games and Puzzles: These activities stimulate the brain and promote cognitive flexibility.
Memory Exercises: Keeping your mind sharp by practising memory exercises can help maintain cognitive function.
Reinforce healthy thought patterns and pathways
Reinforce helpful and realistic cognitions/thoughts rather than distorted ones. For example: "I missed a deadline at work which was less than ideal, but I am using this time to catch up". Rather than " I am a terrible person because I didn't follow through."
Make life easier for your brain
Use Memory Aids: Utilise calendars, reminders, and note-taking apps to help remember important tasks and events.
Prioritise Tasks: Breaking down tasks into smaller, manageable steps can make it easier to focus and complete them.
Frequently Asked Questions about Menopause Brain Fog
Is Menopause Brain Fog Reversible?
The good news is that menopause brain fog is often temporary and can be managed. While some cognitive changes may persist into postmenopause, the majority of women will see noticeable improvement in their cognitive function over time. This is because perimenopause is a transitional phase, and once estrogen levels stabilise in postmenopause, the brain adjusts to it.
This is great news, your memory loss should improve over time once your menstrual cycle stops.
However perimenopause can be a long transition stage lasting 4-10 years. This means you do not have to suffer. There are good treatments that will help you feel like your normal smart and capable self again.
Does Menopause Brain fog cause Alzheimer’s or Dementia?
It is important to know that menopause impacts the aging brain. The reasonably rapid decline in neurosteroids estrogen, allopregnanolone and testosterone in midlife does cause increased ageing of the female brain compared with the male brain which ages at a slower steadier rate and this is why women suffer from increased rates of dementia 2: 1 compared to men.
Brain fog symptoms during perimenopause do not cause dementia, but the long term effects of a lack of protective hormones on the brain ie estrogen, allopregnanolone and testosterone which women experience at midlife causes menopausal endocrine aging of the brain in a way that does not impact men from midlife. This menopause endocrine aging of the brain from midlife does predispose females to dementia.
Women who experience early, premature or surgical menopause are at increased risk of dementia unless they use hormone replacement therapy to age 50 due to this earlier brain aging.
Does low estrogen cause brain fog?
Yes, low estrogen levels during menopause can contribute to brain fog. Estrogen plays a crucial role in brain function, including memory, attention, and mood. As estrogen levels decline during menopause, these cognitive functions can be affected, leading to brain fog.
However, there are many other factors that can also contribute to brain fog during menopause such as sleep disturbances, stress, hormone fluctuations, and lifestyle habits. It's important to address these factors as well in order to effectively manage brain fog during menopause.
It's vital for women to take care of their brain health during menopause by maintaining a healthy diet, getting enough sleep, practising stress management techniques, and incorporating cognitive strategies to support mental clarity and function.
With the right approach, menopause brain fog can be managed and women can continue to thrive during this transitional phase. So don't let menopause brain fog hold you back - take care of your brain and keep it sharp for years to come!
The Takeaway: Menopause Brain Fog
Menopause-related brain fog is a common yet manageable aspect of the menopausal transition.
Hormone replacement therapy during perimenopause or started in the early post-menopause stage not only improved brain fog symptoms, but also can reduce menopause endocrine aging of the brain.
Implement healthy lifestyle habits that support your brain health such as eating a diverse plant-based diet, moving your body, supporting your sleep and using cognitive strategies to lighten your load.
If you are experiencing persistent or distressing cognitive difficulties you should consult with your healthcare professionals for personalised advice and support.
You've got this!
Dr Deborah Brunt is a women's health and menopause doctor in Dunedin, New Zealand and also provides menopause health coaching internationally to support optimal health habits for aging well so you can live your best life.
Schedule a free discovery call with her to learn more about how she could support you with your unique health situation.
References
Conde DM, Verdade RC, Valadares ALR, et al.Menopause and cognitive impairment: A narrative review of current knowledge.World J Psychiatry. 2021 Aug 19;11(8):412-428.