Menopausal ‘brain fog’ is real – it can disrupt women’s labor and raise fears of dementia

For almost two-thirds of women, menopause is accompanied by an unwanted change in memory.

Despite great advances in understanding the medical aspects of menopause – a natural part of life that occurs when a woman has not had a period for 12 months – we are only beginning to recognize the experience and impact of menopause. cognitive changes during menopause.

In most cases, it appears that cognitive changes – that is, problems with thinking, reasoning, or memory – during menopause are subtle and perhaps temporary. But for some women, these difficulties can have a negative impact on labor productivity. And for others, they can raise concerns about the development of dementia.

The big M

Menopause marks the end of the childbearing years. It can happen naturally, at an average age of 49, when the hair follicles in the ovaries are depleted. Menopause can also occur surgically, with both ovaries removed (for example to reduce the risk of ovarian cancer).

The transition from reproductive years to postmenopausal years, called perimenopause, usually lasts four to ten years.

Symptoms of menopause, which can include vasomotor symptoms (hot flashes and night sweats), vaginal dryness, trouble sleeping, depression, anxiety and – brain fog – can extend into perimenopause and last for up to ten years. .

What kind of hazy thought?

Just over 60 percent of women report cognitive difficulties during their transition to menopause.

Women describe difficulty remembering people’s names or finding the right word in a conversation.
Some describe difficulty concentrating or making decisions. As discussed in our recent review, these – subjective cognitive difficulties – appear to be related to performance on memory, recall and processing tests.

Difficulties in verbal memory tests (learning and memorizing information from new words you have heard), verbal fluency (quickly retrieving words from your memory) and attention are observed in women in perimenopause.

Women at work

Although the degree of cognitive decline is subtle and performance generally remains within normal operating limits, the symptoms can be bothersome for the individual. For many women, menopause coincides with the prime of their productive life, when the burden of caring for young children has eased and they have gained experience and seniority over the years. work place.

There is growing interest in the impact of menopause symptoms in the workplace. Research suggests that menopause symptoms can affect productivity and job satisfaction.

Contributing factors include poor concentration and poor memory. Retention of postmenopausal workers is important, for women themselves, but also to ensure that we continue to fight for workforce diversity within our modern workforce.

“Brain fog” is not a medical or psychological term, but a secular term that aptly describes the fog of thought experienced by many women during menopause.

The cognitive changes associated with menopause are not just cognitive decline associated with age. On the contrary, the fluctuating and eventual decline in ovarian hormone production associated with menopause is likely to play a key role.

The hormones produced by the ovaries, estradiol (a type of estrogen) and progesterone, are powerful chemicals in the brain that are believed to protect the brain and improve thinking and memory. The fluctuations and eventual loss of estradiol have been suggested to contribute to cognitive difficulties.

Cognitive symptoms can occur in the absence of other symptoms of menopause. This means that the other symptoms of menopause are not responsible for the cognitive symptoms. However, depressive and anxiety symptoms associated with menopause, sleep disturbances, and vasomotor symptoms can worsen cognitive symptoms.

Is there a link with Alzheimer’s disease?

Alzheimer’s disease is the most common form of dementia and being female is a risk factor. The greater longevity of women does not explain this increased risk.

Instead, the loss of estradiol associated with menopause has been suggested to play a role. Early menopause, such as surgical menopause before the age of 45, has been associated with an increased risk of dementia later in life as well as a faster rate of cognitive decline.

Since similar symptoms can present during menopause and the early stages of Alzheimer’s disease (forgetfulness and difficulty finding words), perimenopausal women may become concerned about dementia.

Women should be reassured that dementia that begins before the age of 65 – called early-onset dementia – is not common (unless there is a family history of early-onset dementia. ). Forgetting and other cognitive difficulties during the menopausal transition are common and an integral part of menopause.

What can help?

Although fluctuations and possible decline in estrogen play a role in cognitive difficulties, the use of hormone therapy does not appear to have a clear benefit on cognitive function (but the evidence remains limited).

More research is needed to determine if lifestyle factors can help menopausal brain fog. We know that exercise can improve cognition during midlife, mindfulness and meditation can be helpful.

At Monash University, we are currently conducting an online survey of women aged 45 to 60 to better understand the cognitive symptoms of menopause.

Avoiding illicit drugs, overuse of prescription drugs, smoking, and excess alcohol can be protective. A diet that includes unprocessed, plant-based foods (like a Mediterranean diet), close social bonds and engagement, and a higher level of education have been largely linked to better cognitive functioning later in life.

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