Brain fog

Historically, women did not live beyond their early 50s. Nowadays, an extended postmenopausal life expectancy means that women are living a third of their lives with low oestrogen levels. This longevity involves greater exposure to maladies of advanced age, such as heart disease and brittle bones (osteopenia and osteoporosis). Of concern to many women is the possible effect of menopause on cognitive function and psychological impairment.

There is considerable evidence to suggest that oestrogen plays an important and positive role in cognitive function and memory. Furthermore, there appears to be a link between an earlier age of menopause and decreased cognitive performance later in life. Other studies, however, show no significant lasting cognitive changes attributable to menopause.

More commonly, a significant number of menopausal women will complain of anxiety and depression, irritability, an inability to concentrate, and poor memory. Poor-quality sleep most likely compounds all of these symptoms.

‘Brain fog’ is a term used to describe problems with thinking or memory. It can occur under many different circumstances, such as sleep deprivation or following a concussion. However, it can also occur in conjunction with menopause.

In contrast to the prevention and treatment of osteoporosis with menopausal hormone therapy (MHT), the prevention of cognitive decline is less certain. Initial observational studies of the effect of MHT on cognitive function were promising, with some earlier studies reporting as much as a 50% reduction in Alzheimer’s disease risk in women using MHT. Later randomised controlled trials, such as the Women’s Health Initiative Memory Study (WHIMS) and the WHI Study of Cognitive Ageing (WHISCA), have shown an increased dementia risk and poorer cognitive outcomes in women who started MHT 10 years or more after their last period. It has been suggested that these results may be attributed to there being a ‘critical period’ early in menopause when the positive effect of oestrogen replacement on cognitive function is greatest.

Unfortunately, there isn't enough medical evidence to start it solely as a treatment for brain fog, but your doctor will decide whether it's right for you based on any other symptoms you may have.

However, there are many other ways you can support your brain health with simple lifestyle changes:

• Studies have shown that regular exercise and a healthy Mediterranean-style brain-friendly diet can effectively alleviate brain fog. A brain-friendly diet is one that is rich in polyunsaturated fatty acids and Omegas 3 and 6 (found in eggs, fish, nuts, and seeds), as well as antioxidant vitamins like A, C, and E.

• Getting adequate sleep regularly will also help.

• Stimulating the brain with crosswords, reading, thoughtful discussion, or even learning a new language has also been shown to improve cognition.

• And even though you might be embarrassed by your symptoms, we also recommend that you boost the support network around you by sharing your symptoms with family and friends and making them aware of any difficulties you are having.

Women often worry that the onset of brain fog signals early signs of dementia; however, this is less likely. Dementia tends to occur much later in life. You can use specific memory tests to assess your brain function, and women experiencing changes in cognition during menopause typically score well on these tests. We recommend that you speak to your GP if you are concerned about the presence of any of these symptoms.

Finally, it is important to consider your psychological health and any underlying mental health issues. These should be addressed with support from your GP and psychologist. Although there is no specific treatment for brain fog, treatments for depression and anxiety have demonstrated improvements in brain fog.

Even though brain fog may be distressing, the good news is that it appears to improve over time. As women transition from perimenopause into menopause, our bodies learn to slowly adapt to changes over time, making many associated symptoms far more manageable.