What are cognitive changes?

Cognitive changes can vary, and may include brain fog, difficulty concentrating or changes in memory. Changes in memory are strongly linked with hot flashes, insomnia and fatigue.

It is still unclear how much of these changes can be blamed on hormones versus the impacts of other menopause symptoms such as hot flashes and insomnia. However, it has been shown that women who have severe PMS-like symptoms are more sensitive to changing hormone levels, and may also experience worse symptoms during perimenopause. 

Studies of cognition (aka “brain fog” issues) indicated that perimenopausal women fared worse than premenopausal women, but that those changes were limited to the time during the menopause transition; postmenopausal women demonstrated identical cognitive performance as premenopausal women.

Self-care for cognitive changes

Have compassion for yourself and be kind – recognize that this is not under your control and that it is temporary. Support yourself with meditation, journaling, taking a green bath (e.g. walking in the woods!) in nature or engaging your creative side through art and music.

Have a conversation with family and friends about what you are experiencing, and ask for support and compassion.

Seek professional help, individual therapy and/or counseling to learn tools for recognizing and working through these common but hidden symptoms of perimenopause. 

As much as you are able, emphasize a healthy lifestyle with enough quality sleep, good nutrition and recreational exercise. Cut down on alcohol, recreational drugs, and late nights. 

Therapy for cognitive changes

It can be very difficult to gain validation for menopausal transitional changes related to cognition so it is important to have a trusted health care provider. If you do not already have an educated primary care provider familiar with recognizing and treating perimenopause and menopause, the North American Menopause Society provides a list of menopause practitioners here.

It is clear that insomnia can negatively affect cognition, so anything that can be done to help get quality sleep is a plus.

Use of nutraceutical therapies (therapies that use food to provide medical or health benefits), may offer relief to some women, although currently there are no FDA-approved (i.e. clinically proven safe and effective) nutraceutical therapies.

 

The Science

The causes of neurobiological troubles during the perimenopausal transition aren’t clear, since basic and applied research is scant and, unfortunately, often conflicting. 

Systemic inflammation is correlated positively with emotional difficulties and “brain fog” or difficulties finding words and thoughts, during menopausal transition.  Brain fog may also result from swings in available glucose to the brain  as shown in the graph

Brinton et al 2015

Statistics

0%

Women in the menopausal transition who report an undesirable change in memory.

Changes in Cognition During the Menopausal Transition

FALSE

Unfortunately, women experiencing the menopausal transition continue to be excluded from the workforce where they feel embarrassed and isolated by their untreated symptoms. Slowly this is changing as employers and insurance companies start to realize that leaving the health concerns of this enormous group of workers unaddressed is costly.

MYSTERY

While the obvious answer is found in gender, age and racial inequity, the study of mid-life women’s sexual and reproductive health has historically been less profitable than studying fertility. Thankfully the “menopause market” is on the rise, which will hopefully drive more dollars into the evidence-based scientific research that is so badly needed to develop more safe, effective and personalized treatments for menopausal women.

Compiled References

  1. Baber, R. J., Panay, N., Fenton, A., & IMS Writing Group (2016). 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric : the journal of the International Menopause Society, 19(2), 109–150. https://doi.org/10.3109/13697137.2015.1129166
  2. Björn, I., Bäckström, T.,Lalos, A. & I. Sundström-Poromaa (2006) Adverse mood effects during postmenopausal hormone treatment in relation to personality traits. Climacteric, 9(4), 290-297. doi: 10.1080/13697130600865766
  3. Brinton, R. D., Yao, J., Yin, F., Mack, W. J., & Cadenas, E. (2015). Perimenopause as a neurological transition state. Nature reviews. Endocrinology, 11(7), 393–405. https://doi.org/10.1038/nrendo.2015.82
  4. Bulan, S. E. (2019). Physiology and Pathology of the Female Reproductive Axis. In Melmed, S., Koenig, R., Rosen, C., Auchus, R. & F. Goldfine (Eds.), Williams Textbook of Endocrinology (14th ed., pp. 574-641). Elsevier.
  5. Minkin, M.J.(2019).  Menopause Hormones, Lifestyle, and Optimizing Aging. Obstetrics Gynecology Clinics of North  America, 46(3), 501–514. https://doi.org/10.1016/j.ogc.2019.04.008
  6. Sabia, S., Fayosse, A., Dumurgeir, J. et al. (2021). Association of sleep duration in middle and old age with incidence of dementia. Nature Communications, 12(2289).  https://doi.org/10.1038/s41467-021-22354-2
  7. Zaidi, M. (2018) FSH, Bone Mass, Body Fat, and Biological Aging. Endocrinology, 159(10), 3503–3514. doi: 10.1210/en.2018-00601
  8. Schmidt, P. J., Nieman, L. K., Danaceau, M. A., et al. (1998). Differential Behavioral Effects of Gonadal Steroids in Women with and in Those without Premenstrual Syndrome. New England Journal of Medicine, 338(4), 209-216. https://doi.org/10.1056/NEJM199801223380401
  9. Drogos, L. L., Rubin, L. H., Geller, S. E., Banuvar, S., Shulman, L. P., & Maki, P. M. (2013). Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms. Menopause (New York, N.Y.), 20(12), 1236–1242. https://doi.org/10.1097/GME.0b013e318291f5a6
  10. Greendale, G. A., Huang, M. H., Wight, R. G., Seeman, T., Luetters, C., Avis, N. E., Johnston, J., & Karlamangla, A. S. (2009). Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 72(21), 1850–1857. https://doi.org/10.1212/WNL.0b013e3181a71193