Brain Fog is a common concern in women going through the menopause transition, with about 40-60% of women reporting some cognitive symptoms during the menopause transition. These changes often include difficulty remembering words, problems focusing or concentrating and distractibility. (SQUIRREL!) Some women show signs of attention deficit hyperactivity disorder. These changes can be distressing because we are worried we may have early-onset dementia, but are in fact, quite normal and usually improve with time. I like to tell my husband to get me an identification bracelet in case I wander off and get lost…These changes aren’t explained by age alone, so menopausal influence is real, but according to neurological performance tests, our performance typically remains normal despite changes in our memory and attention.

Declines in estrogen likely contribute because the brain is rich in estrogen receptors especially in the prefrontal cortex which helps with executive functions like impulse control, decision-making, and planning, and the hippocampus which is involved with memory, learning, and emotion. Menopausal symptoms like vasomotor symptoms (hot flashes and night sweats) have been associated with declines in memory, white matter changes in the brain, and biomarkers for Alzheimer’s Disease. Brain fog may also be related to other factors such as stress, education level, and overall physical health.

Treating menopausal vasomotor symptoms, sleep disturbances, anxiety, and depression can positively impact our cognitive function. Alleviating moderate to severe vasomotor symptoms may help, as VMS is associated with poor memory performance. Of course, if our sleep is better without night sweats, then that will impact our mental and physical health. More research is needed! Boy, if I had a dollar for everytime I said that!

Now having said that, there aren’t any large, clinical studies on this stuff. Most of our guidelines are based on studies of postmenopausal women who did not have vasomotor or other menopausal symptoms. Menopausal hormone therapy appears to be safe in women around the menopause transition (before menopause and within the first decade after a woman’s last menstrual cycle) showing neutral to beneficial effects on cognition. In the Women’s Health Initiative (WHI) study, women over 65 had a higher risk of dementia when treated with hormone therapy, specifically oral conjugated equine estrogen and oral medroxyprogesterone acetate. Hormone therapy is not recommend by any major medical society to prevent or treat cognitive decline.

There are also modifiable risk factors that can greatly impact our brain health. Women should shoot for 150 minutes of moderate intensity exercise weekly, like brisk walking, biking, walking up stairs, gardening. Obviously, your current level of fitness will determine how hard you work at those activities, but aiming to increase heart rate by 50-60% during the activity is a good benchmark. Eating a healthy, unprocessed diet like the Mediterranean diet is recommended, as is avoiding smoking and excess alcohol consumption. High blood pressure, high cholesterol, and diabetes have all been shown to increase the risk of dementia. Maintaining social connections and learning new skills can also reduce our risk of dementia. in the long-term.