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Brain Fog

What is brain fog?

Forgetfulness was the most reported symptom in the Women Living Better Survey.
Brain fog includes things like:
  • Feeling more forgetful (like forgetting names or where you’ve put things)
  • Having a harder time concentrating
  • Having more difficulty making decisions

3 things to know about brain fog during perimenopause

  • 2/3 of people report declining cognitive function during perimenopause. It’s normal! 1,2,3 Some longitudinal studies (over many years) document an improvement in recall post-menopause.4,7

  • Executive function challenges during perimenopause are not unusual. For some, adult ADD medications may offer support. Research suggests that those who have experienced childhood trauma, referred to as Adverse Childhood Events (ACEs) have a harder time. Having your ovaries removed at a young age may also have a negative impact.

     

  • The same things that are good for heart health are good for brain health.

The brain fog when women’s brains seem not to be hitting on all eight cylinders is temporary…During the menopause transition, a woman’s brain may feel a little off, a little muddy, but when the transition passes, the clouds clear and the fog lifts. Sometimes all a woman needs to know is that this too shall pass.

Gail Greendale, M.D.

WLB 2020 SURVEY RESULTS

These data are from the Women Living Better Survey. LRS stands for the late reproductive stage and MT for the Menopause Transition. These are two stages on the path to menopause (the final menstrual period).

I'm more forgetful

% of respondents reporting increased forgetfulness
Overall
0%
With Regular Periods (LRS)
0%
With Skipped Periods (MT)
0%

I have more difficulty making decisions

% of respondents reporting increased difficulty making decisions
Overall
0%
With Regular Periods (LRS)
0%
With Skipped Periods (MT)
0%

I have a harder time concentrating

% of respondents reporting more difficulty concentrating
Overall
0%
With Regular Periods (LRS)
0%
With Skipped Periods (MT)
0%

Brain fog seems to be extreme for me. I normally forget little and stay very organized, but I’m not myself anymore. This is extremely frustrating and very concerning. I’m a professional and feel like I’ve been compromised.

WLB Community Member

Is brain fog related to fluctuating hormones?

  • There are many estrogen receptors in the brain involved in several aspects of brain activity.16
  • Fluctuating estrogen levels have an impact on learning, memory, and concentration.
  • Brain imaging studies focused on cognition document a re-organization of the brain after menopause. New connections are made and used to complete tasks of verbal memory.17,18
The most helpful thing we can do is to normalize these experiences for women who are transitioning through menopause and let them know that women’s brains are sensitive to fluctuating levels of estrogen, both in terms of cognitive ability and mood.

Dr. Pauline Maki, The Brain Fog of Menopause, NY Times, December 2018

Dealing with brain fog

What's good for your heart is good for your brain.

You can lower cardiovascular risk factors by engaging in physical activity (regular walking or other aerobic exercises) and following the Mediterranean diet. 19,20

Combinations of foods and nutrients can help counteract decline of cognitive functions.

“It is clear that no single food or nutrient is the magic bullet to prevent dementia, even with some that have shown potential neuroprotective actions, but none with definitive answers as independent determinants of cognitive decline and dementia…. it is reasonable to think that the combinations of foods and nutrients, as shown by studies on dietary patterns, such as the MedDiet, DASH, and MIND diets… are the ideal way to counteract the increase in the decline of cognitive functions. Clearly, to this must be added other essential factors such as physical activity, sleep quality, and socialization, among non-dietary determinants.” 23

Be strategic about sleep.

If you don’t sleep as well, plan to get enough sleep. Research shows links between sleep and cognition. 21

Utilize tools to remember things and keep in mind - this is temporary!

First, acknowledge the temporary nature of the symptom (deep breath). Then, utilize tools such as memos to self, set alarms for reminders, and acknowledge and accept when a name doesn’t come back right away that it will come back eventually, usually when you are no longer feeling stressed about it.

Consider treating hot flashes & night sweats with hormone therapy.

Hormone therapy is not approved for the prevention or treatment of age-related cognitive decline or dementia.19 However, it’s worth considering treating hot flashes and night sweats if they are interfering with your life, relationships, and especially sleep and you also experience brain fog.

Research shows that hot flashes and night sweats can be associated with memory challenges and that treating them leads to a rebounding of memory performance. 22

ADDITIONAL RESOURCES
Our studies show that although women on average experience a decline in cognition during perimenopause, they are still functioning in the normal range. Only about 9% of women experience more severe changes.

Dr. Pauline Maki, Ph.D

Research shows this is normal

It’s important to keep in mind that longitudinal studies show that women experience brain fog early in the menopausal transition and then it resolves.

  • 62% of women noticed an unfavorable memory change “over the past few years” in a longitudinal study* with 230 participants aged 33-55. 1,11
  • A decline in verbal learning and memory was found in 5 of 6 longitudinal studies.*
    • Less consensus was found on other changes in cognitive function during perimenopause like processing speed, working memory, attention, or verbal fluency. 7,12,13,14,15
  • Large percentages of women expressed forgetfulness in a cross-sectional** study of 16,065 participants.2
    • 31% of premenopausal women
    • 44% of early perimenopausal women
    • 44% of late perimenopausal women
    • 42% of postmenopausal women

*A longitudinal study involves the same participants over many years. A longitudinal study is more likely to suggest cause-and-effect relationships.
**A cross-sectional study involves many participants at the same time.

Brain fog seems to be extreme for me. I normally forget little and stay very organized, but I’m not myself anymore. This is extremely frustrating and very concerning. I’m a professional and feel like I’ve been compromised.

WLB Community Member

A broken train of thought and feeling discombobulated – sometimes like I’m a little bit drunk. Can’t think clearly.

WLB Community Member

REFERENCES

  1. Mitchell E, Woods N. Midlife women’s attributions about perceived memory changes: Observations from the Seattle Midlife Women’s Health Study. J Womens Health Gend Based Med. 2001; 10:351–362. [PubMed: 11445026]
  2. Gold EB, Sternfeld B, Kelsey JL, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000;152:463-473.
  3. Greendale GA, Karlamangla AS, Maki PM. The Menopause Transition and Cognition. 2020;323(15):1495–1496. doi:10.1001/jama.2020.1757
  4. M. Maki & M. T. Weber (2021) A research primer for studies of cognitive changes across the menopause transition, Climacteric, 24:4, 382-388, DOI: 10.1080/13697137.2021.1905625
  5. Schaafsma M, Homewood J, Taylor A. Subjective cognitive complaints at menopause associated with declines in performance of verbal memory and attentional processes. Climacteric 2010;13:84-98.
  6. Weber MT, Mapstone M, Staskiewicz J, Maki PM. Reconciling subjective memory complaints with objective memory performance in the menopausal transition. Menopause 2012;19:735-741.
  7. Greendale GA, Huang MH, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology 2009;72:1850-1857.
  8. Coslov N, Richardson MK, Woods NF. Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Menopause. 2021 Jul 26;28(9):1012-1025. doi: 10.1097/GME.0000000000001805. PMID: 34313615; PMCID: PMC8549458.
  9. https://www.nytimes.com/2018/12/17/well/live/the-brain-fog-of-menopause.html
  10. https://opmed.doximity.com/articles/a-surgeon-s-brain-in-menopause?_csrf_attempted=yes&fbclid=IwAR2ZP53IrR3A4m7HbXutWmdsz__npNiFw9TgAFBxXZAIXB_KTW6Yd44jDkI
  11. Woods NF, Mitchell ES, Adams C. Memory functioning among midlife women: observations from the Seattle Midlife Women’s Health Study. Menopause. 2000 Jul-Aug;7(4):257-65. PMID: 10914619.
  12. Epperson CN, Sammel MD, Freeman EW. Menopause effects on verbal memory: findings from a longitudinal community cohort. J Clin Endocrinol Metab. 2013;98(9):3829–3838.
  13. Kilpi F, Soares ALG, Fraser A, et al. Changes in six domains of cognitive function with reproductive and chronological ageing and sex hormones: a longitudinal study in 2411 UK mid-life women. BMC Womens Health. 2020;20(1):177.
  14. Maki PM, Springer G, Anastos K, Gustafson DR, Weber K, Vance D, Dykxhoorn D, Milam J, Adimora AA, Kassaye SG, Waldrop D, Rubin LH. Cognitive changes during the menopausal transition: a longitudinal study in women with and without HIV. Menopause. 2021 Jan 11;28(4):360-368. doi: 10.1097/GME.0000000000001725. PMID: 33438895; PMCID: PMC8576848.
  15. Weber MT, Rubin LH, Schroeder R, et al. Cognitive profiles in perimenopause: hormonal and menopausal symptom correlates. Climacteric. 2021;24(4):401–407.
  16. McEwen BS. Invited review: Estrogens effects on the brain: multiple sites and molecular mechanisms. J Appl Physiol (1985). 2001 Dec;91(6):2785-801. doi: 10.1152/jappl.2001.91.6.2785. PMID: 11717247.
  17. Jacobs EG, Weiss BK, Makris N, Whitfield-Gabrieli S, Buka SL, Klibanski A, Goldstein JM. Impact of Sex and Menopausal Status on Episodic Memory Circuitry in Early Midlife. J Neurosci. 2016 Sep 28;36(39):10163-73. doi: 10.1523/JNEUROSCI.0951-16.2016. Epub 2016 Sep 28. PMID: 27683911; PMCID: PMC5039260.
  18. Jacobs EG, Weiss B, Makris N, Whitfield-Gabrieli S, Buka SL, Klibanski A, Goldstein JM. Reorganization of Functional Networks in Verbal Working Memory Circuitry in Early Midlife: The Impact of Sex and Menopausal Status. Cereb Cortex. 2017 May 1;27(5):2857-2870. doi: 10.1093/cercor/bhw127. PMID: 27178194; PMCID: PMC6059144.
  19. Maki PM, Henderson VW. Cognition and the menopause transition. Menopause. 2016 Jul;23(7):803-5. doi: 10.1097/GME.0000000000000681. PMID: 27272226.
  20. Maki PM. The Menopausal Brain. Obstet Gynecol. 2018 Dec;132(6):1323-1324. doi: 10.1097/AOG.0000000000002988. PMID: 30399113.
  21. Xu W, Tan c-c, Zou J-J, et al. J Neurol Neurosurg Psychiatry 2020;91:236–244.
  22. Maki PM, Rubin LH, Savarese A, Drogos L, Shulman LP, Banuvar S, et al. Stellate ganglion blockade and verbal memory in midlife women: evidence from a randomized trial. Maturitas 2016; 92:123–9.
  23. Dominguez LJ, Veronese N, Vernuccio L, Catanese G, Inzerillo F, Salemi G, Barbagallo M. Nutrition, Physical Activity, and Other Lifestyle Factors in the Prevention of Cognitive Decline and Dementia. Nutrients. 2021 Nov 15;13(11):4080. doi: 10.3390/nu13114080. PMID: 34836334; PMCID: PMC8624903.
  24. Shanmugan S, Cao W, Satterthwaite TD, et al. Impact of childhood adversity on network reconfiguration dynamics during working memory in hypogonadal women. Psychoneuroendocrinology. 2020;119:104710. doi:10.1016/j.psyneuen.2020.104710
  25. Georgakis MK, Beskou-Kontou T, Theodoridis I, Skalkidou A, Petridou ET. Surgical menopause in association with cognitive function and risk of dementia: A systematic review and meta-analysis. Psychoneuroendocrinology. 2019;106:9-19. doi:10.1016/j.psyneuen.2019.03.013
  26. Shanmugan S, Sammel MD, Loughead J, et al. Executive function after risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: does current mood and early life adversity matter?. Menopause. 2020;27(7):746-755. doi:10.1097/GME.0000000000001535