By Leanna Coy, FNP
Kelly is finding it increasingly difficult to get her work done. She is more forgetful and has a harder time staying on task. When she is at home, her kids and husband chide her about forgetting things she has always known – names, rules to games, and stories. Kelly is getting worried about dementia and feels like she is losing her mind. But could there be something else going on? A friend suggests perhaps brain fog.
Up to 68% of women report some form of brain fog during perimenopause. This change may cause distress for some. More than just forgetting why you walked into a room, some may see their performance at work and ability to keep up with tasks at home affected.
What is brain fog
Brain fog refers to a range of symptoms that cause changes to memory performance. Brain fog is seen in multiple health conditions, including long-COVID, traumatic brain injury, chronic fatigue, hypothyroidism, and with cancer treatment (chemo brain). Symptoms can present as:
- Difficulty finding words
- Losing your train of thought
- More difficulty concentrating or staying on task
- Feeling mentally fatigued
- Slowed thought processing
The changes in perimenopause relate primarily to sex hormones, such as estrogen and progesterone. The sex hormones influence neurotransmitters. A neurotransmitter is a chemical created by nerve cells and is used to communicate with other cells in the body. One area where the sex hormones interact with neurotransmitters is in the brain, where they influence serotonin, dopamine, GABA, and norepinephrine. The influence of sex hormones on these neurotransmitters affects mood, learning, attention, and cognition.
People experience fluctuations in sex hormones throughout their lives. Monthly fluctuations in hormones during the menstrual cycle can cause mood swings and fatigue. Hormonal fluctuations following pregnancy can trigger mood changes that cause postpartum depression. In perimenopause, when less estrogen is available for the neurotransmitters, communication between cells is disrupted, and brain fog can develop.
There are other midlife changes related to hormone fluctuations that further affect cognition. Sleep becomes more disrupted, often with waking more frequently during the night, and trouble falling or staying asleep. Night sweats can also disrupt sleep. Any disruptions in your sleep can affect the quality of your sleep. When you don’t get adequate sleep, your brain does not work as well the following day.
Identifying the cause
There is not one single test to identify perimenopause as a cause of memory or cognitive changes in midlife. Most often, your healthcare provider will assess your risk factors and rule out other potential causes. In addition to hormone changes and disrupted sleep, some other common contributing factors include:
- Increased stress
- Chronic medical conditions, such as poorly controlled diabetes or thyroid dysfunction
- Medications, such as opioids, some antidepressants, and antihistamines
- Substance use, including alcohol and marijuana
Managing symptoms and the role of hormone therapy
As life expectancy has increased, so has the amount of time those with a uterus spend in menopause. A full one-third of a woman’s life is now spent post-menopausal. Increasingly, science is recognizing the long-term effects of lower hormone levels on a woman’s health.
Studies have shown that adding hormone-related therapy (HRT) can improve many aspects of a woman’s health, including brain health. Research indicates estrogen has a neuroprotective benefit, meaning it can help protect nerve cells from damage. HRT can boost attention span, cognitive function, and verbal memory. The risk for dementia is also reduced. The health benefits of HRT are most profound when started early, when estrogen begins to wane. After long-term estrogen deprivation, HRT may actually cause more harm. This makes perimenopause the ideal time for initiating HRT.
The Food and Drug Administration (FDA) has not approved HRT specifically for the treatment of cognitive issues in perimenopause. However, it is frequently used off-label. Using a medication off-label means using a medication to treat a different health condition or at a dose different from what was originally approved by the FDA. Off-label medication use is common.
As with most medications, HRT is not for everyone and should always involve a discussion with your healthcare provider. Common risks associated with HRT include blood clots, strokes, breast cancer, and uterine cancer.
There are self-care steps you can take to manage your perimenopausal brain fog:
Stress management: Exposure to chronic stress can negatively affect your cognitive abilities. Finding methods to reduce your life stressors or learning how you cope with stress is crucial. Try exercise, meditation, talk therapy, and asking others for help.
Sleep management: A good night’s sleep begins with sleep hygiene. Keep a consistent bedtime and wake-time schedule, cut out screen time before bed, and use the bedroom for just sex and sleep.
Physical activity: Regular physical activity is a brain booster. Engaging in activities helps with problem-solving and reduces the risk of cognitive decline. Establish a daily exercise routine. Aim for 30-60 minutes of cardio five days a week and an additional 30 minutes of strength training.
Social connections: Midlife can be a busy for many of us, but it is not a time to cocoon yourself at home. Studies show that the fewer social connections someone has, the greater their risk of cognitive decline. So, make those connections. Join that bowling team, go to karaoke night, or just have friends over for a game night.
Stop using substances (alcohol, marijuana): Long-term substance use alters the brain by damaging the nerve pathways. This damage affects someone’s ability to learn, memory, reasoning, and impulse control. These changes worsen with aging.
Helping your memory: Sometimes the brain just needs a little help in remembering things. Keep a calendar, either physical or in your phone or computer. Use a notebook or apps to take notes and track important information. Avoid multitasking.
When brain fog affects work and home life, the cognitive changes are annoying at best and worrisome at worst. Brain fog in midlife may worry anyone with a family history of dementia. The good news is that brain fog during perimenopause is very common, and dementia midlife is very rare.
Recognizing that perimenopause is often at play can help identify strategies for managing the symptoms. Use self-care to ensure adequate sleep and limit substance use. Work with your healthcare provider to rule out other health concerns and develop a treatment plan that is right for you.