Experiencing difficulty recalling someone’s name, forgetting the reason for entering a room, or struggling to concentrate on a task are common symptoms referred to as “brain fog” that women in their 40s and early 50s may notice.
The good news, according to doctors, is that these problems are likely a result of normal midlife hormonal changes during perimenopause and often improve after menopause. Medications, exercise, and a healthy diet can also be beneficial. However, the bad news is that some women may continue to experience these issues.
Perimenopause usually occurs when a woman is in her 40s or early 50s and is marked by irregular menstrual cycles that can last from three to over ten years. Hormonal fluctuations during this time can cause a range of symptoms, including mood changes, night sweats, and hot flashes. Studies indicate that roughly 60% of women experience a decrease in memory function during perimenopause. However, most women still perform within the normal cognitive range despite these changes.
The International Menopause Society, a group of physicians and researchers who offer advice on menopause treatment, has released new guidelines instructing healthcare practitioners to reassure women that their memory difficulties are not symptoms of dementia. The guidelines suggest that memory problems frequently resolve once a woman reaches menopause, which occurs after not having had a menstrual cycle for one year.
Professor Pauline Maki, the first author of the guidelines published in the Climacteric journal, emphasizes the importance of letting women know that their experiences are normal and that they should not be alarmed.
Experts say that men do not typically report similar memory and cognitive changes because they do not experience the same significant hormonal shifts as women during perimenopause. Additionally, women tend to have stronger verbal memory skills than men, even during perimenopause, while men tend to have more developed visual-spatial abilities. Dr. Maki suggests that women experiencing the most severe vasomotor symptoms, such as hot flashes and night sweats, are more likely to be affected by cognitive issues during perimenopause.
Research conducted by Rebecca Thurston, a professor at the University of Pittsburgh, found that women who experience nighttime vasomotor symptoms display indications of small blood vessel disease in the brain, which can lead to cognitive decline.
Medical professionals indicate that brain fog may stem, at least in part, from poor sleep due to night sweats and hot flashes, as well as common mood symptoms during perimenopause. Treating these symptoms can help alleviate cognitive issues, according to Stephanie Faubion, the director of Mayo Clinic Women’s Health and medical director of the North American Menopause Society. Menopausal hormone therapy, which involves taking estrogen with progesterone, is FDA-approved to address hot flashes.
Alternatively, Dr. Maki suggests that hormonal changes themselves, particularly the fluctuations and eventual decline in estrogen levels, may be responsible for brain fog. Studies have demonstrated that removing a woman’s ovaries before natural menopause can lead to memory decline, whereas administering estrogen therapy can help to restore it.
Doctors and researchers say that women’s memory typically returns to normal after menopause, and the brain compensates for lower estrogen levels by developing new connections. The latest guidelines also indicate that cognitive changes “frequently normalize” following menopause.Dr. Maki suggests that some women may continue to experience a slight decline in the process of learning new information, known as “encoding,” according to preliminary evidence.
In a study published in the Menopause journal in 2021, more than 400 low-income women of color were observed, and their memory problems persisted after menopause. As the first author of the study, Dr. Maki believes that women with less education and limited access to healthcare may be more cognitively vulnerable.
The latest guidelines emphasize that memory issues during perimenopause should not be mistaken for dementia, which is uncommon during midlife and typically does not manifest until women are in their 60s or 70s.