Many women who go through perimenopause and menopause report cognitive changes, including problems with memory and word finding, poor concentration and the dreaded “brain fog” which can make it difficult to think clearly. Often described as disorientating, in some cases debilitating — and often felt in a period of your life when you are at the peak of your career, may have significant familial responsibilities and are potentially caring for ageing parents — these changes can feel even more worrying given some of them overlap with those characteristics of dementia.
But a severe lack of research into the area means we still have huge gaps in our knowledge about why. New research from the University of Cambridge, published in Psychological Medicine, has suggested the menopause causes brain changes similar to those seen in Alzheimer’s disease. Researchers say this could explain why more women develop dementia than men – according to the Alzheimer’s Society, women account for around two thirds of people living with Alzheimer’s disease (the most common form) in the UK.
The study, which drew on data from almost 125,000 women from the UK, divided into three groups: pre-menopause, post-menopause who have never used HRT, or post-menopause who have used HRT. They answered questions about their experience of menopause, mental health and sleep. Some took part in cognition tests and around 11,000 participants also underwent MRI scans to allow researchers to look at the structure of their brains.
In both groups of women post-menopause, the researchers found significant reductions in volume of grey matter – brain tissue that helps process information, control movement and manage memory and emotions. Taking HRT did not appear to mitigate these effects, the authors say, though it did seem to improve reaction times. They also found that women post-menopause were more likely to have sought help for anxiety or depression and were more likely to report insomnia, get less sleep, and feel tired.
Professor Barbara Sahakian, the study’s senior author from the department of psychiatry, commented: “The brain regions where we saw these differences are ones that tend to be affected by Alzheimer’s disease. Menopause could make these women vulnerable further down the line. While not the whole story, it may help explain why we see almost twice as many cases of dementia in women than in men.”
While this might sound alarming, British Menopause Society (BMS) trustee Dr Paula Briggs urges women not to panic. “It’s great to see research into menopause in such large numbers, but it’s really important how we interpret this study. They’re not saying this proves a direct link between menopause and Alzheimer’s disease.”
Dr Fiona Warner, GP for Women’s Health at Benenden Hospital, echoes this: “We need to understand more about whether longer-term this does then equate to these patients going on to develop dementia. We do know women can suffer significant psychological and cognitive symptoms from the menopause so it’s great that we’re finally doing research into it. I do get quite a lot of women who come in and say ‘I feel like I’m going mad, I feel like there’s something really wrong with me’ and have even said I’m worried about early onset dementia.”
Some of the symptoms of menopause which are similar to those of dementia include memory issues and trouble with word retrieval, as well as “the classic brain fog symptoms, like losing your train of thought mid-sentence,” Dr Warner explains. “Anxiety, depression, irritability, anger and frustration are psychological symptoms that you sometimes see in people suffering with menopausal symptoms, as well as those with dementia, so there is some crossover.
“If a patient is of a menopausal age, we will often suggest a trial of some form of hormone replacement treatment to see if that improves their symptoms. In most cases, reassuringly, they do improve with additional oestrogen, but if symptoms aren’t improving or worsening, or if they had any other manifestations, then we would go look into what else might be going on,” she continues.
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There are differences between how symptoms of dementia compared with those of menopause-related brain fog play out, according to Dementia UK. “While someone with brain fog may have difficulties with memory or clear thinking, in dementia, these issues will increase over time, and additional problems will emerge, such as struggling with communication. This means the person’s abilities will decline progressively and they will need more support with everyday tasks,” it says. Memory problems with menopause, however, can improve with treatment – including lifestyle changes – or with time.
The charity also notes that while memory problems are commonly associated with dementia, they are less likely to be a symptom of early onset dementia (in people under the age of 65). “Younger people are more likely to experience changes in vision and spatial awareness, communication difficulties and changes in behaviour in the initial stages,” it says.
The new study raises welcome awareness around the distressing impact menopause can have on cognitive functional abilities, Dr Briggs says, “and mood-related symptoms like anxiety and depression, which clearly impact quality of life and functional ability. I think where women are most exposed is in the workplace. I would hope that one day women won’t feel the need to try and hide these symptoms, that they might feel empowered to say, for example, ‘actually today I just can’t think straight because I didn’t sleep last night.’”
What to do if you have menopause-related brain fog
“My first advice would be to read up about your symptoms, look at the cognitive and psychological symptoms of menopause in particular, there is good information on the NHS website and on the British Menopause Society and the Balance app,” says Dr Warner. “I would also suggest seeking advice from a professional, ideally a GP or practitioner with experience in the area, or someone who has expressed an interest in menopause.”
Managing menopause “is a bit like putting together pieces of a jigsaw,” says Dr Briggs. “Yes, HRT can help but it’s not the only solution. A woman in her early fifties who is menopausal but also has lots of other things going on in her life may benefit from HRT, plus an anti-depressant, maybe also talking therapy. Cognitive behavioural therapy (CBT) can be very effective for managing physical symptoms like hot flushes and night sweats, which are integrally linked with emotions. An excruciatingly hot flush can get you into a panic that spirals out of control and that’s where CBT is very helpful as it helps you manage your reactions to symptoms; it’s also extremely good for sleep.”
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Taking care of yourself during this period of your life can have a meaningful impact on how you feel, Dr Warner says. “It’s important to ensure that you’re eating well and exercising regularly throughout menopause, when your body is under some strain due to fluctuations in hormones. This supports mental health – we know that exercising helps with sleep and releases hormones and chemicals that can help with mood.”
Professor Sahakian agrees that lifestyle is important: “Having a healthy lifestyle can help make that transition through the menopause much better for you. Exercising, having seven to eight hours sleep per night, having a healthy diet, making sure that you have a good social support system of family and friends and keeping your brain active through learning new things are all evidence-based ways to improve your brain health, cognition, wellbeing and mental health.” Reducing alcohol intake and quitting smoking are other worthwhile steps you can take, she says.
But this doesn’t have to mean a total overhaul of your lifestyle. “Something as simple as walking 30 minutes a day at least five days a week can help improve bone strength and mood – people will often get a real boost from that so they want to do more because it makes you feel better,” Dr Briggs adds.
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