Journal / Menopause

Brain Fog and Menopause

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Brain Fog and Menopause

Some types of memory loss or memory lapse can stem from menopause and are very treatable conditions. Scientists have long suspected that estrogen and progesterone play a role in brain fog and menopause, but also Alzheimer's. New studies on dementia and what occurs during a woman's reproductive years support that idea.

Why Can’t I Remember?

If you are like most women experiencing peri- and menopause, you might notice a decline in your cognitive performance with brain fog, confusion, or memory problems. Some people might call it menopause brain fog. You are likely wondering if the memory loss may be due to early dementia or Alzheimer's disease. Most likely it is not.

Memory loss – whether it’s difficulty remembering a person's name or searching for your glasses that are on the top of your head – is a normal part of aging. It may not come as any surprise, but researchers have confirmed that the “brain fog” that often seems to roll in with menopause is real. 

As the hormone estrogen levels start to wane, so does its role in brain function.1 As estrogen levels decline, many women find themselves becoming increasingly forgetful or feeling “foggy.”1-4 That might feel like being a step behind in the conversation, and it can be very concerning.

The hormone estrogen plays many roles in the body, so when it is not balanced, the whole body - including the mind - can suffer.1-2

Stress! Living in the Sandwich Generation

Most of us in peri- and menopause are living in the middle of a generational sandwich - raising our kids and taking care of our parents. In our 40s through our 60s, women often support both parents and children. Whether this support is financial, physical, and/or emotional, it is a stressful time. 

For many women, they can’t remember a time when their lives were more stressful. In the midst of it all, peri- and menopause hits with all of its outrageous symptoms. Menopause is, “a time in a woman’s life when she is taking care of everybody and she needs to take care of herself.” 3,5

Many women try to ignore perimenopause, but it can last 4-8 years.5 When perimenopause begins it has a broad range - it can start in the late 30s to early 50s—a time when they likely face a lot of demands. Menopause can last another 10-15 years. So, it is worth sorting out ways to help yourself by normalizing your hormone levels.

For many women, cognition goes back to normal after menopause. But for others it never gets better, and for some it gets worse. With all of the scary information in the media about Alzheimer’s, it's hard to ignore that maybe we've been forgetting things lately.

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Common Causes of Memory Lapses

If all of this sounds familiar, you're not alone. It is true that the number of people with dementia is increasing, but that is partially due to the fact that more people are living longer leading to neurodegenerative diseases like Alzheimer’s.1,6,7,8 However, there are many other reasons for memory problems, which is good news. 

Unlike a neurodegenerative disease, if your cognitive symptoms are due to decreased hormone levels they don't have to get worse - in fact, they can get better. Treatment is available - hormone replacement therapy (HRT).

First, let’s identify the possible reason for a faltering memory. Most often memory lapses are due to one of the following: 

  1. Hormonal Changes with Peri- and Menopause. Low hormones can cause brain fog, anxiety, and memory lapses. Research is clear,  memory loss is common in perimenopause and menopause.

  2. Stress, Anxiety, and Depression. These three states of mind will definitely affect how your brain functions - especially its ability to recall the little things like, “where are my sunglasses?” Being stressed and distracted is a perfect reason to forget where you put those glasses. Your brain can be ‘not in the mood’ to process or take in new information.1,7,9 That’s fair. 

    As we age, many of us are not getting out and interacting with friends and family as much as we used to. Likely, we aren’t exercising enough and not taking proper care of ourselves leading to anxiety and depression that will worsen memory issues.

  3. Alcohol.  Many people drink in order to forget - and it comes as no surprise that it can affect your ability to remember. As we age, our ability to metabolize alcohol may become increasingly problematic. As women age, natural metabolic changes, and drops in hormones can exaggerate the effects of alcohol. Even as little as one drink a day can be enough to cause memory problems, and those lapses can become even more pronounced if you drink more.1

  4. Insomnia. Poor sleep and memory problems are often linked regardless of your age. Your ability to pay attention when sleep deprived is a fight you just won’t win; you will likely be sluggish and less able to retrieve information quickly.

    Sleep also plays an important role in your ability to store memories. We know that dreams are a part of our mental processing and experts think that memories are sorted and filed away when you sleep. If you don’t get enough deep sleep you won’t be able to properly file those memories away. Sleep disturbances are very, very common in perimenopause and menopause, but can be improved with HRT.

    Scientists have studied the relationship between memory and sleep for over 100 years. We know that the ability to keep key memories - and also to discard unimportant, excessive information – takes place during sleep.2

  5. Medications. There are many medications that can impact your memory, but we will discuss just two types. The most common are medications that you may be taking daily - like the antihistamine found in Benadryl, Tylenol PM, and Advil PM (all have Diphenhydramine). These medications can directly alter the brain's ability to retain information, and if you are taking them daily, they may also be impacting your ability to think clearly the next day.1

    When you treat anxiety or insomnia with benzodiazepines (such as Ativan, Valium, and Xanax) you can also be impacting your ability to remember. To add to the complexity, if you start taking these medications in your 40s and 50s, and continue taking them as you age, your body's response to what was once a ‘normal’ dose may change. Normal levels can become too much and cause increasing memory problems.1 Even if there were no memory problems when you started taking the medication, your ability to recall can get increasingly worse with age.1

    If you are noticing changes in your mental processing, talk to your doctor about the medications you are taking. It could be a simple fix of changing the dosage.

  6. Medical problems. While it is a less common cause, memory loss may be caused by medical conditions like brain injuries, stroke, and vitamin deficiencies. So, it's also important to consider these causes with your doctor.

How Can Hormones Help? 

Hormones, particularly estrogen, have lots of jobs, but one that is intriguing is the role they play in keeping the brain young and active.4 With a link between estrogen and progesterone levels and brain health, it makes sense to look at hormone replacement therapy (HRT) as an option for fighting cognitive decline. 

Many studies focused on menopause have failed to report estrogen as brain protective. New studies have shown that starting estrogen replacement therapy earlier might help fight cognitive declines.3,4

One way for women to minimize the dramatic hormonal changes that occur at menopause is to use HRT. That approach fell out of favor with the Women's Health Initiative. More recent studies suggest that hormone therapy can be really helpful if women get it early enough.6 The effects of hormone therapy depend on the timing of use.  

When women started taking estrogen after age 65, they were more likely to have trouble with memory. But women who started taking estrogen earlier did not have memory issues. Estrogen may benefit the mental function of younger women because it reduces hot flashes and so many other menopause symptoms.6

"The more hot flashes a woman has, the worse her memory performance. And when we intervene to address those hot flashes (with HRT), her memory performance bounces back." 6

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Other Ways to Help Prevent Mental Declines.

In addition to hormonal supplementation, there are lifestyle changes that can help reduce your risk of these cognitive declines.10 These changes can also help alleviate the other symptoms of menopause and can lower your risk of heart disease. 

  1. Diet. Ensure you eat a nutritious diet that has lots of fiber, vegetables, fruit, whole grains, and legumes. Include moderate amounts of fish and olive oil, with meat and dairy, and reduce processed foods. Not only will eating this way potentially help with brain health, but it can help lower your risk for heart disease, diabetes, cancer, and many of the symptoms of menopause.

  2. Exercise. We have heard it for years,  exercise is good for the brain. While it doesn’t have to be a crazy exercise class, being active throughout the day has been associated with a much lower risk of Alzheimer’s disease later in life.3,4

  3. Think. Think. Think. Stimulate your brain in new ways, try a new language, memorize a poem, or join friends for a new game? Whatever it takes to get you concentrating and engaged in thinking will help to grow your brain to be stronger and more creative. This kind of brain engagement can help build extra reserves that can help prevent Alzheimer’s.3

  4. Reduce Stress. High-stress levels can adversely impact the brain, and women’s brains seem to suffer from stress more noticeably than men of the same age.3,4 Meditation and calming exercises can be an effective way to get your brain to relax, increase the blood flow to the brain, and reduce cortisol (your stress hormone) levels.3,4

  5. Quit smoking. Smoking is obviously very bad for your health, but it is toxic to the ovaries which produce estrogen and progesterone.3 Women who are smokers typically reach menopause two years earlier than nonsmokers (before 50).

  6. Other Ways.

    • Sleep. Get at least 7 solid hours of sleep per night.

    • Stay socially engaged. It is sometimes tough, but it is important.

    • Take educational classes. There are so many ways to take classes now - phone apps, online courses, etc., why not?

    • Seek help for depression.

Summary: 

Scientists suspected that estrogen and progesterone play a role in menopause brain fog. Brain fog is common for most women experiencing peri- and menopause. There shouldn’t be a great concern if you notice a decline in your cognitive performance with brain fog, confusion, or memory lapse. 

While memory lapses may feel scary, most have a treatable cause, specifically HRT. Most memory problems are temporary and can be treated by normalizing your hormone levels, stopping or changing the dosage of medications, getting better sleep, and/or improving your diet. 

If you notice memory problems, don't automatically assume the worst. Instead, start collecting information about the lapses you're having. Ask others around you if they've noticed changes and make sure you understand what Alzheimer's is. 

The people who are close to you are often the first to see differences in your behavior or to notice patterns. You should see your doctor immediately if you experience memory problems that are putting your safety at risk, like leaving things on the stove, or unsafe driving.

"This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment."

References:

  1. https://www.health.harvard.edu/mind-and-mood/is-it-dementia-or-something-else

  2. https://www.sleepfoundation.org/how-sleep-works/memory-and-sleep

  3. https://www.considerable.com/health/dementia/menopause-alzheimers-dementia/

  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198681/

  5. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal

  6. https://www.npr.org/sections/health-shots/2018/07/23/630688342/might-sex-hormones-help-protect-women-from-alzheimer-s-after-all-maybe

  7. https://www.alz.org/aaic/overview.asp

  8. https://www.npr.org/sections/health-shots/2016/03/30/472161906/possible-heart-benefits-of-taking-estrogen-get-another-look

  9. https://www.dailymail.co.uk/health/article-5529805/Hormone-replacement-therapy-boost-brain-stop-memory-loss.html

  10. https://www.texaschildrens.org/blog/2015/10/memory-changes-it-menopause-or-alzheimer%E2%80%99s