The fog of menopause

Nearly two-thirds of women experience brain fog as a symptom of menopause. It may involve difficulty remembering words or names, struggling to concentrate, or the common scenario of walking into a room for a particular reason but then completely forgetting what that reason was.

These experiences can feel frightening for at least some women, who worry they may be developing dementia. What’s more, they can also have an impact on a woman’s quality of life, self-esteem and work.

The good news is, in most cases, there’s no need for alarm. As stated, many women experience brain fog at midlife, and chances are it’s only temporary.

The even better news is that researchers in Australia are now trying to better understand brain fog and are investigating why these cognitive changes occur. (Cognitive changes are those related to mental processes such as thinking, remembering or understanding.)

They want to find out if there is a link between brain fog and other menopausal symptoms like sleep difficulties, mood changes or vasomotor changes such as hot flushes or night sweats.

“Forgetfulness and fogginess can be highly concerning for many women,” says Associate Professor Caroline Gurvich, a clinical neuropsychologist, Deputy Director of the Monash Alfred Psychiatry Research Centre, and the lead investigator in the study.

She says the development of evidence-based resources to help the management of menopausal cognitive symptoms are desperately needed. Such resources would be able to reduce stress and anxiety and ensure that women thrive during this time in their lives.

What is brain fog?

Brain fog is not a medical term, but Assoc Prof Gurvich explains, it’s universally considered to be ‘just right’ for describing some of the difficulties that women can experience during menopause

Fluctuating hormones and stresses in a woman’s life – juggling hormonally-charged teenage children, caring for elderly parents, and balancing busy careers while running their homes – have been suggested as key factors contributing to brain fog.

“Not everyone experiences these [cognitive] changes, and we want to understand who does and why,” says Assoc Prof Gurvich. “We want to find out if the cognitive changes persist after 12 months. We want to understand the pattern over time.

“We also really want to understand what the experience of brain fog is for women. We will be asking questions about memory as well as assessing different aspects of cognition.”

The difference between early symptoms of dementia and brain fog

Forgetfulness and word finding difficulties are commonly described during menopause. Similar symptoms are also reported during the early stages of dementia.

Assoc Prof Gurvich says it’s important to distinguish between menopause-related cognitive concerns, mild cognitive impairment (which is a transition stage between healthy cognitive ageing and dementia), and dementia.

Dementia during midlife is not common – unless there is a family history of early onset dementia. Most women who have cognitive concerns during perimenopause (the lead-up to menopause) still perform within normal ranges on neuropsychological tests (tests often used in screening for dementia).

However, when there is a worsening in test results compared to a previous test, a diagnosis of mild cognitive impairment may be made.

Assoc Prof Gurvich says that women should be reassured that occasional forgetfulness and word finding difficulties are common during menopause.

“If these symptoms are leading to distress or substantially impacting daily functioning, women should speak to a healthcare professional,” she adds.

The great recruit

Assoc Prof Gurvich and her team hope to recruit up to 500 women between the ages of 45 and 60 who are biologically female and fluent in English, and not pregnant or lactating, to participate in the online study on brain fog.

It will involve a 30-minute questionnaire about mood and menopausal symptoms. The women will also be given 30 minutes to complete online computerised cognitive tasks. They will then be asked to repeat the questionnaire 12 months later.

Steps to soothe and sharpen your mind

Firstly, if you’ve been feeling more forgetful and ‘brain foggy’ of late, it’s important not to panic; we’re nearing the end of another challenging year and almost everyone is feeling more tired and exhausted than usual. Check in with your friends or family and talk about your experiences, you may find you’re not alone in what you’re going through.

For those looking to improve their brain fog, and soothe and sharpen their mind, Assoc Prof Gurvich suggests the following:

• Exercise is hugely beneficial
• Mindfulness and meditation can be helpful in reducing levels of anxiety and stress
• Boost your thinking skills through activities that challenge your brain in an enjoyable way. These might include learning a new language or a musical instrument or doing puzzles
• Avoid illicit substances, smoking, or drinking excessive amounts of alcohol
• Eat a Mediterranean diet. A diet rich in antioxidants is vital for brain health and the richest sources of these are found in brightly coloured vegetables and fruits – staples of the Mediterranean diet
• Use a diary or a list to help put some structure in place to reduce anxiety. Take notes, use calendars and reminders.