A Husband Asks About Memory and Menopause

Ask Dr. Jen

My wife is having an issue and we're getting fuck-all from doctors about it.

She is 52, and had a hysterectomy a few years back. Over the past few years she's been having trouble with short-term memory, mostly in the form of being forgetful about where she puts things, or doing small tasks like remembering to close a gate behind her or things like that. It's frustrating for her, but can also lead to bigger trouble in some cases, which isn't hard to imagine.

She's talked to her doctors (both women) and they just shrug their shoulders and say, "Yeah, menopause'll do that", which of course isn't helpful.

Do you have any experience with this and maybe some advice as to a doctor we can talk to about it? Maybe mental exercises or even links to places that have more info? We're coming up pretty empty.

I really appreciate this. Thanks!

- Concerned Spouse

Short Take

The menopause transition is associated with brain fog, which sounds like what is being described. It’s common and unfortunately is often disconcerting when experienced, but it’s temporary and reversible. It’s also important to rule out other causes of these symptoms.

Go On…

About two-thirds of women experience some cognitive changes during the menopause transition, meaning the years leading up to the final menstrual period. This is commonly experienced as memory difficulties, such as forgetting where the keys were left, or problems finding words. The experience is often referred to collectively as brain fog.

No one really knows why it happens, but it is likely due to changing hormone levels. Some areas of the brain shrink during menopause, but over time others grow in what appears to be a compensation. I like to think of menopause like uploading a new operating system, during the transfer (menopause transition) things are glitchy, but once you are used to the new platform, everything works great. In fact, many women report a clarity once they are through their menopause transition. Whether this is due to changes in brain function or something else entirely is not fully understood.

The idea that menopause itself damages the brain isn’t supported by evolutionary evidence. The wise woman or grandmother hypothesis tells us that women in menopause provided essential support to family members by gathering food and likely by other contributions. If no one could remember where to gather the food or what they had gathered they wouldn’t have been very helpful to the family unit. Brain imaging studies also tell us the brain adapts to these changes. While some areas shrink, other areas grow.

The effects of the menopause transition on cognitive function have been studied and indeed there are some subtle changes that researchers describe as a temporary absence of learning. Some studies have shown subtle decreases in cognitive function, but they still stay within the normal range. The good news is the brain recovers, meaning brain fog is temporary and reversible.

Many people worry that brain fog is an early sign of dementia, but dementia starting in midlife is uncommon and there is no data that suggests that brain fog is a gateway to dementia.

Anyone with symptoms of brain fog should be evaluated for other conditions that can affect cognitive function and memory as well as those that increase the risk of dementia. So it’s important to check blood pressure and be screened for diabetes, depression, and thyroid conditions. If there is any concern about sleep, testing for sleep apnea might also be indicated.

The role of menopause symptoms, such as hot flashes, sleep disturbance, and low mood as they relate to brain fog isn’t well understood. These symptoms don’t seem to affect brain fog per se, but they can affect cognitive performance in other ways, which doesn’t help. Brain fog doesn't improve with hormone therapy. However, if someone has symptoms that can be treated with menopausal hormone therapy, such as hot flashes, night sweats, or low mood, then hormones may be worth a try. If you feel better you may be better able to cope with the brain fog and improving sleep and reducing hot flashes may improve cognitive performance. Other treatments for hot flashes, such as gabapentin and certain antidepressants can also be explored.

If there is a family history of early onset dementia or early Alzheimer's disease a visit to a neurologist and formal neuropsychiatric testing is likely indicated. Anyone who feels their memory issues are interfering with their daily life or are worsening should probably also receive neuropsychiatric testing and an evaluation by a neurologist.

There are several potentially modifiable risk factors that account for about 40% of dementia cases worldwide, so anyone worried about their brain health in menopause might want to consider what they can do here. Some of the things that affect brain health that may be in your control in your midlife and beyond include the following:

• Getting tested for diabetes and aiming for the best control possible if diagnosed

• Being screened for high blood pressure and getting treatment if needed

• Preventing head injury, working on balance is something that can help here, because fewer falls mean fewer changes to hit your head and of course always wearing a helmet on a bike or while skiing

• Stopping smoking, this is a big one

• Losing some weight if your BMI is over 30, some data suggests even a 5 lb weigh loss can help

• Regular exercise, both aerobic and resistance training

• Treating depression if diagnosed

• Avoiding excessive alcohol

• Treating hearing impairment, this is also a big one

• Frequent social contact

One diet that is frequently discussed with regards to dementia prevention is the MIND diet, which is basically the Mediterranean diet and the DASH diet. Read more about that diet here.

I tell my patients that brain fog certainly feels worrying, but it’s not typically medically worrisome. And in one study, women in menopause with brain fog still outperformed men on cognitive testing.

References

Greendale GA, Karlamangla AS, Maki PM. The Menopause Transition and Cognition. JAMA. 2020 March

Livingston G, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020; 396: 413–46