When we think of menopause symptoms, hot flashes and night sweats often dominate the conversation. Yet, the impact on brain health during this transition is equally crucial.

Experiencing perimenopausal brain fog and witnessing a loved one's postmenopausal cognitive decline has sparked my reflection on the link between menopause and brain function. How do hormonal shifts affect cognition, and what can be done to manage symptoms? Understanding this intersection is key to navigating this life stage with clarity and empowerment. Let’s dive into this topic together.

Hormonal Dynamics and Brain Health

Brain health means keeping your brain in good shape and assuring proper function for your age (1). Cognitive issues tend to be more prevalent among postmenopausal women compared to their premenopausal counterparts (2). However, cognitive problems are also notable during perimenopause, affecting a significant portion of women (3). Perimenopause, the years leading up to menopause, is characterized by fluctuating hormone levels and irregular menstrual cycles. Postmenopause refers to the period after menopause — when periods stop for a consecutive 12 months.

The hormones estrogen and progesterone are vital for brain health (2, 4). Research suggests estrogen may help protect cognitive functions from declining as we age  (2). As these hormone levels drop during the menopause transition, women may notice symptoms like slower recall, difficulty finding words, and problems with memory, focus, and attention — all referred to as "brain fog," says Kathleen Jordan, MD, Chief Medical Officer at Midi Health, a virtual clinic specializing in perimenopause and menopause.

Research increasingly demonstrates the impact of menopause on the brain. It affects brain cells' generation, connections, and survival, especially in memory-related regions. Menopause also decreases the brain's glucose levels — the main energy source for brain cells. (5)

 Vasomotor symptoms, sleep difficulties, and depression in perimenopause may be linked to cognitive problems (3). Dr. Jordan stresses the significance of sleep for cognitive function while underscoring how symptoms such as night sweats can disrupt rest. Additionally, fluctuating and declining estrogen during the menopause transition may interfere with the normal output of serotonin and norepinephrine, which help stabilize mood and energy, notes Dr. Jordan. Finally, chronic inflammation may also contribute to cognitive problems. Postmenopausal women in particular show higher levels of inflammation markers (2).

Lifestyle Modifications and Tips for Supporting Brain Health

There are steps you can take to support brain health, Dr Jordan says. She recommends the following lifestyle changes:

 1. Eat well: A nutrient- and antioxidant-rich diet can help keep the mind strong. Focus on consuming more berries, nuts, beans, olive oil, and leafy greens. These foods from the Mediterranean and MIND diets can help reduce the chance of cognitive decline.

2. Move more: Walking, weightlifting, and stretching all count. Physical activity creates new brain cells and can protect against memory loss.

3. Keep learning: Challenge your brain in new ways, like doing crossword puzzles or tackling a new language. Even taking a new route home from work (without using GPS) can help flex memory muscles.

4. Prioritize sleep: Aim for seven to eight hours each night. Regular sleep has a protective effect on the brain. Create a consistent sleep routine to prep your body for bedtime. If you’re struggling to fall or stay asleep consider consulting your doctor.

5. Keep stress in check: Managing stress can help you think more clearly. Find a regular stress-relief practice that works for you, whether it involves journaling, meditating, or a sweaty spin class.

6. Make time to connect: Social isolation can negatively impact cognitive function. Staying connected to friends and family is proven to keep the mind sharp.

7. Take care and optimize your overall health: Talk to your healthcare provider about other risk factors for cognitive decline that are within your control. Maintain a healthy weight, manage chronic conditions like diabetes and hypertension, and quit unhealthy habits like smoking and consider reducing alcohol consumption.

8. Supplements: Some supplements have evidence supporting their role in potentially optimizing brain health. For example, magnesium can aid sleep, while ashwagandha can help manage stress, says Dr. Jordan. Before adding a supplement to your routine, especially if you’re on medications, it's important to consult with a healthcare provider to avoid potential interactions. Additionally, it's advisable to research supplements and choose from reputable, independently tested brands.

Hormone Therapy and Brain Health

Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) such as hot flashes, night sweats, and sleep difficulties, as well as the genitourinary syndrome of menopause (GSM) (6). Hormone therapy can improve brain chemicals, sleep, and cognitive function, says Dr. Jordan.

 It’s important to note that timing matters. Estrogen therapy can offer cognitive benefits if taken early in the menopause transition, according to the 2022 hormone therapy position statement of The North American Menopause Society (NAMS).

Despite recognizing cognitive benefits, NAMS doesn’t recommend hormone therapy solely to treat or prevent dementia or cognitive decline. (6) When considering if hormone therapy is right for you, it's essential to talk to your healthcare provider about your medical history and symptoms and carefully assess the potential advantages and drawbacks.

Embracing healthy practices and tailored menopause treatment can empower you to optimize your brain health. What changes have you made to support your brain health? Let's talk about it.

Written by: Johna Burdeos

Resources:

1. Wang Y, Pan Y, Li H. What is brain health and why is it important? BMJ. 2020 Oct 9;371:m3683. doi: 10.1136/bmj.m3683.

2. Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: A narrative review of current knowledge. World J Psychiatry. 2021 Aug 19;11(8):412-428. doi: 10.5498/wjp.v11.i8.412.

3. Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive Problems in Perimenopause: A Review of Recent Evidence. Curr Psychiatry Rep. 2023 Oct;25(10):501-511. doi: 10.1007/s11920-023-01447-3.

4. Henderson VW. Progesterone and human cognition. Climacteric. 2018 Aug;21(4):333-340. doi: 10.1080/13697137.2018.1476484.

5. Harvard Health Publishing. Menopause and memory: Know the facts.

6. North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society.