Menopause is often thought of as a reproductive change in life, but it’s also a neurological one. Some of the most common side effects women experience as they transition through menopause are symptoms that stem from the brain, such as forgetfulness and problems with concentration. These are sometimes collectively referred to as “brain fog.”1,2

Brain fog can crop up in everyday situations: misplacing car keys, blanking on a common word, trouble focusing on a task at work, or forgetting a doctor appointment. It can be worrisome, stoking fears that these changes are permanent or even an early sign of dementia. But there’s good news on both fronts.3

Cognitive changes that arise as a woman transitions to menopause tend to be temporary. And unless you’re genetically predisposed, developing midlife dementia is extremely rare. The final piece of good news is that there are steps you can take to maintain or improve cognition and your overall health.2,4 

Estrogen loss impacts the brain

Menopause typically occurs between ages 45 and 55 and marks the time when the ovaries stop producing eggs (ovulating) and menstrual periods end. Most women experience several years of menopausal symptoms before their menstrual periods stop completely. During this time, the body’s declining level of estrogen causes hot flashes, night sweats, mood changes, sleep problems, and vaginal dryness.5

Although more commonly thought of as a sex hormone, estrogen also plays a crucial role in maintaining cognitive health.5 With receptors scattered throughout the brain, estrogen influences regions involved in cognition, including the hippocampus and prefrontal cortex. Mayo Clinic researchers hypothesize that a loss of estrogen deactivates these receptors and causes changes to the brain associated with menopause.6

But the brain is adaptable. For example, a loss of estrogen temporarily leads to less glucose metabolism in the brain, which cells rely on for energy. Instead, the brain uses adenosine triphosphate (ATP) as an alternative fuel source.  During these temporary periods of adaptation, women experience side effects, such as hot flashes and problems sleeping. These side effects impact the brain in their own right, triggering mood changes and cognitive issues.2,6 

Menopausal hormone therapy and cognition

Menopausal hormone therapy (MHT) utilizes estrogen or a combination of estrogen and progestogen to replace decreasing hormones and relieve menopause symptoms. Theoretically, these benefits also might help maintain cognition. 

However, results are conflicting, even within the same research studies. For example, the Women’s Health Initiative (WHI) linked MHT to an increased risk of dementia in a five-year follow-up. However, in an 18-year follow-up, women enrolled in the WHI saw their risk of dementia decline. The reason for this discrepancy isn’t fully understood.4,7 

There’s some evidence to suggest that when it comes to taking MHT, there is a “window of opportunity.” Women early in the menopause transition might experience cognitive benefits from taking the therapy, but giving MHT well after the onset of menopause, in women 65 or older, is more likely to hurt cognition. Young women who have had their ovaries removed (oophorectomy) might benefit cognitively by taking hormones until they reach the natural age of menopause.3

Although research continues into MHT’s effects on cognition in menopausal women, it’s important to note that no major medical association or professional organization currently recommends women take MHT for brain health.3

Lifestyle approaches to improving cognitive health

Although there has been no definitive ruling on MHT for protecting cognition, it is known that specific lifestyle measures are linked to improved brain health. A multi-pronged approach is recommended to lower the risk of cognitive issues, such as dementia. Here are several actions to incoporate:3,8-10

  1. Heart health is brain health. Anything that benefits the heart benefits the brain. Work with a health-care professional to treat high cholesterol and keep diabetes under control. It’s important to keep blood pressure at a healthy level of 120/80 mmHg or lower.
  2. Boost the brain with regular physical activity. At least 150 minutes of moderate-intensity aerobic exercise weekly is optimal and can help with other aspects of health, such as sleep.
  3. Practice relaxation. Activities such as meditation or yoga can help relieve stress.
  4. Get adequate sleep each night. Although the amount of time needed to recharge varies by individual, getting 6-8 hours nightly is a good rule of thumb. 
  5. Keep an eye on weight gain. A body mass index (BMI) of 18.5-25 is considered healthy. 
  6. Focus on nutrition. Research indicates that an overall healthy diet that includes the omega-3 fatty acid DHA positively impacts brain function and plays an essential role in cognition.11 The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a style of eating that emphasizes plant-based healthy foods and incorporates omega-3s in the form of fatty fish.12 Read more on How DHA Omega-3 Fatty Acid Affects the Brain.
  7. Skip cigarettes and avoid excessive alcohol intake. One alcoholic beverage a day for women and two for men is considered moderate. One drink is the equivalent of 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits (80 proof). 
  8. Keep your social calendar active. Being socially active is associated with reduced rates of disability, mortality, and the risk for depression. It also might support brain health and delay the onset of dementia. 
  9. Exercise the brain. Reading or learning a new language or skill can increase your brain’s ability to deal with cognitive declines (cognitive reserve). 

A word from Thorne

In addition to diet and lifestyle measures, several nutritional supplements can support brain health before, during, and after menopause, including DHA and nutrient and botanical formulas for brain support. 

References

  1. Hayashi K, Ideno Y, Nagai K, et al. Complaints of reduced cognitive functioning during perimenopause: a cross-sectional analysis of the Japan Nurses' Health Study. Womens Midlife Health 2022;8(1):6. 
  2. Mosconi L, Berti V, Dyke J, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep 2021;11(1):10867.
  3. Maki PM, Jaff NG. Brain fog in menopause: a health-care professional's guide for decision-making and counseling on cognition. Climacteric 2022;25(6):570-578. 
  4. Cognitive symptoms and disorders in the midlife woman. North American Menopause Society. https://www.menopause.org/docs/default-document-library/coghenderson.pdf. [Accessed January 23, 2023]
  5. Patient education: Menopause (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/menopause-beyond-the-basics. [Accessed January 23, 2023]
  6. Taking a closer look at menopausal hormone therapy and cognitive health. Mayo Clinic Discovery’s Edge. https://discoverysedge.mayo.edu/2022/10/04/taking-a-closer-look-at-menopausal-hormone-therapy-and-cognitive-health/. [Accessed January 23, 2023]
  7. Zárate S, Stevnsner T, Gredilla R. Role of estrogen and other sex hormones in brain aging. Neuroprotection and DNA repair. Front Aging Neurosci 2017;9:430. 
  8. Mediterranean diet for heart health. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801. [Accessed January 23, 2023]
  9. Alcohol use: weighing the risks and benefits. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/alcohol/art-20044551. [Accessed January 23, 2023]
  10. Stay mentally and socially active. Alzheimer’s Association. https://www.alz.org/help-support/brain_health/stay_mentally_and_socially_active. [Accessed January 23, 2023]
  11. Sun GY, Simonyi A, Fritsche KL, et al. Docosahexaenoic acid (DHA): An essential nutrient and a nutraceutical for brain health and diseases. Prostaglandins Leukot Essent Fatty Acids 2018;136:3-13. doi: 10.1016/j.plefa.2017.03.006. 
  12. Rakel D, ed. Chapter 11: Alzheimer’s Disease. In: Integrative Medicine. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. [Accessed January 30, 2023]