Brain fog, confusion and anxiety leave women questioning sanity
For women, cognitive changes like forgetfulness, sleeplessness, irritability and confusion cannot only be frustrating – but deeply unnerving.
‘You Are Not Crazy’: that’s the title of the opening chapter of Doctor Lisa Mosconi’s book The Menopause Brain.
As she tells readers, women aged between 30 and 60 may question their sanity if they find themselves experiencing certain neurological-related symptoms that can begin in perimenopause and menopause. They can include things like forgetfulness, sleeplessness, irritability, confusion and what is often described as ‘brain fog’.
“It might be a sense of disorientation or you find yourself doing increasingly absent minded things like entering a room only to wonder what made you go there in the first place. “Belongings may be misplaced, with milk cartons finding their way into cabinets and cereal boxes ending up in the fridge,” Dr Mosconi writes.
For that group of women, those cognitive changes cannot only be frustrating but deeply unnerving. While they are believed to be temporary and the result of hormonal changes, severe cases can persist and have a significant effect on a woman’s quality of life.
In submissions to last year’s Senate Inquiry into issues around perimenopause and menopause, women explained the impact of those cognitive symptoms and their struggles to get medical help.
“I couldn’t recall things I knew I knew. I would see friends, who I have known for 20+ years and greet them with ‘hey you!’, because I couldn’t remember names,” one woman wrote.
“Someone would ask me a question in a work meeting, and I would say, ‘I’ll come back to you” because even though I knew the answer, I couldn’t remember it. Did I have dementia? It is in my family. I was scared! I mean I was terrified! I did get really depressed and anxious. I struggled to get out of bed or to get to sleep for that matter! I lost all my confidence and felt like an impostor in my own life.”
Another concluded she was no longer the person she once was before perimenopause.
“I was a happy, fit, fun-loving person. With a good job and lots of friends. I loved taking my dog for a walk and enjoyed lots of social events with my husband. I now can no longer do any of these. I have become a person who can’t tolerate society and other people. I now suffer from mood swings, anxiety, panic attacks, depression, lack of sleep, fatigue, difficulty concentrating, forgetfulness”.
The brain and menopause is still an area lacking in scientific research. Jean Hailes for Womens Health acknowledges cognitive changes and feelings of “brain fog” are common, with 62 per cent of women reporting it as a symptom of menopause.
Symptoms affecting the brain have not historically been discussed or researched as widely as others, like hot flushes. Therefore, confusion remains about what therapies may help people who experience adverse cognitive symptoms, and there is a lack of consensus and awareness about the symptoms themselves.
For some women, like Katherine Milesi, developing their own coping strategies in the workplace may be sufficient enough. But for people who require more medicalised help, Jean Hailes advises people who experience adverse menopause symptoms to seek out a GP who specialises in women’s health.
Changes in mood and behaviour are areas of focus for Professor of Psychiatry Jayashri Kulkarni.
“Oestrogen is a potent brain steroid. It’s called a neuro-steroid and it affects the brain in many, many, many different ways. There are oestrogen receptors throughout the brain. There is absolute evidence from animal work and from human work to show that oestrogen has significant effects on the brain chemistry as well as the brain circuitry and they’re the ways that we think, we behave, we feel and we move.”
Kulkarni is the director of Monash University’s HER Centre Australia which aims to understand and advocate for women’s mental health. She says it is not yet clear why some women have such a tough time with their mood, depression, memory gaps, and difficulties finding their words, especially during perimenopause.
She is advocating for changes to clinical guidelines to allow greater access to Menopausal Hormone Therapies for people who experience significant cognitive symptoms. It is a controversial issue, with medical groups concerned about a lack of scientific evidence.
“All the guidelines strongly advocate antidepressants, which seems counter common sense for a woman who’s really struggling with depression because of perimenopause. Why wouldn’t you go with the hormone strategy, since it was the hormone disturbance that caused that depression? This is the controversy. People still say, ‘Oh no, no, depression has got nothing to do with hormones’. That neuro scientifically doesn’t make sense.”
Kulkarni maintains she is not trying to overmedicalise menopause and is only talking about a small group of patients with the most complex of mental health needs. She says that can include people who have experienced trauma in their earlier years and then experience significant mood disorders during perimenopause.
“Depression, significant, severe depression, with suicidality is clearly a life-threatening situation. So, we’ve got different people running the different guidelines who are not seeing this group of patients, because traditionally, menopause has been a gynaecological domain of work, or endocrine domain of work, not mental health.
“The women I’m seeing have come to me – a tertiary level psychiatrist – because they’ve got significant mental ill health and I’m talking about that group; that’s the group I’m trying to help.”
Research in this area is growing, especially in Australia, as more is understood about potential cognitive effects of menopause. As part of this, the senate inquiry into menopause has recommended workplaces offer greater flexibility and policies around peri and menopause.
The Australasian Menopause Society is one of the groups that provides medical professionals with education and clinical recommendations. It is more cautious, stating on its website: “It is premature to recommend MHT for cognitive function until more substantiated clinical correlates are available.” Instead, it suggests women speak with a GP about what therapies would suit their individual needs. It also suggests complementary medicine options may help some women, including vitamin E, cognitive behavioural therapy, hypnosis, and yoga.
All women who live long enough, will go through menopause. It’s defined as being a year after a woman’s last period and marks the end of her reproductive years. For most women this will happen between the ages of 45 and 55, though it can also be outside of those years or be medically induced. While menopause is a completely normal and natural part of ageing, the transition is also a major midlife event and can be an important time for women to focus on their health and wellbeing.
Doctors suggest around a quarter of women won’t get any adverse symptoms of menopause, while around a quarter will experience prolonged or severe symptoms for which they may seek medical help. The remainder will experience mild to moderate effects which can sometimes be managed through lifestyle changes and improvements to diet and exercise.
Professor Kulkarni says women who experience more significant cognitive impairment during menopause sometimes fear they are in the early stages of dementia.
According to the Alzheimer’s Society, women make up an estimated 65 per cent of people who currently have dementia. Age remains the biggest risk factor for the disease, and women statistically live longer than men. While it is commonly asked whether there is a link between cognitive changes some women experience in peri and menopause and dementia, the evidence is lacking.
“Oestrogen is thought to have a range of protective effects on brain health, including an ability to block some of the harmful effects of substances involved in Alzheimer’s disease,” the society notes.
“Most of the diseases causing dementia start developing in the brain around 10 to 20 years before clinical symptoms show, which for many women is around the time of their menopause.
It’s tempting therefore to connect the loss of this brain-protecting hormone with the start of processes in the brain that ultimately lead to dementia. However, the relationships between sex, menopause and dementia risk are extremely complex and until recently researchers have not prioritised menopause as an opportunity to learn more about dementia.”
Professor Kulkarni is encouraged to see more research happening in this space. In the meantime, she says there are several things women can do throughout their lives to improve their brain health.
“Things like maintaining good blood pressure, which means maintaining a good weight and not eating terrible fatty foods. Having good cholesterol and triglyceride, exercise is really critical, brain exercise – which equals things like learning a new language or challenging yourself with new things or even a new environment and so on, will make those circuits grow and develop and maintaining healthy relationships.
“Smoking is also a big is a big no no. And interestingly, alcohol is a real no no. In terms of brain health, it’s quite toxic to brain cells.”
The Australasian Menopause Society and Jean Hailes for Women’s Health also have resources for nurturing brain health.
