Brain Fog and Brain Health

Memory, concentration, and cognitive impairments are frequently referred to as ‘brain fog,’ a common experience during the perimenopause and menopause. For some women, changes in cognitive abilities can be unsettling, raising concerns about conditions like dementia.

While brain fog can be debilitating, effective treatments such as Hormone Replacement Therapy (HRT) are available, along with measures to mitigate its impact on daily life. It’s also crucial to consider long-term brain health and strategies to reduce the risk of dementia.

Defining "Brain Fog"

Brain fog is a term used to describe a cluster of symptoms that affect cognitive functions. These symptoms encompass memory issues, difficulty recalling words, names, or numbers, reduced mental clarity, trouble concentrating, increased distractibility, forgetfulness (like entering a room without remembering why), challenges with word retrieval, and sluggish or unclear thinking.

Brain fog can stem from various causes, including inadequate sleep, stress, an unhealthy diet, side effects of medications (e.g., chemotherapy), or medical conditions like anaemia, an underactive thyroid, depression, chronic fatigue syndrome, or migraines. Hormonal changes during events such as pregnancy, perimenopause, and menopause can also contribute to brain fog.

What is the role of hormones in brain function?

The brain is full of oestrogen receptors in areas associated with learning and emotional regulation. Oestrogen plays a role in stimulating brain activity, maintaining neuron function, and acting as an anti-inflammatory agent.

Testosterone, produced by the ovaries as well, strengthens brain nerves and the arteries that supply blood to the brain, which is vital for dementia prevention. Testosterone may also contribute to mental energy, drive, and motivation.

What are the effects of declining hormones on the brain?

During the perimenopause and menopause, hormonal shifts can lead to changes in the brain, including alterations in the hypothalamus’s temperature control zone. This can result in hot flushes and night sweats, both of which can affect memory. Hot flushes have been linked to memory problems, while night sweats disrupt sleep, impacting verbal learning and memory.

You may notice changes in memory, concentration, ability to focus, follow instructions, engage in complex problem-solving, and make quick decisions efficiently. Brain fog is a major contributor to workplace challenges, where cognitive demands are high.

Balancing professional, domestic, and caregiving responsibilities can become overwhelming, leading to feelings of regret, frustration, guilt, and shame when things are forgotten or neglected. The term ‘brain fog’ doesn’t fully capture its impact on a woman’s confidence or its effect on her relationships.

You may also experience other psychological symptoms during perimenopause or menopause, such as anxiety, low mood, or irritability.

What strategies can be used to alleviate brain fog?

If you are experiencing brain fog, addressing hot flushes, night sweats, and sleep issues is crucial.

HRT is the most effective treatment for these symptoms.

In addition to HRT, here are several measures to help alleviate brain fog:

  • Engage in regular aerobic exercise, even brisk daily walks, aiming for 150 minutes per week.
  • Quit smoking.
  • Monitor your blood pressure and maintain it within a normal range.
  • Adopt a healthy diet rich in fruits, vegetables, protein, and healthy fats, akin to a Mediterranean diet.
  • Prioritise adequate sleep.
  • Stay socially connected with friends and loved ones.
  • Pursue enjoyable activities and make time for relaxation.
  • Use memory aids like to-do lists, calendar reminders, phone alerts, or strategically placed post-it notes.

How can you promote future brain health?

Women face an increased risk of dementia post-menopause, not solely due to their longer lifespan compared to men. Studies indicate that women’s brain cells deteriorate at a faster rate, possibly linked to sex hormones, although the precise reasons remain unclear.

Dementia results from brain disease processes, influenced by factors like age, genetics, ethnicity, cognitive reserve (related to education, job complexity, and social engagement), and lifestyle choices.

Certain medical conditions elevate dementia risk, including obesity, cardiovascular disease (high blood pressure, elevated cholesterol, type 2 diabetes), hearing loss, traumatic brain injury, and depression.

To safeguard your brain’s health, consider the following steps:

  • Keep your mental faculties sharp by engaging in activities that challenge your cognitive skills, such as reading, puzzles, learning new hobbies, languages, or musical instruments.
  • Prioritise sleep, aiming for at least 7 hours per night.
  • Care for your mental well-being by reducing stress, relaxing, seeking help for anxiety or depression, and participating in enjoyable activities.
  • Foster close relationships to combat social isolation, enhancing mental well-being and reducing dementia risk.
  • Address hearing difficulties promptly, as hearing loss is linked to an increased risk of dementia.
  • Maintain a healthy cardiovascular system by quitting smoking, reducing alcohol consumption, managing high blood pressure and cholesterol, staying physically active (2.5 hours weekly on average), and maintaining a healthy weight.
  • Adopt a brain-boosting diet featuring plant-based foods, healthy fats, and gut-friendly bacteria.

Does HRT reduce the risk of dementia?

While research findings are mixed, recent studies suggest that HRT may reduce the risk of Alzheimer’s and other neurological diseases. Oestrogen, in particular, is believed to protect against brain plaque formation. Body-identical HRT initiated within six years of menopause is considered the most protective. However, HRT should always be complemented by a healthy lifestyle.

Currently, HRT is not recommended solely for preventing cognitive decline or dementia, as further research is needed to establish this link.