Women of a certain age know the feeling. You get up from the sofa and go to the kitchen. Once you arrive, you forget why you’re there. Or, you experience the frustration as words simply don’t come to mind when you need them to… ‘What was the name of that fermented vegetable from Korea, something with ‘ki’? Oh yes, kimchi!’ 

Brain fog has been associated with menopause for some time now, but many women worry that this could be a sign of things to come – or even early dementia. Professor Petra Stute, deputy chief physician and head physician at the University Hospital Bern, has conducted extensive research on this topic. We asked her why it happens and whether we should be prepared for it to worsen.

What exactly is brain fog during menopause?

The term recently became more commonly used because of the Covid pandemic and in that context refers to the impairment of memory caused by the disease. However, the cognitive abnormalities experienced during menopause and in those with long Covid are different. In the case of Covid, the brain fog is still being researched. For menopause, the natural decrease in oestrogen levels is a significant factor. This is because oestrogen influences the functionality of neurotransmitters. These are the messengers that affect nerve cells in the brain, which impact memory performance.

So, does decreasing oestrogen make us more confused and less intelligent over time?

No, of course not. It’s not as if we all inevitably drift towards a kind of dementia due to declining oestrogen levels. When women undergo a cognition test because of brain fog, the results for the vast majority show that they are not sick but completely normal. What is interesting is that, before menopause, women’s brain function is generally better than men, especially in verbal memory performance. But during menopause, this may decline a bit. So, subjectively, this change can be perceived as dramatic.

What happens to the brain during menopause to cause brain fog?

The so-called verbal memory and verbal learning centres are altered. These are areas where women are normally very good. Suddenly, recalling words, names and stories becomes more difficult. It’s also typical to enter a room and forget why you went there in the first place. In my practice, women often start to fear that they have dementia. 

Can you alleviate the fear of dementia?

Very rarely does dementia begin before the age of 60; it usually doesn’t set in until after 70. The feeling of brain fog during menopause is not even comparable to dementia symptoms. In fact, during menopause, everything else in the brain continues to function well. We don’t lose the ability to plan and act strategically, nor do we lose our spatial memory. We also don’t think more slowly. The dementia-like symptoms are just small memory loss changes but they can be quite disturbing.

So, no cause for concern?

A doctor should still inquire whether there are any cases of dementia in the patient‘s family. If a family member has been affected at a very young age, it might be a good idea to involve a neurologist or psychiatrist from a memory clinic. But in general, it’s not necessary and women shouldn’t worry too much.

Could there be other reasons for this slight confusion in mid-life?

Indeed, women in this age group often have a lot to deal with. Their careers are at their peak, their children may still be at home and their parents are ageing. When a woman comes to my practice because of brain fog, I look at the entire context and don’t forget the differential diagnoses. This means ruling out depression or other illnesses because hormonal changes can also lead to depression or severe sleep disorders. Both of these conditions lead to cognitive abnormalities. Therefore, doctors should not write off symptoms as normal menopausal complaints right away. It is important that they conduct a more thorough examination. Also, it’s easy to say that everything is within the normal range and send them on their way but for the affected woman, brain fog can be a real problem. Especially if she is professionally challenged and can’t recall words or names during a presentation.

 Could hormone therapy help?

Probably yes, but the medical guidelines explicitly state that hormone therapy should not be recommended solely for cognitive symptoms. However, if a woman complains of other symptoms as well, such as severe hot flushes, sleep disturbances and bad moods, a doctor may consider hormone therapy as a treatment option.

Is there a connection between hormone replacement therapy and dementia – can it prevent dementia?

We have seen an increasing number of studies released that suggest there is probably a certain time window during which the benefits of hormone replacement therapy are at their highest. Current research suggests that, if a woman starts taking hormones before the age of 60, the risk of developing dementia is slightly lower, as it is also with heart disease. However, if the therapy begins after the age of 65, the risk of developing dementia appears to be slightly higher.

Do you have any advice for dealing with brain fog?

Adequate sleep and relaxation exercises can help. You may also have a vitamin B12 or iron deficiency, which can be checked by a doctor. It is crucial not to withdraw but to remain socially active in order keep the brain active.

Does this brain fog persist for the rest of one’s life?

Here’s the good news: Brain fog is a symptom that goes away. It’s important to know that the fog occurs during menopause and for most women, it disappears when menopause passes. The whole process takes about four years, as the brain gradually adjusts to the change in hormone levels.