Let’s Chat About “Brain Fog”

Have you ever walked into a room and suddenly couldn’t remember why you were there? Or gone into a coworker’s office to talk about something only to find that you can’t recall what you wanted to talk about? If that sounds familiar, you’re not alone. You’re probably experiencing something we call “brain fog.”

In this Let’s Chat About Your Brain blog, I am going to share important information about menopause and how it can affect your brain. I will also give you five tips to help you with your brain fog and five questions to ask your healthcare provider.

Memory issues and brain fog

During one of my first talks on menopause years ago, I mentioned brain fog and the audience really lit up. I saw so many heads nodding yes and they seemed to understand what I was talking about. I have to admit that I’m not even sure I knew exactly what it was at that time! But, that was then, this is now. Today, we know so much more about how changing estrogen levels during menopause and perimenopause can lead to memory issues and/or cognitive decline. Unfortunately, these changes can also be mistaken for signs of dementia or Alzheimer’s disease. Many of my patients walk into my office convinced they have dementia or are just simply crazy. Fortunately, after some discussion, I help calm their fears about both scenarios.

Liz’s story

I truly want women to know they aren’t crazy. They don’t have dementia, and they don’t need to suffer. Liz is a perfect example of a patient who came to me because she wasn’t feeling like herself. She was 48 and had been experiencing “brain fog” for about six months. Her kids would constantly say, “Mom, I told you that already!” She also found herself walking into a room for something and forgetting what it was she was supposed to get. At work, she was having to constantly make lists so she didn’t forget to complete her tasks, and she had recently forgotten a client meeting and had to scramble at the last minute to cover up her error. She was becoming so stressed about everything in her life.

Liz was even more concerned because her mom had an early and rough menopause (which her family knew because she was moody and not fun) and now was suffering early dementia. Liz was afraid she was going to follow in the same footsteps as her mom and became tearful as she told me she thought she was going down the same path. She didn’t want her kids to have to deal with what she was currently dealing with—taking care of a mom with dementia.

I asked Liz a series of questions to see what was truly happening and determine what treatment options would be best for her. She was experiencing hot flashes, night sweats, irregular periods, and the dreaded brain fog. All of these are common symptoms of perimenopause that can really affect your daily life. The night sweats were causing Liz to have poor sleep, and the irregular periods were causing her to have days of low estrogen. I also checked for any physiological changes Liz might be experiencing, including her cholesterol and blood sugar levels.

The perfect storm

Liz was in the middle of what we call “the perfect storm.” This occurs when your menopause symptoms collide with the changes in your body chemistry (including changes in hormone levels), causing havoc with your body. Unfortunately, the perfect storm also puts you at a higher risk for heart disease and dementia. It’s a good wake-up call to start making some lifestyle changes before it’s too late! Liz left my office realizing her symptoms were her wake-up call and ready to make some changes.

Good sleep is essential

Many women (including Liz) don’t realize how important good sleep is to your health. A lack of sleep increases your risk of heart disease, stroke, weight gain, depression, and dementia. I mentioned earlier in this blog how low estrogen can affect your memory. Without going into too much detail, here’s how it works: Estrogen is a hormone that helps cells in the brain function the way they’re supposed to function. There’s an important chemical called serotonin that you make when you sleep and you spend this chemical on stressful things in your life.

When your estrogen level is low, you spend more serotonin on these events. If you’re not sleeping well, you aren’t producing enough (or any) serotonin, making it difficult to deal with multiple stressors in your life. How are you supposed to remember anything when you are always in survival mode? It’s a vicious cycle that is difficult to stop if you don’t make any changes.

There is a report called the KEEPS study that looked at the importance of estrogen during menopause. The study included a large number of women in early menopause and divided them into three groups: Group one did not take any estrogen, group two took oral estrogen, and group three used an estrogen patch. The results showed that both groups two and three had slower structural changes in the brain than group one (no estrogen), lowering the risk of dementia. I encourage you to take a look at this study. If you’re still not convinced about the importance of considering options for the treatment of menopause!

Five tips to help you with brain fog:

1. Breathe—Just because you’re having some memory lapses, it doesn’t mean it will be like this forever! You don’t have dementia and you’re not going crazy.
2. Use the symptoms as a gift to focus on self-care—It’s time to get your act together; look at this as your wake-up call to ask for help.
3. Look at underlying issues that put you at risk—Did you have postpartum depression after you had children? Do you have a family history of depression? If you answered yes to either of these questions, you have a greater risk for developing anxiety and depression during menopause which can cause brain fog. Knowledge allows you to prepare and think about the best ways to cope. This includes exercise, yoga, meditation, and potential medication options.
4. Consider your options for treatment—Start with focusing on a healthy lifestyle, including doing your SEEDS every day. You might also consider taking a low-dose Selective Serotonin Reuptake Inhibitor (SSRI) to help replace your serotonin if you’re not getting enough sleep. And, finally, consider seeing a therapist to help you navigate through this difficult time.
5. Remember the power of gratitude—Meditation, deep breathing exercises, and thinking about what you grateful for can get you out of “fight or flight” mode. I highly recommend reading The Relaxation Response book—it will show you how to use meditation and gratitude during a fight or flight response.

Five questions to ask your healthcare provider:

1. What is my phase of ovarian function—reproductive, perimenopause, or menopause? I mention this in many of my blogs because it can provide so much information, including your current estrogen level.
2. What are my risk factors for memory problems or mood disorders? Work with your healthcare provider to determine your risk factors and figure things out before it’s too late!
3. Which habits affect my risk? Talk about sleep, exercise, alcohol consumption before bed, and anything else your provider thinks might contribute to your brain fog.
4. What could I do better to help my memory? My mood? My focus? There are tricks you can do to help with your memory—ask your healthcare provider what tricks he or she thinks works best.
5. What are my treatment options for my stage of ovarian function? Look at your “whole health,” including your history and risk factors. Work with your provider to determine the best options for you depending on your current stage.

By Dr. Diana Bitner