Supporting World Menopause Day 2022: Cognition & Mood
As our ageing population continues to grow, more and more women are likely to experience menopause, a natural and gradual stage affecting women in their midlife. Menopause is defined as the absence of menses for 12 consecutive months (a year). In other words, it marks the end of the female reproductive years since the ovaries will stop producing 2 essential hormones responsible for fertility: oestrogen and progesterone.
According to the Ministry of Health Malaysia, menopause may happen from age 45 to 55, with the average menopausal age among Malaysian women around 50. However, it can also happen to some women below age of 40; also known as premature (early) menopause, due to various factors such as: surgery (removal of cancerous ovaries), autoimmune disorders (ie: SLE, Rheumatoid arthritis, hypothyroidism), genetic conditions, viral infections or idiopathic (unknown causes).
World Menopause Day 2022: Cognition & Mood
Despite the increasing incidences of menopause in our ageing population, this condition is still not widely talked about as it should be, especially in the Asian culture. Observing this special day is seen as an opportunity to create awareness on this topic and to better inform the public on early recognition of symptoms and educate on ways to cope and manage the symptoms better without negatively impacting their daily lives.
Globally, World Menopause Day is celebrated on the 18th of October every year to raise awareness, debunking common myths (often negative connotations) associated to it. Some of the common symptoms of menopause are as following:
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Hot flushes
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Sweating
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Emotional lability
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Sleeping difficulties
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Poor memory
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Reduced sex drive
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Urinary incontinence
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Vaginal dryness
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Osteoporosis
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Increase in hair loss
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Loss of skin elasticity and dry skin
Image credit: Australian Menopause Society
Menopausal symptoms experienced by one women may differ from another. This year, the theme of World Menopause Day 2022 determined by the International Menopause Society (IMS) is cognition and mood, focusing primarily on brain fog and memory difficulties in menopause.
Menopause brain fog explained
Menopause brain fog is essentially a group of symptoms that occur during the early stages of menopause and symptoms may include trouble remembering words and numbers, misplacing common items (ie: keys, mobile phone), short attention span with difficulty concentrating, struggling navigating between tasks and forgetting important appointments and events.
The have been multiple studies in the past to show that decline in women’s memory during perimenopause (around menopause) is a real problem, most likely contributed by the decline in reproductive hormone levels. These troublesome symptoms are usually mild and may affect your day-to-day activities. However, the good reassuring news is that, your memory will improve over time and going back to the baseline post menopause in most women
How is brain fog related to menopause?
Brain fog is believed to be caused by the rising and falling of hormone levels. Oestrogen, progesterone, follicle stimulating hormone (FSH), luteinizing hormones (LH) are all responsible for difficult psychological functions of our body, including memory and cognition. Just like other associated symptoms that a women may experience during her menopause, recent study published in Journal of Neuroscience highlighted that menopausal brain fog is also closely associated with the decline in level of oestrogen, Estradiol is the form of oestrogen produced primarily in the ovaries and drop significantly during menopause. These hormone levels are closely related to memory processing in the hippocampus
Menopausal Hormone Therapy (MHT)
There have been multiple contraindicating evidences in regards to MHT when it comes to treating menopause-related brain fog and memory lapses. Whilst there are concerns in such that MHT used in treating menopausal symptoms such as hot flushes can predispose one to dementia; however, research has reported that if started early on during menopause in healthy individual and dementia is ruled out by your doctor, MHT appears to be a safe and most effective option to relieve physical menopausal symptoms alongside brain fog.
This treatment involves taking either low-dose oestrogen or a combination of oestrogen and progestin (a synthetic version of progesterone). MHT can be commercially found in the form of pill, skin patch, vaginal ring, skin gel, cream or spray.
It is important to consult your doctor prior to taking any MHT as it is contraindicated among women who have breast/ovarian/endometrial cancer, stroke, or heart diseases. With proper evaluation, your doctor will assess if the benefits of starting MHT outweighs its risks and suggest the best MHT for you, if deemed necessary.
Fighting brain fog
Menopausal brain fogs may not be preventable entirely since its hormonal-related. However, there are some healthy lifestyle habits you can incorporate that may ease your symptoms and enhance your overall cognitive function.
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Eat clean, eat healthy
A well-balanced, healthy diet essentially fuels the body and the brain in which it may also help to overcome some menopausal symptoms. For instance, a Mediterranean diet that is rich in omega-3 fatty acids and other unsaturated fats have been suggested to promote brain health and keep you mentally sharp. This includes green, leafy vegetables, fruits, whole grains, cold water fish (ie: salmon, mackerel), beans and nuts as well as olive oil.
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Get adequate rest
Not getting enough sleep or poor quality sleep may exacerbate brain fog and make it hard to concentrate or retain new information.
To allow a better sleep quality and more restful sleep health, you can try the following:
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Stick to a proper routine sleep schedule, as to when you go to bed and wake up as consistent as possible, even on weekends
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Avoid eating large meals before bedtime and try to stay away from spicy or acidic foods. (p/s: Helpful if you experience hot flushes as well)
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Resist taking in stimulants such as caffeine and nicotine before bed
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Practice relaxation from time to time and ensure your bedroom is quiet, dark and provide a comfortable environment for you to fall asleep
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Ensure your room is distraction-free. Remove all electronic devices from the bedroom.
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Staying physically active
Engaging in regular physical exercises will not only improve cardiovascular health but also reduces the risk of dementia. It is recommended that 30 minutes of cardiovascular exercises (brisk walking, running, cycling etc) for at least 5 days (a total of 150mins/week) shall do the trick. Although it’s not scientifically proven that exercise can overcome memory loss due to menopause, it is believed that physical activity may increase the production of chemicals that are responsible for the repair of existing brain cells and the growth of new ones.
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Exercise your mind
Exercise is not just limited to the body alone, as our mind too requires regular workouts as well, especially as you age. Engaging in brain exercise such as doing crossword puzzles, sudoku, reading or learning a new skill that may stimulate your brain is highly recommended for people experiencing brain fogs or to anyone with signs of memory loss. These activities may keep your mind in check and boost your memory health instead of letting it deteriorate. Keeping in touch regularly with a small circle of friends and family may also boost brain function and is highly encouraged. Afterall, it is always a good time spending quality time with your loved ones.
All in all
Menopause induced memory and other cognitive problems linked to menopause may improve with time. By instilling the suggested strategies in your daily life, brain fog associated with menopause may be better managed. However, if you notice your menopausal symptoms including brain fog getting worse eventually, do make an appointment with your doctor to rule out other possible health issues and to get advice if you are suitable to be started on MHT.
To learn more about menopause, kindly refer to our previous article on a detailed explaination about menopause! Menopause Explained
Written by Janelle Leong, Bpharm(Hons)
Reviewed by Ashwini Nair, MB BCh BAO
References
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World Menopause Day 2022 - National Today. Available at: https://nationaltoday.com/world-menopause-day/. Accessed on 17th October 2022
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World Menopause Day 2022 Engagement Toolkit. Available at: https://www.imsociety.org/wp-content/uploads/2022/09/WMD-2022-Engagement-Toolkit.pdf. Accessed on 17th October 2022
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Menopause - MyHeath portal KKM. Available at: http://www.myhealth.gov.my/en/menopause/. Accessed on 17th October 2022
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Hormone Replacement Therapy - MyHealth portal KKM. Available at: http://www.myhealth.gov.my/en/hormone-replacement-therapy/. Accessed on 17th October 2022
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What Causes Menopause Brain Fog and How’s It Treated? - Healthline. Available at: https://www.healthline.com/health/menopause/menopause-brain-fog. Accessed on 17th October 2022
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9 Tricks to Battle Memory Loss in Menopause - Everyday Health. Available at: https://www.everydayhealth.com/menopause-pictures/tricks-to-battle-memory-loss-in-menopause.aspx. Accessed on 17th October 2022.
