This blog focuses on cognitive changes that commonly occur during the menopausal transition. See the first blogpost on menopause on our website for a recap of foundational menopause information. Here, we will describe some real-life examples of these cognitive changes as they appear on the surface. These illustrations are important because cognitive changes can be misinterpreted as neurological or emotional problems when they are, in fact, hormone-driven and modifiable if taken seriously by medical and mental health professionals.
Scenario 1: Woman in 50’s — “I think I have undiagnosed ADD. I’m distracted easily, having a hard time concentrating at work, and messing up things that I didn’t used to. It’s hard for me to multi-task and I’m struggling to juggle work, kids, life, etc.”
Scenario 2: Woman in her early 60’s — “I’m scared I have early onset dementia. I’m getting forgetful, I feel slower, and it takes me longer to remember names and information that I used to spit out and recall quickly.”
Scenario 3: Woman in late 40s — “I just feel like something’s wrong. I feel foggy all the time. I don’t have energy. I don’t sleep well and don’t know if it’s anxiety or life stress or some underlying medical condition.”
It may seem hard to believe that hormonal changes can be at the root of these symptoms, but the neuroscientific literature paints a pretty convincing picture that there are several ways that menopause has direct and indirect effects on the brain and quality of thinking, including:
(1) There are cellular and structural changes to the brain due to declining levels of estrogen, especially in the hypothalamus, prefrontal cortex, hypothalamus, and amygdala;
(2) Estrogen supports the healthy functioning of many crucial processes in the brain; estrogen loss is associated with increased systemic inflammation, mitochondrial dysfunction, and negative changes in the cholinergic and dopaminergic systems;
(3) Sleep disruptions from vasomotor symptoms (hot flushes, night sweats), which affect 50-80% of women, contribute to acute cognitive problems and magnify already elevated levels of depression and anxiety.
Lastly, it is believed there’s a “critical window” of opportunity, potentially right before estrogen starts to drop, where hormone replacement interventions may alter the trajectory of cognitive symptoms. Many variables play into this equation and the most logical place to start is by discussing cognitive concerns with your doctors. If you relate to one of the above scenarios, a comprehensive neuropsychological and/or psychological examination can be helpful for proper diagnosis and treatment options, including counseling with one of our health psychologists to explore lifestyle and behavioral protocols for menopause-related cognitive, emotional, and physical changes.
Lauren Gashlin, PsyD
Clinical Health Psychologist