Lift the fog

I have met with several patients lately who complained about entering midlife and menopause, only to find they suddenly feel like they’re losing their memory.

They say they find it difficult to read, or they can’t even remember what they just read.

Their memory just seems “off.”

Many women complain of this “fuzzy brain,” which can hit them at any moment of the day. They’ll walk into a room and they can’t even remember why they’re there. They’ll step into a coworker’s office to talk about something, only to find they can’t recall what they wanted to talk about.

Sound familiar? Well, it should, because you are not alone.

A patient I’ll call Lisa was 46 years old when she came to see me in the Spectrum Health Medical Group Midlife and Menopause Clinic.

She heard her older friends talking about menopause and how they felt like they were losing their minds. They joked that once their periods stopped, they could not remember anything anymore. They even started making lists for everything—but sometimes they forgot where they put their list.

They all agreed they felt stupid at times when they couldn’t remember names of people they had met several times. They also experienced issues with having trouble remembering what they had just read.

One of Lisa’s friends went on hormone replacement therapy and felt much better, including sleeping better, no longer experiencing hot flashes or night sweats, and having the energy to exercise again. Another friend was thinking about trying this for herself, but still had some questions she wanted answered.

Lisa felt the same as her friends, but she hadn’t wanted to share her feelings because she was so much younger and didn’t know others felt that way, too.

She thought she was all alone and something might be wrong with her.

That ‘foggy’ feeling

When I met with Lisa, I asked her to tell me about her biggest fear regarding menopause. She said she was afraid to have to suffer like her mom suffered.

Her mother experienced early menopause at age 49, and when her periods stopped, her mood and demeanor completely changed.

Lisa’s mom had been very social, but she became withdrawn, forgetful, anxious and scattered, worrying about everything.

Lisa told me a story about how she and her kids went to her mother’s for dinner one night, but her mom had completely forgotten they were coming—even though she had invited them.

She was totally unprepared and reacted by bursting into tears and hiding in her room.

As Lisa and I talked in more depth, she also confided in me that her mother had been dealing with some very tough issues when she began menopause.

At age 45, she was widowed and found herself worrying about financial security. She also went through a breast cancer scare. Lisa’s mom was just starting to get back on her feet when her periods stopped, and the perfect storm of hot flashes, night sweats and interrupted sleep began.

Her mother did not have dementia as Lisa had feared, but she did have situational depression made worse by menopause.

In general, Lisa was very happy and healthy. She had a strong marriage, well-adjusted kids, a rewarding job and good friends. She exercised occasionally, as she found it difficult to find the time to exercise every day, and she admitted to eating too much fast food because of her family’s hectic schedule.

Lisa’s periods had been irregular for the past six months, becoming closer together and heavier. She was experiencing night sweats for a few nights before each period, and she noticed she was also moodier and increasingly irritable during that same time.

Lisa also felt “foggy” and had trouble remembering things beginning two days before her period and lasting until her period ended.

Fortunately, the fog always lifted as soon as her period ended, but she was tired of the roller coaster. Her “foggy” feeling also made her worried she was headed down the same road her mom had traveled.

Overload

I didn’t want Lisa to worry about suffering as her mom did, so I put her fears to rest by explaining the difference between cognitive decline and dementia.

Cognitive decline—the state of our brain not working as well as we expect—can be a factor associated with aging. However, it can also be related to menopause or the loss of estrogen, as well as your overall health.

Dementia is when you experience cognitive decline and mental status changes such as lack of time and place, and basic functions.

Low estrogen does not cause dementia, and memory loss (“fuzzy” brain) from stress, lack of sleep or being overworked is not a sign of dementia.

Estrogen, however, does affect your mental function.

The areas of the brain responsible for complex thinking and learning are dense with estrogen receptors and estrogen is known to aid in blood supply, nerve conduction, and maintenance of several systems that are important for memory function, learning and cognitive function.

Doctors don’t exactly understand the role of hormone replacement therapy in dementia, but we do know it can make dementia worse if it is started in a woman who already has dementia. We also know that hormone replacement therapy does not increase the risk for dementia if it is started early in the menopause process.

As I explained to Lisa, when the brain is busy coping with stress and unresolved issues with kids, ailing parents, or a difficult boss, there is less space available to remember other things in your life, such as a book you are reading, your work schedule or the schedule of other family members.

Our brains can only do so much, and in this over-scheduled life many of us have chosen, everything—sleep, hormones, or another item added to the schedule—makes a difference.

Hormone replacement therapy is a great option for many women who are able to use it safely.

In fact, after starting the therapy, many women have observed how they feel like themselves again. They can think more clearly, process thoughts more quickly and simply feel better overall.

Of course, it’s important to check with your health care provider to make sure you can safely take hormone replacement therapy.

Lisa left my office with information about the therapy and a newfound understanding of how to take better care of herself. She’ll now be prepared to make important decisions in the future, and she’ll know when to call for help when she needs it.