Brain fog or dementia? Factsheet

Brain fog is a very common symptom of the menopause, and many women say that their brains feel like ‘cotton wool’. You might have noticed that you’re increasingly forgetful, can’t remember names, lose your keys, write endless to-do lists, and find it hard to retain information. This can make it especially hard to function at work, and you might struggle to concentrate when reading or watching TV.

These symptoms can be so severe that you may even start to worry that you have dementia. This is particularly scary if you have a family history, and some women become so concerned that they are referred to have testing at a memory clinic. Fortunately, the right type and dose of hormone replacement therapy (HRT) (with testosterone for those who need it) can often improve brain fog and help you think more clearly.

How estrogen and testosterone affect the brain

Two of the main female hormones, estrogen and testosterone, play an important role in cognition and memory. When the levels of these hormones begin to fall during perimenopause and menopause, this can lead to a range of cognitive symptoms including memory loss, difficulty staying focused, word­finding difficulties, losing your train of thought and getting confused easily.

Estrogen stimulates the brain, keeps the neurons firing, supports the growth of new cells and helps existing cells to form new connections. When estrogen levels fall in midlife, your entire body – including your brain – goes into a sudden deprivation state. At a cellular level, estrogen pushes your brain cells to burn more glucose, which is its main fuel. Studies have shown that there is an overall reduction of brain energy levels during menopause, which can trigger hot flushes, night sweats, anxiety, depression, brain fog, and the host of other cognitive symptoms mentioned.

Testosterone (produced by the ovaries too) strengthens nerves in the brain, and contributes to mental sharpness and clarity, as well as overall energy levels. It also strengthens arteries that supply blood flow to the brain which is crucial to protect against loss of memory.

The good news is that we can support brain health with simple lifestyle changes. Although memory loss and brain fog can be alarming when it happens, there’s no need to panic about these menopausal effects on the brain. Midlife is a turning point, and there are many things you can do to support brain function.

A healthy diet

There are clear links between what we eat and our hormone balance. A brain friendly diet is one rich in polyunsaturated fatty acids, such as Omega 3 and Omega 6, which are found in eggs, fish, nuts and seeds. Your brain will thank you for giving it plenty of these nutrients.

Another important dietary consideration is giving your brain antioxidants, in particular vitamins A, C and E. The brain is the most metabolically active organ in the body. When it burns glucose, free radicals are formed which have unwanted effects in your body, including the brain, as they make your cells age faster and work less efficiently. It’s important to have antioxidants in your diet as they can balance out these free radicals and minimise the negative impact of them on your cells.

Regular exercise

Regular exercise can also support brain health – it’s important to make time to keep active by doing an activity that you enjoy. If you’re not keen on going to the gym or joining a fitness class, yoga is a great way to relieve stress and promote relaxation. Going for a daily walk can improve fitness and increase mental and emotional wellbeing.

It can be challenging to start a new nutrition and exercise plan, especially if you’re dealing with menopausal symptoms. The key is to make small, sustainable changes that become part of your everyday routine. Many women find that their energy and motivation to exercise increases when they start taking HRT.

Deep sleep

It’s common to have trouble sleeping during the perimenopause and menopause, as the brain can’t regulate sleep properly without the hormones, estrogen and progesterone. If you struggle to fall or stay asleep, or you wake up in the middle of the night, there’s a good chance you’re missing out on some of the deep sleep, that’s most beneficial for your brain. Deep sleep is when all the toxins and impurities are removed, so this phase of sleep is important to keep the brain healthy.

For this reason, it’s wise to take steps to improve your sleep habits, such as limiting screen time before bed, keeping your bedroom cool, dark and comfortable, and using pillow sprays or aromatherapy oils to help you feel calm and relaxed.

Many women find that the quality of their sleep dramatically improves when they begin taking HRT. Better sleep also boosts mood, energy levels and concentration, helping the cloud of brain fog to lift.