The menopause is a term for the cessation of periods because of a decrease in female hormone levels.
It occurs between the ages of 45 to 55 years in the majority of women, with a global average age of 50-51 years.
It can sometimes occur naturally earlier or following surgical removal of the ovaries (oophorectomy) and/or uterus (hysterectomy).
The perimenopause is a term for the time when there are symptoms before the cessation of periods.
One has reached the menopause naturally when there have been no periods for 12 months continuously.
There are symptoms at the menopause and perimenopause that may continue into the postmenopausal years.
These symptoms may impact on a person’s life, including personal relationships and work.
There are myriad physiological and psychological changes associated with the menopause, including changes in cognition and mood.
In fact, this was the theme chosen by the International Menopause Society for this year’s World Menopause Day, which was commemorated on Oct 18.
It was a day to increase awareness about this natural biological development in women, and to improve the health and well-being of menopausal women.
Cognition and mood
The US Centres for Disease Control and Prevention (CDC) defines cognition as a “combination of mental processes that includes the ability to learn new things, intuition, judgment, language and remembering”.
Research findings have shown that menopausal women have distinct cognitive profiles, each with relative strengths and weaknesses.
About 20% were cognitively vulnerable with characteristic weaknesses in verbal learning and memory, with associated sleep disturbances.
The cognitive performance of the remaining 80% were within normal range.
The fluctuating oestrogen and progesterone hormones during the menopause also increase the likelihood of mood disorders and depression.
Mood refers to a person’s general emotional state and its consistency with the prevailing circumstances and one’s ability to function.
There is a spectrum of moods that includes irritable, anxious, depressive, empty, brightly elevated (or sunny hypomania), darkly elevated (dark hypomania) or a mixed state.
The primary predictors of mood disorders during this phase of a woman’s life are previous history of depression, history of postpartum depression and severe pre-menstrual symptoms.
The symptoms range from increased irritability, crying episodes, poor sleep, anxiety and feelings of low mood.
The intensity of these symptoms lessens in the post-menopausal years.
A study of about 4,000 perimenopausal Malaysians reported a 54% prevalence of depression symptoms.
These symptoms were higher in the perimenopausal period than in the post-menopausal period.
Brain fog
Menopausal women can also experience brain fog.
Brain fog refers to a group of symptoms that include daily life disruptions, e.g. misplacing commonly-used items like keys; forgetfulness, e.g. in relation to appointments, events and reasons for doing something; difficulty remembering words and numbers; and trouble concentrating, e.g. being easily distracted, losing your train of thought and absent-mindedness.
These troublesome symptoms can affect quality of life and are associated with poorer performance on tests of attention, verbal skills and working memory.
The memory problems may be caused by fluctuating hormone levels, especially oestrogen, and by some menopausal symptoms like hot flushes, sleep disturbances and mood changes.
Most women who have brain fog have concerns as to whether the memory issues are early symptoms of Alzheimer’s disease or dementia.
While memory issues are very common around the menopausal years, they usually improve with time.
All women go through the menopause, but most do not develop dementia.
Dementia in midlife is very rare unless there is a family history of early-onset Alzheimer’s disease.
The other symptoms of menopause-related brain fog are also usually mild and will improve in the post-menopausal years.
Hormone therapy
Oestrogen has been shown to have a positive impact on long-term cognition.
Women who are older at menopause have better cognitive function, especially verbal memory.
On the other hand, women with primary ovarian insufficiency, i.e. premature ovarian failure (where menopause occurs before 40 years of age) have poorer long-term cognitive function.
Cardiovascular risk factors in mid-life can predict the risk of cognitive decline and dementia in later life.
Diabetes, hypertension, smoking and raised cholesterol levels during the 40s double the risk of developing dementia when older.
Menopausal hormone therapy (MHT) is the most effective treatment of menopausal symptoms.
However, the effects of MHT on brain function and cognition are complex.
MHT may help brain fog.
Research has shown that it appears to be safe for cognition in a healthy person who starts MHT early.
In addition, oestrogen therapy alone appears to be safe even in late menopause for cognitive function.
Guidelines from the Internation-al Menopause Society note that there is insufficient evidence to recommend MHT use for the treatment or prevention of cognitive dysfunction.
As such, MHT is not recommended at any age to treat memory difficulties or to prevent cognitive decline or dementia.
On the other hand, treatment with oestrogen is advised in early menopause, or when the ovaries have been removed, thus causing a surgical menopause.
It is advisable to discuss the risks and benefits of MHT with one’s doctor.
Healthy heart, healthy brain
Anyone who has menopause brain fog and is concerned about getting dementia in later life can postpone or even prevent dementia by staying healthy.
Some of the risk factors for dementia like age, female gender and family history cannot be changed, but the good news is that there is much that can be done.
One important thing to remember is that a healthy heart is closely associated with a healthy brain, so taking care of your heart will also help to take care of your brain.
The following measures can help protect and promote both heart and brain health:
- Watching your weight by having a body mass index (BMI, which is weight in kilogrammes divided by the square of height in metres) of less than 25, or a waist-hip ratio of less than 0.9.
- Maintaining blood pressure below 140/90mmHg.
- Regularly monitoring or screening for high blood pressure, diabetes and obesity, which are all harmful brain risk factors if not controlled.
- Carrying out regular physical activity as cardiovascular fitness decreases the risk of dementia.
Ensure that you do a minimum of 150 minutes of moderate-intensity physical activity weekly.
- Consuming plenty of vegetables and fruits, and reducing sugary, starchy and fatty foods.
- Getting sufficient sleep.
- Minimising stress.
- Stopping smoking.
- Avoiding second-hand tobacco smoke and air pollution.
- Consuming alcohol moderately.
- Protecting the head from injury.
- Exercising the brain by learning new skills, reading, etc.
- Staying connected with family and friends as social engagement also promotes brain health.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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