Is it all in my head? -Cognitive Changes Related to Menopause Written by: Doreen Bridgman MS,CCC,SLP and CBHC

As a woman, I cannot tell you the number of times I have been asked, “Are you sure it isn’t all in your head?”  

This question was in response to statements about menstrual cramps, unexplained emotional responses after having my first child, and “brain fog” in my fifties.  Well, it turns out these changes were “all in my head,” but not the way the question inferred.  I wasn’t creating, exaggerating, or imagining these issues, they were related to the impact of hormones on my brain function.  I was part of the estimated two-thirds of women who experience some degree of cognitive change related to menopause.  Women can experience menopause differently; some will have few and mild symptoms, while others experience prolonged, severe challenges. 

These changes can occur in:

1. Memory and Concentration:  The term “menopausal brain fog” is associated with forgetfulness, difficulty focusing, and decreased mental clarity.  Hormonal fluctuations, especially a decrease in estrogen, are believed to be related to cognitive shifts.   Estrogen influences brain function through effects on the vasculature and the immune system. Estrogen is involved in the process of neurons modifying their connections, neurogenesis (formation of new neurons in the brain) in the hippocampus (brain’s memory center) and the strengthening of synapses (connections) based on recent activities.  This is how episodic memories (memories of everyday events that can be stated or recalled) are created.  Estrogen influences several neurotransmitter systems, including acetylcholine, serotonin, noradrenaline, and glutamate. Acetylcholine is important in memory processes.  

2. Mood Swings and Emotional Regulation:  Mood swings, irritability, and increased. 

sensitivity is frequently experienced during menopause.  This difficulty with emotional regulation can make it challenging for women to manage responses to everyday stressors. 

3. Increased Risk for Alzheimer’s:  Alzheimer’s disease following menopause indicates that estrogen may have an important role in protecting the brain from damage caused by Alzheimer’s.  When estrogen levels are reduced, so may be this protective effect.  Increased anxiety and emotional distress can be caused by a fear of cognitive decline related to menopause.  

The cognitive changes experienced during menopause do not occur in isolation; they can have a significant impact on a woman’s emotional well-being in the following ways:

1. Increased Stress and Anxiety:  Women may be worried about their level of forgetfulness and difficulties with attention, which can trigger anxiety about their abilities and self-worth.  This increased stress and anxiety can also lead to increased cognitive difficulties.  

2. Strained Relationships:  Mood swings and irritability can put a strain on relationships with partners, family members, and friends.  Women may feel misunderstood, and those close to them may struggle to adapt to the emotional ups and downs, impacting their overall well-being.   

3. Negative Self-image:  Cognitive changes can reduce self-confidence and lead to a negative self-image.   Women may become frustrated with their memory challenges or difficulty staying organized, which can reduce self-esteem and self-confidence.

Life did not stop while I was going through menopause as it doesn’t for all women.  Work and family responsibilities remain constant, so what can be done to manage the cognitive and emotional changes?

1. Hormone Replacement Therapy (HRT):  HRT is beneficial for some women, but it is important to weigh the benefits and risks with a medical provider.

2. Lifestyle Choices:  Lifestyle choices can have a positive impact on managing the challenges related to menopause.  These include:

1. Maintain a healthy and well-balanced diet.  The MIND (Mediterranean-Dash Intervention for Neurodegenerative Delay) diet, rich in omega-3 fatty acids and unsaturated fats, has been found to reduce Alzheimer’s.  

2. Exercise 5x a week for 30 minutes after getting medical clearance.

3. Maintain social contacts.  Spend time with family and friends.

4. Sleep 7-8 hours each night.

5. Reduce stress levels and set realistic expectations.  Implement strategies and ask for help when needed.

3. Support and Understanding:  Recognize you are not alone and seek support from family, friends, and professionals.  They can provide assistance, support, and strategies to manage the current challenges.  There is no shame in asking for help.

Menopause is a natural life transition and the cognitive and emotional symptoms often resolve over time. However, acknowledging the emotional turmoil and cognitive changes during that time is important so that self-confidence and emotional health are not negatively impacted during that time and beyond. The suggestions and strategies mentioned above will allow women to approach menopause proactively and maintain their confidence.

DOREEN BRIDGMAN, MS, CCC-SLP-CBHC is co-owner of BrainThrive Consulting and owner of The Cognitive Coach LLC.  Doreen is the co-creator of the ©Long Live Your Brain Program, an online brain health program to increase cognitive reserve, improve attention and memory and allow people to stay engaged in their daily lives.  Visit www.longliveyourbrain.com for more information.  Doreen is an Amen Clinics Certified Brain Health Coach and a licensed Speech-Language Pathologist.