Losing it- brain fog and perimenopause

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During the pandemic, a man named Josh Wardle invented a game for his partner, Palak Shah who was fond of word games. His game, Wordle became a world-wide phenomenon with people texting their family and friends the results every morning, encouraging some competition and a lot of camaraderie. My family and I joined the Wordle craze and then sought out other similar games. Taylordle, Quordle, Heardle and WORLDle- to name a few. One of my kids found another game called Framed. The original version consisted of six snapshots from a movie that were presented one at a time with the opportunity to guess the name of the movie after each one. I’m a Gen Xer who spent hours in front of the TV watching shows and movies. So of course, I thought I had this game in the bag.

A young girl is captivated by the glowing screen of a vintage television, lying comfortably in her room with a soft pink backdrop.

And I did have it in the bag. For a while. I was able to guess the movie titles with a fair amount of consistency. But over the course of the pandemic and beyond, I noticed that I wasn’t doing as well.  I still recognized movies and could recall the plots, but the titles escaped me. Yes, that movie with a red pill and a blue pill…Keanu Reeves and I can picture the scene with green lights, but what was the name…. I’d move through my six guesses quickly until my phone flashed the answer in front of me. Ugh. The Matrix.

Competitive by nature, this did not sit well with me. Was I becoming stupid? Was this the middle age brain fog that I had heard about, or could I have early onset DEMENTIA or a BRAIN TUMOR or a STROKE? When you’re losing games to your kids early in the morning, and the world is imploding, life feels dire and it’s easy to hyperbolize (true story- I couldn’t remember that word and needed to use the online thesaurus just now).  I made a doctor’s appointment, and she asked me what prompted me to come in.  While she did not seem particularly sympathetic to my plight of losing word games, we did talk about my symptoms and its correlation to perimenopause.

A woman with a puzzled expression against a vibrant yellow background filled with question marks and exclamation points, capturing the essence of confusion.

Forty to sixty percent of women in the perimenopause period describe “brain fog” which can refer to a multitude of symptoms including difficulty remembering words; an inability to focus; and distractibility. The menopause transition period can cause insomnia, anxiety and depression which can also cause brain fog so it’s important to look at all causes- primary and secondary.

In addition, the brain contains estrogen receptors.  When the amount of estrogen in the body decreases those areas of the brain don’t get activated. Guess where these receptors are?  They are in the hippocampus and the prefrontal cortex.

What does the hippocampus do? Nothing important- just forming new memories and consolidating them into long-term storage. And what does the prefrontal cortex do? Hmmm…. It helps planning and decision making, problem solving, attention, and impulse control. Sound familiar? In short, during perimenopause and menopause the part of the brain that controls memories and executive function is not getting activated. Well of course, I was losing at word games. I didn’t stand a chance.

So, is the obvious solution to start estrogen and all be fixed? Not so fast. Four important things to remember with hormone replacement therapy:

1)    Estrogen has been shown to help cognitive function in women who undergo premature menopause after a hysterectomy (and ovary removal).

2)    In women who are in the natural menopausal transition, estrogen has NOT been shown to improve cognitive function (We need more studies!!!!)

3)    Estrogen DOES help alleviate menopausal symptoms (such as hot flashes and insomnia) which indirectly may help memory cognitive issues.

4)    POSTmenopausal women over the age of 65 who take conjugated estrogen and medroxyprogesterone have shown a doubling of dementia rates.

Anything else?

Brain health can be boosted by engaging in moderate exercise for 150 minutes weekly and healthy eating (especially a Mediterranean Diet). Avoid smoking and excessive alcohol consumption. See your primary care doctor to make sure your cholesterol, blood pressure and blood sugar are all in the normal range. Do those word puzzles, hang out with friends, pick up a musical instrument and utilize that brain of yours. You’re worth it!

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