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One of the harder-to-define symptom areas of the menopause is the mixture of cognitive function (thinking) impairment – the ‘poor concentration, memory loss and general brain fog’ described by many women. It’s harder to specify a pattern compared to other menopausal symptoms, but this can be just as disabling.

This article was included in issue 82 (autumn 2019) of  The Menopause Exchange newsletter.

Are you at risk?
Menopausal symptoms – flushes and sweats interrupting sleep, aching limbs causing tiredness, mood swings or low mood and anxiety resulting in poor sleep or inability to focus on complex tasks–will all contribute to a reduced ability to think clearly, concentrate and recall. There’s no definitive test but cognitive function is definitely part of, and affected by, the bigger picture.

Psychological reactions to everyday problems may affect cognitive function, even outside the menopause. While the menopause isn’t necessarily a stressful time, it occurs at a point in life when you may be dealing with other life challenges, such as parents’ ill-health, bereavement, teenagers, children leaving home (or not leaving home) or work demands. Having hot flushes and night sweats can be stressful; conversely, being anxious and stressed can make hot flushes more difficult. Going through the menopause may affect self-esteem, leading to low mood due to negative beliefs about the menopause, and stigma about age and reproductive status.

These cognitive symptoms may also be part of other conditions that become increasingly common as people age. These include thyroid problems, respiratory, kidney disease and vascular disease, anaemia, diabetes and, for a few, the beginnings of dementia.

Getting a diagnosis
If you feel that poor concentration and memory loss are affecting your life and work capacity, your GP should check you over to exclude other causes and then focus on what may help. An initial history and examination may reveal that you have a thyroid problem, but you’ll usually also need to exclude other disorders. You may need to have blood tests to check your liver, kidney and thyroid function and blood sugar, vitamin D and iron levels. An ECG may detect possible hardening of the cerebral (brain) arteries and an MRI can show cerebral vascular disease or other changes. But this is unlikely to be available as a first-line test on the NHS unless your GP ’s neurological examination suggests cause for concern. The bottom line is that your GP will be looking to exclude any other cause of impaired thought processes before accepting that it’s part of your menopausal pattern.

Treatment options
There’s no specific treatment, but managing general menopause symptoms and ensuring a healthy lifestyle will all help, including reducing anxiety and stress. HRT may have beneficial effects on low mood and low libido and may help cognitive function as flushes reduce and sleep improves.

National Institute for Health and Care Excellence (NICE) guidelines in 2015 on the menopause include recommendations that may help impaired menopausal cognitive function. These include: cognitive behaviour therapy (CBT), which reduces stress and may help cognition; breathing techniques; lifestyle changes; and complementary therapies.

  • CBT can be helpful for a range of problems, including anxiety and   stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue. It focuses on the links between physical symptoms, thoughts, feelings and behaviour. The way we think about symptoms in certain situations tends to affect how we feel and what we do, and these reactions can in turn increase the intensity of bodily reactions and affect our higher mental function.
  • Think about what makes you feel calm or content, however small (e.g. relaxing, yoga, going for a walk, exercise, calling a friend, reading a book). Try to do more of these activities, even for just a short time every day. Aim for a balance between rest and activity, and pace your activities throughout the day. Consider the benefits of positive thought, e.g. instead of ‘I won’t be able to function tomorrow’ think ‘I have managed before so I know I can cope’.
  • Relaxation and paced breathing can calm down your body’s physical and emotional reactions, again helping clarity of thought and concentration. Paced breathing is slow, even breathing from your stomach, increasing lung capacity and oxygen supply to your brain, and has a significant calming effect. Putting one hand on your chest and one hand on your tummy helps as you get used to this way of breathing. The hand on your chest should stay fairly still and the hand on your tummy should rise and fall as you breathe. Let your shoulders relax and focus on your breathing for a few minutes to give you time to pause and think more clearly.

Lifestyle advice
Lifestyle changes may help your sleep, concentration and memory.

  • Limiting early evening light in the bedroom helps your brain to release melatonin linked to the onset of sleep. This includes light emitted from mobile phones and laptops, so switch these off.
  • Limit caffeine and alcohol, both of which have a negative impact on sleep onset and quality.
  • A cool sleeping environment helps facilitate sleep.
  • Develop a good bedtime wind-down routine with relaxation and paced breathing.
  • Maintain a regular sleep pattern – avoid ‘lie-ins’ and naps after 3pm which eat into sleep the following night.
  • Even after a poor night’s sleep, research consistently shows that it’s better to continue as planned the next day and not to cancel activities and plans, as this can set up unhelpful thinking and behaviour that makes sleep problems worse.
  • Complementary therapies and products such as soy and black cohosh may help but are unregulated.

About the author
Dr Gill Jenkins is a GP in Bristol with over 25 years experience and an interest in women’s health, lifestyle management in health and travel health.

Created Autumn 2019

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