Although hot flashes are the main symptom, there are several other symptoms associated with menopause such as:
A new study published in the journal January 12th menopause found a link between menopausal symptoms, particularly depression and sexual dysfunction, and cognitive performance in areas such as memory, attention and language skills.
Memory disorders and other cognitive problems are often not considered menopausal symptoms
“Often times, women don’t recognize these symptoms as part of menopause,” says Margaret Nachtigall, MD, a gynecologist at NYU Langone Health and clinical assistant professor at the NYU School of Medicine, both in New York City. “Because cognitive problems can develop slowly, they may not see this in connection with a loss of estrogen,” she says.
2 out of 3 women report cognitive problems during menopause
According to the Office on Women’s Health, a part of the Department of Health and Human Services, up to two-thirds of women in perimenopause report cognitive problems.
Problems with word retrieval, losing the train of thought are typical memory problems in mid-life
“For the women I see in the clinic, this can manifest itself as memory problems, the inability to find the right word for what they want to say, the dishes in the cupboard instead of the dishwasher, not sticking to everything remember what they wanted to go to the store or were in a meeting on their list and forget what they wanted to say, ”says Dr. Nightingale.
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Study included women at different stages of transition into menopause
To investigate whether women’s cognitive performance is related to the severity of menopausal symptoms, investigators examined 404 women in a rural area in northern India. The subjects were between 40 and 65 years old and were not receiving hormone therapy (HT).
The women were divided into four groups so that researchers could study the frequency and severity of various symptoms depending on the stage of change in menopause.
- Premenopausal women who still had regular menstrual cycles
- Perimenopausal women who have had irregularities in their cycle
- Women in the early postmenopausal period who had stopped bleeding completely for 12 months, with five years or less since their last menstruation
- Late postmenopausal women who last menstruated 5 years or more before
Researchers used standardized tools to record the presence and intensity of 21 different menopausal symptoms, including sexual dysfunction, vasomotor symptoms (hot flashes), depression, and anxiety.
A Hindi version of the Mini-Mental State Examination (MMSE) was used to measure cognitive performance and assess the impact of menopausal symptom severity on general cognitive performance and its five domains, including
- Language and spatial skills
The investigators found that the type of menopausal symptoms in women differed depending on the stage of life.
- Anxiety was the most common premenopausal symptom, reported by 24.1 percent of subjects.
- Hot flashes and anxiety were reported by more than 50 percent of perimenopausal women.
- More than half of women in early postmenopause reported having anxiety, depression, hot flashes, and physical symptoms such as difficulty sleeping or fatigue.
- Over 60 percent of late postmenopausal women had depression, sexual dysfunction, and physical symptoms such as difficulty sleeping or fatigue.
Severe menopausal symptoms have been linked to brain fog
The researchers found that women’s cognitive performance was related to the severity of certain menopausal symptoms, particularly depression and sexual dysfunction.
Sexual dysfunction can manifest itself in different ways during menopause, and people are often reluctant to talk about it, says Nachtigall. “Some women feel like their vagina is dry, itchy, or has a feeling like sandpaper in the vagina,” she says.
Decreases in arousal or sexual response and desire are also symptoms of sexual dysfunction, according to the North American Menopause Society.
The authors found no association between the severity of vasomotor symptoms and cognitive performance, although other studies suggested that such an association exist.
Lack of estrogen can cause many different symptoms
During menopause, the ovaries don’t produce estrogen, notes Nachtigall. “We have estrogen receptors almost everywhere – the brain, eyes, teeth, bones – so it’s not surprising that when you are lacking estrogen you can experience all of these different symptoms. It makes sense that a person with more menopausal symptoms and more severe symptoms would also have lower cognitive function, but interesting that they were able to show this in this study, ”she says.
These findings reflect what Nachtigall sees in her own practice. “Often times, people who have more hot flashes, depression, and generally more menopausal symptoms are the same people who have difficulty with cognitive function.”
Hormone therapy has been linked to improved cognition
This study provides further support that women going through menopause or perimenopause should seek care, Nachtigall says. “When you see a doctor, talk about the symptoms you are having, even if you don’t think they are related to menopause,” she says.
This can lead to an important discussion of various treatment options, including whether or not hormone therapy (HT) can help with your symptoms, Nachtigall says. “Estrogen has been shown in several studies to improve symptoms of cognitive function. Estrogen has also been shown in many studies to reverse hot flashes, improve mood, improve sexual functioning, and improve vaginal dryness, so it can be a good option for many people, “she says.
Research published in menopause found in December 2019 that for some women who were more exposed to estrogen, it could have a cognitive advantage later in life, both through a longer reproductive window and through the use of longer-term HT.
The risks and benefits of hormone therapy should be discussed with your doctor, as it isn’t for everyone, including women who have unexplained bleeding, estrogen-receptor-positive cancer, or have severe liver disease or clotting disorder, Nachtigall says.
Treating the underlying medical conditions can alleviate cognitive symptoms
The results of this study indicate that not all menopausal-related symptoms are hot flashes; there are other symptoms, says Stephanie S. Faubion, MD, the director of the Center for Women’s Health at Mayo Clinic in Rochester, Minnesota and the medical director of the North American Menopause Society (NAMS).
“These include those cognitive changes that women often describe as well as mood issues that need to be addressed,” says Dr. Faubion. That doesn’t mean all of these symptoms can be treated with hormone therapy – there could be other problems or conditions that contribute to these symptoms that need to be addressed and evaluated, she adds.
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“The important thing to know is that we don’t know whether hormone therapy during menopause will help memory in the short or long term. But we know if you’re going to be taking hormone therapy for other menopausal symptoms – hot flashes, night sweats – it tends to help with your mood, ”she says. The relationship between depression and memory problems is well known, adds Faubion.
Insomnia, other sleep symptoms, can be an early sign of an estrogen deficiency
If not with hormone therapy, is there any way I can treat “brain fog” or memory problems? “Solutions to memory problems can be related to sleep problems or an underlying sleep disorder. It can also be improved through coping with stress or treating underlying mood disorders such as anxiety or depression, ”says Faubion.
Nightingale reiterates that sleep is an important issue and often a problem for women during menopause. “A lot of the people I see complain of insomnia, and that’s one of the first signs of estrogen deficiency that menopausal patients experience,” she says.