Perimenopause is a natural occurrence in a woman’s life that leads to menopause, most often happening in the 40s but potentially starting even earlier. This time of life brings with it a sharp reduction in hormones, especially estrogen, that can and often do lead to a number of significant health changes
Among those changes, many women report changes in their thinking or cognitive function. These changes are all too often ignored or even stigmatized, yet they should be understood as part of the perimenopausal process. Cognitive decline is not a part of normal aging; it is a part of perimenopause for many women. And, if we are going to understand it adequately, we must also understand its probable causes and its potential relationship to the more common mood swings and episodes of depression that occur during this time.
Understanding Perimenopause
Before exploring the effects on cognition, it is best to begin with a straightforward definition of perimenopause. Perimenopause is simply the time leading up to the big event, when production of the priming hormone, estrogen, starts to wind down. It can last several years, with women in this stage subjected to a veritable potpourri of complaints, including irregularity of menstrual cycles, hot flashes, night sweats, mood swings, and sleep disturbances. (Not a very enjoyable time, period!)
Cognitive Changes During Perimenopause
- Memory Issues
Cognitive changes, especially memory disruptions, are among the most frequently mentioned complaints of women moving through the stages surrounding menopause. The potential side effects on mental sharpness and clarity of thought are getting more attention in research and are, of course, the subject of much conversation among women experiencing these changes. Some experts now believe that the lack of estrogen may play a role in the inability to concentrate or focus on tasks, but most agree that more study is needed to figure out exactly what is going on and why. - Difficulty Concentrating
Numerous women in the perimenopause contend with an inability to concentrate or focus on tasks. Many have become accustomed to being high achievers; therefore, the following cognitive functions that are often taken for granted can become troublesome:
- Completing work projects
- Reading a book without losing track of the storyline
- Following conversations with the right amount of attention so that the talker knows you’re “with” them.
Stress and the kind of brain fog that comes with not getting enough sleep can make the natural state of your mind feel like quicksand.
- Slower Processing Speed
Slower processing speeds are another cognitive change that may occur during perimenopause. Women might notice that it takes longer to comprehend novel information or respond to queries. This change can be disheartening, particularly in the work world, which thrives on rapid-fire interactions, misunderstandings, and ever-present multitasking. Why is this happening? A slew of recent research pointed to the obvious culprit—estrogen and its many metabolites, or byproducts, that are formed when the hormones are broken down. - Emotional Changes and Their Impact on Cognition
The period leading up to menopause is commonly referred to as perimenopause, and it can last for several months or years. During this time, a woman undergoes many changes, both physical and emotional, all of which can affect her life and her relationships. Not all women go through the same changes in the same way, but the following list describes some common changes in the physical and emotional realms that many women report during perimenopause. - Sleep Disruptions and Cognitive Function
Many women suffer from poor sleep during perimenopause, with insomnia or disrupted slumber due to night sweats or other hormonal changes. The worry is that not getting sufficient shut-eye could lead to actual cognitive decline, particularly as the National Institutes of Health (NIH) recently reported that a significant number of women (up to 60 percent) have experienced some type of cognitive impairment during the past few years. Poor sleep was the biggest factor that troubled many women.
Causes of Cognitive Changes During Perimenopause - Hormonal Fluctuations
Cognitive changes that occur during perimenopause are mainly due to fluctuations in hormones. The most important of these is a decline in estrogen. Estrogen is known to protect the brain and to help it function in a way that maintains cognition. When levels of estrogen fall, the alterations in neurochemistry and in the neuroprotective environment the brain usually enjoys may be just enough to cause some women to have difficulty “finding the words” they need to retrieve from memory, or to reason as they usually do. - Stress and Anxiety
Changes in cognition may also be related to increased stress and anxiety levels. The emotional toll of perimenopause, in conjunction with a woman’s other life responsibilities, can lead to elevated stress levels. And we know that chronic stress can adversely affect cognitive function, which may be experienced during this time as difficulties with memory and concentration. - Sleep Deprivation
As noted previously, disturbances in sleep are frequent at perimenopause. The cognitive consequences of not getting enough sleep can be very serious, resulting in loss of memory, attentional deficits, and much slowed thinking. This was established a long time ago, and in the past few years, there has been a lot of discussion about how the findings pertain to menopause. But the is really the “why” behind the cognitive complaints some women may have during this time.
What to Expect: Individual Variability
Cognitive alterations during perimenopause are widespread among women and vary greatly in appearance and intensity from one woman to another. Some women might find that the changes have significantly affected their day-to-day functioning. Others might perceive them as a minor nuisance not worth discussing in a medical setting. Still, others frankly say they have experienced no changes whatsoever, and considerable evidence suggests that some women are simply not affected at all.
Strategies for Managing Cognitive Changes - Prioritize Sleep
Setting a regular sleep schedule and forming a sleep-conducive environment can boost sleep quality. Try these strategies:
- Limit caffeine, especially in the afternoon and evening.
- Keep a consistent sleep schedule.
- Have a relaxing pre-sleep routine.
- Stay Mentally Active
Participating in tasks that require mental effort can assist in preserving cognitive performance. Puzzles, reading, and the acquisition of entirely new skills can substitute for the recommended occupational therapy of a few decades ago. Ways of stimulating the brain are ways of keeping it increasingly healthy. - Manage Stress
Practicing stress reduction methods can help lower anxiety and cognitive impairment
For some women, anxiety and depression can be a significant issue during the perimenopause. The brain is undergoing massive changes; there can be an increase in amyloid plaque deposition (the same type of plaque that is associated with Alzheimer’s disease). Some studies have shown that up to 60% of women experience cognitive issues (not necessarily memory problems) during the perimenopause. Both anxiety and depression can contribute significantly to that situation. - Maintain a Healthy Diet
A diet that is balanced and abundant in fruits, vegetables, whole grains, and healthful fats lends itself to optimal cognitive health. Of the nutrients that support the structure and function of the brain, omega-3 fatty acids are particularly notable. Found primarily in fish and seafood (shellfish), omega-3s (EPA and DHA) are delivered best through these water-based sources, although other foodstuffs (like fortified eggs) can also provide these beneficial fats. - Seek Professional Help
When cognitive changes occur, and if they become overwhelming or start to seriously affect daily life, consider seeking some professional help. Seeing a healthcare provider or a mental health professional can give you the support and resources you might need to manage these changes during this pre-menopausal stage.
Conclusion
The natural alterations in cognitive functioning that some women undergo during perimenopause are not well understood, even by many health care providers. Yet, they are as natural as the changes in hormone levels. Cognitive alterations during perimenopause do not guarantee a woman will experience dementia. Medline Plus states, “Some researchers think that the changes in hormone levels during perimenopause may affect the brain in ways that cause certain cognitive changes. Hormone replacement therapy (HRT) may help some women with cognitive changes and is helpful for some women who have hot flashes and who otherwise don’t feel well.