Mind, Mood, Memory & Menopause

No Pause at Menopause

When the face slackens & the waist thickens
When the hair whitens & the knees weaken
Reading is a chore, the letters are a blur
Libido flags & the pelvis sags
Faces flush & tempers flare
Tears gush & voices blare
The woman in me, where is she?
I hate you, I love you, I hate me
I don’t know what to do
I know her not, this boo hoo hoo
When menopause does me scare
Then I need you there!

Menopause is a period of hormonal change after the age of 50 years with cessation of menstruation. It is an emotionally and physically challenging period for women as it accompanies normal aging as well.

Between the ages of 10 years and 50 years which is the reproductive phase of a woman’s life, the body is accustomed to the female hormone oestrogen which has benefits in preserving a woman’s well-being in addition to regulating the menstrual cycle.

In most women, there is a period of premenopause, menopause and postmenopause and symptoms can continue for several years across this time span which can be from 48 years to 52 years on average.

The brain is profoundly impacted during menopause with changes in memory, mood and brain efficiency as oestrogen has a role in nurturing neurons and dendrites of the nerve cells as well as the blood supply of the brain.

Symptoms of Mind and Brain Dysfunction

Mood

Fluctuations in oestrogen levels cause hot flashes and mood swings during menopause. These can be very disturbing to the woman experiencing them and if people around them do not understand them, they are often accused of being difficult and fussy. These changes are physiological and not in the control of the individual. Supporting them with compassion and understanding is important.

Memory

Oestrogen plays a crucial role in the formation and retrieval of memories, particularly in the hippocampus or the memory brain. Fluctuations in levels of oestrogen can affect short-term and long-term memory, forgetfulness, trouble recalling information and difficulty in learning new material.

Attention

Changes in oestrogen levels can also affect the ability to focus attention, sustain concentration on tasks, and switch between different tasks efficiently. Menopausal women may find long conversations and discussions stressful and are often easily distracted and less focussed.

Executive Function

These are the cognitive functions responsible for planning, organizing, problem-solving, decision-making and self-regulation. This can lead to difficulty in multitasking, setting goals, adapting to change and irritability and mood fluctuations which can impair the ability to manage daily tasks and prioritizing activities.

Cognitive Decline

Controversial research findings suggest the speed of cognitive decline in women after menopause may be more than in the average individual. But the final information on this is still under study.

Common cognitive symptoms during menopause:

• Forgetfulness
• Difficulty concentrating
• Finding the right word to say quickly
• Slow thinking

All of these changes are associated with age and menopausal stage being more in perimenopausal women due to erratic hormone fluctuations. Overall health and lifestyle factors also influence the occurrence and severity of cognitive symptoms being less in healthy women. Women with comorbidities like diabetes, hypertension, cardiovascular problems and other pre-existing health conditions are more at risk for developing cognitive symptoms in menopause.

What Lifestyle Modifications Can Reduce Risk of Cognitive Problems in Menopause?

Lifestyle Modifications

Diet – A balanced diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats with omega-3 fatty acids found in fish, nuts and seeds can all support cognitive function.

Exercise – Regular physical activity including aerobic exercise (e.g., walking, cycling, dancing, swimming, etc. which increase the heart rate), strength training (with weights) and balance exercises improve blood flow to the brain and produce BDNF (brain derived neurotrophic factor) which nourishes neurons.

Sleep Hygiene – Prioritizing good sleep by maintaining a relaxing bedtime routine, and ensuring comfortable sleep for 6-8 hours can prevent cognitive decline.

Cognitive Training – Engaging in activities that stimulate cognitive function such as puzzles, sudoku, brain games, word games, reading, learning new skills and participating in social and intellectual activities can help maintain cognitive abilities and promote neuroplasticity (the ability of the brain to change in structure, chemistry and function in response to environmental inputs).

Pharmacological Interventions – In some women, hormone replacement therapy may be indicated and this decision should be taken by the gynaecologist caring for the patient.

Some women may need medication for sleep, or to manage mood with tranquillizers or antidepressants.

Healthy lifestyle practices like avoiding smoking and alcohol, ensuring meaningful social connections for emotional well-being and management of chronic health conditions like diabetes and hypertension with regular medical care and follow-up is essential.

Regular monitoring and follow-up are mandatory in women experiencing cognitive symptoms to monitor any worsening.

Women with cognitive symptoms should be encouraged to communicate openly with family and their medical caregiver and not feel embarrassed to mention symptoms if any.

Psychosocial support from family, friends and community is important for menopausal women to help them navigate the ups and downs of these changes.

While menopause can produce considerable disturbances in physical, emotional and mental well-being for a few years around the age of 50, most of these symptoms often are fluctuant and get less intense within 1-2 years in most women.

Have the mindset that this is a welcome change with freedom from menstruation and the risk of pregnancy.

Furthermore, it increases your bandwidth to enjoy your life when often the children are grown up and managing on their own, you are free to pursue your own interests and just have to enjoy the senior years with people of your choice doing activities you love or could not pursue earlier in life.

Just love and live life – menopause frees you to do that.