What women need to know about brain fog and perimenopause
Recognising the signs early can protect cognitive health
Almost everyone experiences periods of brain fog at some point, when memory, focus or mental clarity may not be quite as sharp as usual. Although both men and women can experience these symptoms, for women there may be deeper physiological processes connected to midlife changes that require earlier medical attention to protect cognitive function.
“It can be deeply troubling for anyone experiencing brain fog, which for women can sometimes coincide with menopause,” says psychiatrist Dr Bavi Vythilingum, who practises at Netcare Akeso Kenilworth.
“Many women shrug off hot flushes and night sweats, yet evidence is emerging that these are more than just uncomfortable symptoms; they could be contributing to brain fog or to longer-term cognitive risk if not addressed.”
As a psychiatrist with a special interest in women’s wellbeing, Dr Vythilingum says the potential link between menopause and cognition warrants attention. “Women approaching midlife who seek help for brain fog are often worried about early-onset dementia, or fear that these symptoms may be a lasting part of life after menopause,” she says.
Psychiatrist Dr Bavi Vythilingum
“In perimenopause, it’s common to have trouble finding the right word. It’s not that you have lost the words. Think of how the brain files away nouns like houses in cul-de-sacs – instead of taking the most direct route to the word you want, your brain takes a detour to reach the right ‘address’ for the word. Women experiencing this will often recall the word with perfect clarity later,” she says.
“The hot flushes and night sweats typical of midlife changes are vasomotor symptoms involving the dilation of blood vessels, which can leave women feeling excessively warm and significantly disrupt sleep,” Dr Vythilingum notes.
“General secretary of the International Menopause Society, Prof Pauline Maki, validates many women’s experiences of brain fog in menopause. She is a former president of the North American Menopause Society and Professor of Psychiatry, Psychology and Obstetrics and Gynaecology at the University of Illinois.
“Prof Maki explains that vasomotor symptoms can directly affect sleep and, hence, memory. Mood also plays a major role in cognitive function, and hormonal changes in midlife can sometimes trigger anxiety or depression. This leading researcher in the field assures us that brain fog during menopause should not be misinterpreted as a sign of Alzheimer’s disease.
“This year, the International Menopause Society has updated and re-released guidelines on menopause, a significant development for women and their healthcare practitioners. Crucially, it has re-examined the use of hormone replacement therapy (HRT) across multiple aspects of menopause, beyond the typical symptoms such as hot flushes.”
The Society also examined HRT in relation to cognition, cardiometabolic risk, thrombolytic risk, and other risks or uses of HRT, providing an authoritative, evidence-based reference for informed decision-making, freely available at www.imsociety.org.
“Women should be encouraged to recognise the subtle signs of perimenopause and seek help early for any changes affecting their wellbeing. Many treatment options exist, both hormonal and non-hormonal, and the WHO emphasises the importance of individualised care that considers each woman’s unique symptoms and health profile.
“Menopause affects mood, sleep, cognition and general wellbeing so profoundly that every healthcare provider who treats women needs to recognise the signs and guide them to appropriate support,” she says.
In any mental health emergency, or for advice on accessing mental health care for yourself or a loved one, reach out for support. Netcare Akeso offers a 24-hour crisis line on 0861 435 787. Trained counsellors are available to talk and can guide you through the available options for assistance.
What is perimenopause?
Perimenopause is a precursor stage to menopause that can last several years, and the World Health Organization notes that it can affect women’s physical, emotional, mental and social wellbeing.
Usually, the first sign of perimenopause is when a woman’s periods become irregular.
“Previously regular cycles of 28 or 30 days become erratic – shortening to 15 days one month, stretching to 35 the next. Flow also varies dramatically, from very heavy to unusually light,” Dr Vythilingum explains.
“A lot of women refer colloquially to menopause, when in fact they are experiencing perimenopause. Menopause is defined as one year since your last menstrual period.”
