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  • “Brain Fog” in Menopausal Women. It is scary But Reversible.

    Menopause is a very challenging time for most women. Besides the stress of transitioning from the caregiving responsibilities of raising children, to empty nesters, a woman goes through both physical and emotional symptoms that can be disabling and stress-provoking.

    Emotional symptoms can range from mood swings to irritability, sadness, lack of motivation, aggressiveness, and even depression and anxiety. Some women who are struggling with existing depression, bipolar depression, or schizophrenia can experience worsening symptoms or even a relapse of their illness.

       One such common umbrella of symptoms that develops in perimenopausal, menopausal, and postmenopausal women is what we call “ Brain Fog”. It’s a term that healthcare professionals use to describe symptoms of reduced focus and mental clarity to increased mental fatigue, and forgetfulness.

       Brain fog can arise in many other conditions like post-cancer treatment, and various psychiatric conditions like anxiety, depression, OCD, PTSD, psychosis etc. It has also gained recent recognition due to its presence in long-haul survivors of COVID.

    Many women mistake these cognitive changes or brain fog with having some sort of dementia.

    A study was published in the journal Scientific Reports by Dr. Lisa Masconi, an Associate Professor of Neuroscience in Neurology and Radiology at Weill Cornell Medicine (WCM), and the Director of the Alzheimer’s Prevention Program at WCM/NewYork-Presbyterian Hospital. In that study, she scanned the brains of 161 women between the ages of 40 and 65 who were in various stages of perimenopausal and postmenopausal transition. The scans showed a decrease of both gray and white matter, increases in deposits of the Alzheimer’s-associated protein amyloid beta, and a reduction in glucose in the brains of these women. Thus explaining all these cognitive and memory changes that women in menopause were showing.

    What causes these changes in our body as we hit that period of menopause? 

    The hormone estrogen that a woman’s ovaries generate throughout her reproductive years, is not only essential in maintaining fertility and reproductive health. But it is very crucial to maintaining vigor, and normal emotional and physical growth of a woman. Dr. Masconi, through her research, found that estrogen is believed to push neurons to burn glucose to make energy”; thus keeping the brain younger and healthier.

    As estrogen declines with age, our neurons start slowing down and age faster.  This explains the cognitive changes, like trouble focusing, concentrating, increased forgetfulness, depression, anxiety, and all other menopause-related symptoms, including hot flashes and insomnia. 

    What will happen if women do not address these symptoms and do not seek active treatment? 

    Fortunately, even without addressing these symptoms, or not seeking any treatment per se, the studies show that the first year of menopause is the worst, but memory and learning ability generally rebound to normal after the menopause process is complete. For some that can take as less than one or two years but for a good percentage it could take up years, and some studies show it may take 10 years to clear that brain fog.

    So what can women do to help eliminate some of these symptoms related to menopause?

    Hormone replacement therapy: The aim of HRT is to restore female hormone levels. There are two main types of HRT:

    Combined HRT (estrogen and progestogen) – for women who still have their uterus.

    Estrogen-only HRT – for women who have had their uterus removed via a hysterectomy

    Although there are some studies that have shown some benefits of Hormone replacement therapy for brain fog and helping the woman to regain her vigor, most of them have failed to show that HRT or hormone replacement therapy can reverse these changes. However, there are still studies ongoing.

    Your doctor will determine whether or not you are a candidate for HRT and whether the benefits of using HRT are more than the risks.

     Not all women can tolerate them. Some of the most serious side effects of HRT are blood clots, high blood pressure, and risk of stroke. 

    Then there are some herbal and other plant-based treatments, supplements, and mind-body therapies called complementary alternative medicines that can be used, but again there is not much data on their effectiveness.

     Non-Hormonal Treatments:  SSRI or Serotonin reuptake inhibitors are medications commonly used for anxiety and depression. They have been found to be effective in some women with the cognitive change of menopause, as well as anxiety or mild depression associated with it. Your provider may put you on low-dose SSRIs like Escitalopram, fluoxetine, or sertraline, etc. 

    Some providers may also use other non hormone medications like Gabapentin, and Selective Estrogen Receptor Modulators ( meaning drugs that act like estrogens on some tissues like tamoxifen and raloxifene).

    Use of ADHD medications: A study done in May of 2021 at the University of Pennsylvania indicates that medications used for ADHD can help women regain some of their mental faculties associated with this menopausal-related brain fog. In this study, they used a drug called lisdexamfetamine (LDX) or Vyvanse. The study showed at least 40 percent improvement in symptoms of cognitive decline in menopausal women as opposed to just 17 percent in those who were given a placebo. However, only your health practitioner can determine whether or not these medications can help, as they are not free of some serious side effects. It’s all risk versus benefits.

    Natural ways of slowly overcoming symptoms of brain fog associated with menopause?

     1:Healthy diet. Avoiding junk food, high sugary drinks, red meat, and simple carbs. Resorting to a diet rich in protein, and complex carbs, choosing a  Mediterranean diet, with a lot of fruits and vegetables, olive oil, and fish, can be extremely beneficial in retaining cognitive alertness and decreasing the intensity of the brain fog. 

    2: Hydration. Drinking 8 to 9 glasses of water daily.

     3: Exercise: At least 30 min daily exercise at least five times a week 

     4: Supplements like vitamin B complex, Vitamin D, Vitamin C, omega three fatty acids, and a supplement that you can find in your local grocery store by the name of NAC ( N acetylcysteine) have been found to be quite effective for maintaining a healthy brain function. There are also some reports of the benefits of Ginkgo biloba in improving memory. But do check with your provider or doctor before starting these supplements. 

     5 Reducing Stress level: Reducing your stress level by joining a local gym, or a yoga class, spending more time in nature, journaling, talking to a therapist, incorporating a 10-minute meditation in your daily routine, being mindful of your day-to-day activities, showing gratitude for little things that you have been blessed with. These de-stressing activities can help substantially with both physical and cognitive symptoms associated with menopause.  

     6: Establish healthy social connections. Talking to a caring family or friend who listens in a nonjudgemental way is a great way to improve your level of alertness, decrease depression, focus, and stay relaxed. 

      7: Developing hobbies, like puzzles, gardening, taking up a  new sport, or playing a new instrument, can also be quite helpful. 

       8: Ensure proper control of blood pressure by maintaining a low-salt diet and taking your medications on time if you have been diagnosed with high blood pressure. And check your cholesterol frequently and ensure it is within range.

     9: Sleep: Mostly and most importantly, ensure you get a good night’s sleep by maintaining proper sleep hygiene, limiting your screen use, and listening to a meditation tape at bedtime. 


    North American Menopause Society, or is a very helpful organization for women going through this stage. There is a lot of helpful information about menopause, a series of videos with beneficial information, a list of Local practitioners in your area who can help you with menopause-related symptoms, and a lot of beneficial books on menopause.


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