Ask the Doctors: Tips on dealing with cognition issues during menopause

Dear Doctors: I’m 52 and going through menopause. I knew about the insomnia, night sweats and hot flashes. What’s upsetting is I’m also becoming mentally less sharp. Is this part of menopause? Would hormone replacement therapy help?

Answer: Menopause is one of the major milestones in a woman’s life, yet women often face menopause alone, while there’s an abundance of books, classes and medical visits that help prepare them to have a baby.

A woman is in menopause when she has gone 12 months without a menstrual period. The transition to menopause, known as perimenopause, is often gradual. It occurs due to a natural decline in reproductive hormones as a woman’s ovaries cease to function.

Symptoms include the sleep disruption, night sweats and hot flashes you mentioned. They also can include cramps, headache, weight gain, fatigue, sore breasts, thinning hair, low libido, urinary incontinence, depression and anxiety.

The memory changes you’re experiencing often accompany menopause as well. It’s estimated that up to two-thirds of women experience some degree of menopause-related cognitive impairment or brain fog.

This can include problems with decision-making, learning and retaining new information, concentrating, thinking clearly and forgetfulness.

Though the reasons aren’t completely clear, research suggests a link to the decline in reproductive hormones, particularly estrogen. Sleep disruption is also believed to play a role.

Hormone replacement therapy — low-dose estrogen or a combination of estrogen and progesterone — is sometimes prescribed to ease physical symptoms of menopause. Some women say it also helps with cognitive issues.

But long-term use of HRT is associated with adverse health effects, including an increased risk of breast cancer, heart attack, stroke and blood clots.

Talk to your healthcare provider about whether the benefits outweigh the risks for you.

Lifestyle changes can make a difference, starting with a well-balanced diet. Consider the Mediterranean diet, which is rich in brain-boosting omega-3 fatty acids and unsaturated fats. Eating a wide variety of fresh fruits, vegetables and leafy greens has been linked to improved cognition.

Exercise is also helpful. Studies have found that even light exercise, such as a yoga or tai chi, or a low-intensity session on a stationary bike can improve memory.

Quality sleep is important to cognition, too.

For most post-menopausal women, these cognitive changes don’t last. If symptoms worsen, though, ask your healthcare provider to rule out other possible causes.

Drs. Eve Glazier and Elizabeth Ko are internists at UCLA Health.