The Washington Post had a recent health article I wanted to discuss. They quote doctors and women who talk about the very real effects of perimenopause on cognition and mood. As someone in my late 40s going through this, it rang true to me. It was somewhat reassuring that this happens to so many of us, but also kind of scary like what else is in store? I haven’t had hot flashes yet but know that’s coming. Here’s more on that. They say that they need to do more research because of course they do. Women’s issues are ignored and glossed over.
“I have patients complaining all the time about their brain function,” says Cindy Parnes, a gynecologist and founder of the New Jersey Women’s Wellness Center in Montvale. “They are worried. But I tell them there are many Hallmark cards about [midlife forgetfulness], and if Hallmark is making cards, it’s because a lot of people can relate to it.”
The Department of Health and Human Services’ Office on Women’s Health says up to two-thirds of women in perimenopause report cognitive problems, although estimates as to the extent of affected women differ among experts. It’s also still unclear what causes these deficits — hormones or other factors — and whether they continue postmenopause.
With all the uncertainties, however, scientists don’t doubt these problems exist, and can be disruptive.
“Growing evidence says this is real,” says Miriam Weber, associate professor of neurology and obstetrics and gynecology at the University of Rochester, whose research suggests that symptoms typically begin during perimenopause.
“Multiple studies have shown declines in memory and attention,” Weber says. “What we don’t know is whether it persists. So far it seems like it may be temporary, just through the transition” from perimenopause through menopause…
Pauline Maki, past president of NAMS and professor of psychiatry, psychology and obstetrics and gynecology at the University of Illinois at Chicago — and one of the study authors — estimates that 1 in 10 women will have “clinically significant” menopause-related cognitive changes, even into the postmenopause years. She says more research is needed into how long — and why — these symptoms can last.
“We need a better understanding of who is vulnerable to persistent menopause-related cognitive changes and why, so that we can personalize strategies for maintaining cognitive health into the postmenopause,” she says.
Researchers believe hormones are involved, although they aren’t sure how or to what extent.
“We think it does have to do with hormonal changes, but memory problems are also related to things like depression, sleep disturbances and hot flashes,” Weber says. “However, we know that even when we control for those, we still see these effects. So they aren’t the whole story.”
Studies find that hormone replacement therapy doesn’t prevent or improve cognition deficits in menopausal women. But research suggests that it can prevent the onset of depression upon entering perimenopause.
“I think it’s very clear that a subgroup of women do develop depression, for some for the first time in their lives, and there is evidence that declining estrogen contributes to its development,” says Peter Schmidt, chief of the behavioral endocrinology branch at the National Institute of Mental Health and one of the study authors. Replacing waning estrogen “does seem to be effective in improving mood,” he adds.
So what is the answer to this? I don’t want to take hormone replacement therapy because my mom is still getting hot flashes in her 70s as she tries to taper off hers. Plus I’ve gone on very low dose birth control and still had high blood pressure from it. However I’ve heard that you can just take estrogen and that may help. I’m trying to eat healthier (meaning less sugar) but also by just replacing snack food with fruits and vegetables. There’s no easy answer. I posted about this on Twitter and so many of you told me you’re going through it too. I also got some great suggestions and am grateful for that. I’m thinking of you and hoping we all get some relief.
Photos credit: Alex Green, Ketut Subiyanto and Andres Ayrton on Pexels
