Is brain fog a sign of dementia or a normal symptom of perimenopause and menopause?
Can migraines start during perimenopause?
What can you do to relieve these symptoms, and when should you be worried about them?
Menopause and fluctuating hormones can have a huge impact on brain health, and many women worry that the resulting symptoms could be a sign of something more sinister.
Katie invited Professor Guy Leschziner, Consultant Neurologist and a Professor of Neurology and Sleep Medicine at King’s College, London, to the podcast to help us understand how to protect our brain health and potentially reduce the risk of developing Alzheimer’s and dementia in midlife, menopause and beyond.
Listen to the full conversation in The Latte Lounge podcast episode above.
Brain fog is a very poorly understood condition that has really come to the fore in recent years. Not only because of menopause but also as a large number of people suffering from long covid are complaining of very similar cognitive complaints to women in perimenopause. Professor Leschziner explained the difference between these complaints and those which you would expect to present in early-onset dementia
He also discussed the relationship between brain fog and insomnia, how that could be helped with HRT and lifestyle measures, and how oestrogen can be protective of brain health as well as cardiovascular and cerebrovascular disease.
Some of the key advice from this episode:
How can brain fog be treated?
It is usually a question of treating what we know is there and seeing whether or not the brain fog resolves as a result. For many women, when they are treated with HRT, their cognitive function is resolved.
When should we be more concerned that it could be something like early-onset dementia?
It's very unusual for brain fog to be the first feature of dementia.
The cognitive processes that occur in the early stages of dementia are not just difficulty thinking or clarity of thoughts. What people with dementia (or their relatives) usually complain of is the loss of autobiographical memory, getting lost in places that should be incredibly familiar, or marked behavioural changes.
It's a somewhat difficult clinical picture of brain fog, but if you are concerned that you may be exhibiting more marked cognitive impairment, then see your GP to see if there are any strong features to suggest that this is something other than the cognitive dysfunction associated with perimenopause.
If so, get a referral to a neurologist or another cognitive expert.
Is there evidence to prove that having enough oestrogen is brain protective?
Dementia is multifactorial. There are strong influences of both genetics and lifestyle. One of the biggest aspects of risk for cognitive dysfunction or cognitive impairment associated with conditions like Alzheimer's or other forms of dementia is a disease of the vasculature or blood vessels.
Certainly, oestrogen appears to be protective against cardiovascular and cerebrovascular disease, which is perhaps one of the reasons why there is such a disparity in terms of coronary heart disease between younger men and women, so oestrogen may, to some extent, be protective against developing these conditions.
There are certain protective factors that apply to everyone, not just women who are going through menopause.
Regular exercise, making sure your blood pressure is well controlled, not smoking, not drinking too much and continuing to develop cognitive function by taking up new skills are all protective and should apply to everybody.
We know that poor quality sleep directly influences our cognitive abilities the following day, but there's an increasing body of evidence to suggest a link between sleep and long-term cognitive decline.
It seems to be the case that people who sleep very little have an increased risk of cognitive dysfunction later on in life, which does create significant anxieties for many people with insomnia, but insomnia and sleep deprivation don't always equate.
In fact, for the majority of individuals with insomnia, when it's recorded using brainwaves, actually the amount of sleep that they're getting is not hugely different from normal individuals. For the vast majority of individuals with insomnia, although they may well complain of cognitive decline, this is reversible.
Even the majority of individuals who say that they are sleeping for just four or five hours a night may have a degree of sleep state misperception.
Although they are waking up repeatedly through the night, their brain tells them that they've been awake between those awakenings, whereas actually, the brainwaves show us that they've gone back to sleep again and the actual number of minutes that they're spending asleep is not as short as they think.
Why do we experience an increase in migraines during midlife and menopause, and what can women do for relief?
There is no doubt that migraine is under hormonal regulation. Women are much more likely across the board to suffer from migraine than men.
A sizeable proportion of women with migraines find that they get much worse at a particular point in a menstrual cycle. It's very common for women, particularly during menopause, to see either a significant deterioration in migraines or actually to develop them for the first time.
If they're very intermittent, there are some lifestyle factors that you can undertake to try and improve your migraine control. We know that people with migraine tend not to respond very well to any changes in their environment.
Eat regularly, and make sure that you're not dehydrated.
Trying to maintain your body's environment in a stable format is going to be helpful in controlling your migraines.
There are also some complementary therapies, such as magnesium supplements, for which there is some evidence of improving migraines.
Try taking a standard painkiller as an abortive therapy. Ibuprofen, aspirin or even paracetamol should be taken as soon as you feel the migraine coming on because it's much easier to treat in the early stages than wait until it's fully established.
For more frequent migraines, there is a range of drugs that can be enormously helpful in terms of reducing the frequency or severity.
In individuals who only have very severe migraines in their pre-menstrual period, when they're still menstruating regularly, we will very occasionally use the oral contraceptive pill and run it through for three months at a time so that the impact of their migraines on their quality of life is limited.
Occasionally we can use preventative migraine treatments during the premenstrual period in order to try and prevent those migraines from coming on within that window.
For some women who are perimenopausal, HRT can actually cause a dramatic improvement in their migraines.
What should you do if you’re concerned about brain health?
Make sure that there's nothing that you are doing in your lifestyle that might be impacting you. Many of the things that we've already discussed, exercise, sleep, and stress, we can address relatively easily.
The first port of call is your GP, and arriving armed with a bit of information to back up what you are saying may be very helpful to try and address any aspects of perimenopause you've identified that might benefit from HRT.
Many practices now have a women's health or an HRT lead. These are GPs who are particularly interested in this aspect of medicine, and it's worth exploring whether or not your practice has somebody like that because the more informed, the more experienced your GP is, the more likely you are to get a resolution to your symptoms.
Sleep issues can be absolutely debilitating during midlife and menopause. Many of our FB group members complain about disrupted sleep and insomnia and the knock on effect on their ability to work, to function at home and on their relationships can be pretty devastating.
Professor Guy Leschziner is a Consultant Neurologist and a Professor of Neurology and Sleep Medicine at King’s College, London. He is a published author with ongoing research interests in sleep disorders including restless leg syndrome, has presented 2 series on the brain and sleep for BBC radio and you may recognise him from "The Secrets of Sleep" on Channel 4.
You can find Professor Leschziner on Twitter as @guy_lesch or visit his website.