Does Early Menopause Mean Cognitive Decline?

From the sleep-deprived days of early motherhood to the ever-evolving demands of midlife, women in various life stages are likely more than familiar with the disorienting feeling of “brain fog.”

But when do forgotten appointments, small lapses in judgment, or trouble recalling memories or names signal more than the average “brain fog” associated with menopause— and can transitioning through this life stage early play a role?

Here, Bonafide Chief Medical Officer, Dr. Alyssa Dweck, talks about the potential causes of early menopause, whether or not it’s linked with cognitive decline, and what women can do to potentially protect their brain health as they age.

What Causes Early Menopause?

Most women reach menopause—measured by the cessation of a menstrual period for 12 consistent months— in between their late 40s and early 50s.¹ Early menopause, however, which occurs before age 45, can happen on its own or due to surgeries, medications, or certain health conditions/procedures, including:²

• The removal of reproductive organs (hysterectomy or oophorectomy)
• Chemotherapy
• Autoimmune diseases (i.e. thyroid disease, rheumatoid arthritis, etc.)

Other variables that may contribute to early menopause include smoking, a family history of early menopause, or chromosomal syndromes stemming from birth.³ 

What is Cognitive Decline in Early Menopause?

While symptoms like hot flashes and mood swings are hallmark of the menopause experience, regardless of age, lesser-known symptoms, like brain fog—which can include forgetfulness, confusion, and trouble concentrating—are also experienced by more than 60% of women transitioning through this phase of life.⁴

While brain fog is not an official clinical diagnosis, but rather a constellation of symptoms, Dr. Dweck says it’s a common complaint from women she treats in her practice. 

“Women during menopause typically complain of “brain fog,” explains Dr. Dweck. “The term is not a formal medical diagnosis, but rather a collection of symptoms including poor memory and word recall, difficulty focusing, trouble with decision making, lack of mental clarity and a general feeling of mental cloudiness.”

Signs of Cognitive Decline

Other symptoms of brain fog commonly associated with cognitive decline experienced during menopause can include:⁵

• Forgetfulness
• Missing appointments or events
• Trouble following conversions or recalling words
• Trouble navigating otherwise well-known destinations
• Poor judgement or decision making
• Issues remembering names or places

Now, newer bodies of research are suggesting that entering menopause early may lead to cognitive decline and potentially increase women’s risks for developing dementia later in life, but more research is being done in this area to determine any definitive complex connection(s).^6,7 

Another study published by Canadian researchers suggests women who experience a greater number of menopause symptoms may be more susceptible to developing cognitive and behavioral impairments later in life.⁸ Although this particular study’s findings are observational and not population-based it does beg the question—does menopause actually cause cognitive decline?

Causes of Cognitive Decline During Menopause and Beyond

While many variables can influence a woman’s likelihood for cognitive decline, hormonal shifts experienced during menopause can be partly to blame, according to Dr. Dweck.

“Lower estrogen levels have a significant effect on the brain, which is rich in estrogen receptors,” explains Dr. Dweck. “In addition, sleep disruption due to night sweats and nocturnal awakenings, which are also effects of low estrogen, can lead to daytime grogginess and brain fog.”

Researchers have uncovered this aforementioned link between drops in estrogen during menopause and changes in memory performance and function.^9,10 Women navigating menopause, in addition to having several of the risk factors listed below, may be even more at risk for experiencing cognitive symptoms:^11,12,13

• Sleep disorders
• Mental health disorders
• Alcohol and/or drug use
• Deficiencies or too-high levels of vitamins or minerals
• Sedentary lifestyle
• Smoker/consume alcohol
• Unhealthy diet
• Hypertension
• Stroke or vascular disease

Can You Reverse Cognitive Decline?

Fortunately, Dr. Dweck reassures us that menopause-related cognitive decline may be temporary for many women— and managing common menopause symptoms may positively impact memory and cognition, simultaneously. 

“In general, many report a significant improvement in the symptoms of brain fog with time,” says Dr. Dweck. “Additionally, brain fog may lessen with management of hot flashes and night sweats, and as sleep improves.”

There’s unfortunately no foolproof way to eliminate every risk for developing illnesses like dementia, but science supports the idea that a healthy lifestyle may help to reduce your chances.

Some things you can consider doing to help reduce your risk(s) for dementia and/or cognitive decline, include:^14,15

• Eating a healthy diet rich in omega-3 fatty acids
• Manage blood sugar issues
• Maintain a healthy weight.
• Exercise regularly
• Limit or avoid alcohol consumption
• Avoid smoking (or take steps to quit)
• Maintain healthy blood pressure
• Connect regularly with friends and loved ones
• Get adequate amounts of sleep each night.

Dr. Dweck adds that incorporating brain exercises into your daily routine is another powerful way to maintain brain health in addition to covering the basics of nutrition, exercise, and stress management. 

 “‘Exercises for the brain’ such as reading, music, games and puzzles and community engagement, as part of your daily routine, can also be helpful,” explains Dr. Dweck. “It’s important to ensure medical health, medications, diet, exercise and stress reduction are optimized as well, since brain fog can present as a symptom of other health issues.”

Brain Fog in Menopause? You’re Not Alone—And Help Exists

If you’re experiencing any symptoms of cognitive decline, it’s important to start the conversation with a healthcare provider who is aware of your current health status, medications, and family medical history. A qualified physician can help determine the root cause of brain fog, or if you’re dealing with a different condition, and troubleshoot safe ways to address your symptoms. 

Early Menopause Causes & Cognitive Decline | Cognitive Decline Signs

Resources

1. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
2. https://womenshealth.gov/menopause/early-or-premature-menopause
3. https://womenshealth.gov/menopause/early-or-premature-menopause
4. https://www.healthdirect.gov.au/blog/how-to-combat-menopausal-brain-fog
5. https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC10095144/
7. https://newsroom.heart.org/news/early-menopause-may-raise-risk-of-dementia-later-in-life
8. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0301165
9. https://pubmed.ncbi.nlm.nih.gov/27683911/
10. https://www.health.harvard.edu/blog/menopause-and-memory-know-the-facts-202111032630
11. https://www.alzheimers.org.uk/about-dementia/types-dementia/mild-cognitive-impairment-mci-causes
12. https://www.sciencedirect.com/science/article/pii/S2666245024000187
13. https://www.health.harvard.edu/staying-healthy/staving-off-dementia-when-you-have-mild-cognitive-impairment
14. https://www.nhs.uk/conditions/dementia/about-dementia/prevention/
15. https://www.alzheimers.gov/life-with-dementia/can-i-prevent-dementia#what-can-you-do