Transcription
Okay, raise your hand if you ever thought or worried that you were developing early onset Alzheimer's because of the brain fog or memory changes that you were starting to experience in the perimenopausal phase or in the menopausal transition. I know my patients come to me all the time worried about brain fog, memory changes, and concerns about their brain health in general.
So today's video is going to be all about brain health, and we're going to discuss three things because, you know, I like to do things in threes. We're going to discuss when, when is it the worst? We're also going to discuss why, why are these changes something that you are experiencing? Why is it so common, which it is, if you didn't think that it was? And three, what, what can you do about it? So if you want to know more about brain health in perimenopause and through the perimenopause transition, then stick around.
If you watch this video all the way to the end, I'm also going to tell you my thoughts on the use of hormone therapy and Alzheimer's disease, which is a question I get over on my Instagram all the time. So if you're not already following me over on Instagram, I'm at hormone.health.doc, where we have an amazing community and lots of really good conversations. That really is a great place to let me know what are the questions that you are struggling with, what are the things that you want to learn about, and it's definitely making this channel an even better place for you to head to for all of your evidence-based menopause information.
Hi, if you don't know me, I'm Dr. Heather Hirsch. I work as a menopause director at the Brigham and Women's Hospital, where I see patients on a consultative basis for perimenopause and menopause, and I'm also faculty at Harvard Medical School. And I love, love, love, love my job because a lot of what I do is really validate some of the things that you are experiencing and break down what you're experiencing is relatively common, especially because perimenopause and menopause is still so under, understudied.
This means I do menopause day in and day out, and I can assure you, brain fog is something that I hear my patients worry about all of the time. I had an accountant tell me that she actually retired early because she was worried she was going to make a huge mistake at her job. I've had teachers of all levels, be it elementary school or universities, saying that they're worried about their job security because they just can't keep up with their students. I have even had patients tell me they've had left their stoves on, they've left their doors open, they've had things stolen out of their cars because they are just so forgetful, and this is not like them.
So to get to our very first point, is when is this most obvious? Well, a lot of research is showing that actually, a lot of changes in memory and in verbal memory, um, happen in perimenopause. So perimenopause is the time leading up to menopause. So your periods start to change, and that's really a great way to know that you are in perimenopause. If you're interested in learning more about that, check out this video here that I did on perimenopause. But research really does show that the perimenopausal phase, which is not when you're, you know, 60 or 70, but you're experiencing that change in those hormonal levels, your estrogen is going down, and a lot of other symptoms are happening, that is the most prominent time to start developing concerns for your memory or even, you know, your verbal memory.
One study that really nailed this was a study of women who had surgical menopause. So surgical menopause is when you have your ovaries removed. Now, you can keep your uterus in, you can take your uterus out, you can do either of the two, it doesn't matter. But if you take both ovaries out, that is surgical menopause. And studies have shown that after surgical menopause, they can see a patient's memory and cognition decline. And when they treated them with hormone therapy, they actually improved. Because what's happening when you go through surgical menopause is you're losing your estrogen really quickly because it's happening at that moment that you have your ovaries removed during your surgery.
Now, certainly, cognition and cognitive changes can change throughout the menopause transition and can persist a few years into menopause, or heck, even decades or so after menopause. But research really does show that the first instances of that cognition changing or declining or changing really happens in perimenopause.
So on to number two, which is why, why does this happen? Well, I just said those estrogen levels start to decline in perimenopause, and we have estrogen receptors all over our body, in fact, from head to toe, not just in our breasts and not just down in the pelvis, but from head to toe. And we have a lot of estrogen receptors in our brain, and those receptors really help us shape and model our, our brain and our cognitive function. Two areas of really intense research on the brain in terms of the change, the fluctuation, or loss of estrogen is in the hippocampus area of the brain and the prefrontal cortex.
Now, your prefrontal cortex, this is sort of your decision-making center of your brain, if you will, the thing that's giving you that list of things that you need to do that you might be forgetting that you need to write down, right? That's something I hear really commonly. And the hippocampus is sometimes where we have a memory or we are turning something we're learning into something that we can better understand. And so it's a deeper part of the brain. Those two areas have been researched really intensely and have been shown that they really can change in terms of their functionality in perimenopause as those estrogen levels are declining.
Research also shows that women who have a lot of hot flashes or bothersome hot flashes also have a change in their memory and in their cognition. And so I would also argue that while definitely we see direct effects of losing estrogen in the brain on MRI scans and other types of scans, other things that can indirectly affect our cognition are things like hot flashes, whether it's because it also directly has an effect on the brain or it just really throws you off in the moment and you start to stumble a little bit, or they keep you up at night and so you're not getting really good sleep. There's many reasons why there can be this indirect cause during the perimenopause transition and into menopause, etc., um, as to why that cognition is declining and or changing. And it doesn't mean that you have early Alzheimer's. It really can be a very common sign of perimenopause and the menopause transition.
So on to number three, which is what, what can I do about this? So if you do recognize it and you have been Googling and maybe you landed on this video because you were Googling, "Do I have early dementia? Do I have Alzheimer's disease in my 40s, in my 50s?" Right? So maybe you're here and you're just now learning that this could be a part of the loss in estrogen, a part of peri-menopause, and a part of your menopause, post-menopausal course.
So the first thing you can do is relax, because it is so, so common. As menopause experts and menopause specialists here in the United States, we work under the governing body of NAMS, which is the North American Menopause Society, and really most of us are very familiar with brain fog as being a very common clinical scenario that we see in our patients. Now, if you have a clinician who, you know, bless his or her heart, isn't up to speed on everything happening in women's health in midlife, they may not be able to recognize that, and someone may not have told you that this is really normal in perimenopause and not, not to worry. I mean, certainly anything that's changing, I definitely advocate for you to talk to your doctors and speak up about the changes that you're seeing. But there are definitely things that we can do, and it does not mean you are bound to determined to have dementia by any means, even if you have a family history. It just means that you really want to focus on what are some of the things that you can do. So let's get into those things now.
The first thing I am going to talk about is the use of hormone therapy. Now, hormone therapy is not, is not FDA approved to treat the cognitive changes that you might see in perimenopause and into the menopause transition. However, I did already say a few minutes ago that for women who had surgical menopause, who did take estrogen without a progesterone because they don't need, when they don't have their intact uterus, they did have improvements in their cognition. So there is some data to show that perhaps estrogen can be helpful. On the contrary, the WHI study, that stands for the Women's Health Initiative Memory Study, showed no improvement in cognitive function and perhaps even a declining cognitive function in women on oral, uh, conjugated equine estrogen and medroxyprogesterone acetate, the brand name for that is Prempro. But these women were over age 65. And if you've watched a lot of my channel, I really have a great perimenopause playlist, which I will click right, link right there. They also have a really nice hormone therapy playlist, which I will also link right there. But in terms of hormone therapy, we definitely know there's a lot of safety benefits and efficacy when used within 10 years of your last menstrual period. So the question really does remain, and we don't yet know the answer to, is does estrogen replacement help with some of the cognition and the changes in, uh, brain function, whether it's memory or whether it's verbal or, you know, just the skills, the skills that you need to do every day in your professional life and in your personal life?
Now, I will say personally, and this is personally, this is just something I see anecdotally because I treat patients all the time, I do definitely see an improvement in people's cognition when they start hormone therapy, not always, but a good part of the time. But again, there is not a clear evidence-based studies head-to-head on, you know, using hormone therapy versus some other type of intervention to see which one is better or to really sort of nail down how efficacious it is. But what I do want to say is, if you are starting your estrogen therapy within 10 years of menopause, it is not going to hurt your cognition, and if anything, it could help it.
Hormone therapy, though, is not the only thing that you can do. There is lots of data and research showing that things like exercise can be really beneficial for your cognition. The second thing you can do is sleep hygiene. You really, really want to make sure you are getting excellent sleep because really, that's a no-brainer. Because if you're not sleeping well, of course, you're going to be a little foggy and fuzzy the next day. I do have a whole video on sleep hygiene that I'm going to link right here that goes over some of my favorite tips about making sure you're getting really good sleep in the perimenopause and menopause transition.
Other things that you should definitely look into is if you do have any underlying depression or any other mental health conditions, definitely make sure that you treat those, whether it's cognitive behavioral therapy, which is talk therapy, or with medication. You definitely want to talk to your provider about treating any of those other underlying medical comorbidities. Another thing that's been shown to be really beneficial is social activities. So yeah, just hanging out with your friends, and if you can at the same time, do some brain games. So play Monopoly or do some games, you know, certainly other brain games that can stimulate, you know, enhancing those neurotransmitters that fire to really warm up and and awaken that cognitive function in your brain. You know, learning a new instrument, learning a new language, traveling, definitely there's lots of things that you can do to improve cognition, um, just on your own.
The last thing I was going to say is, what about the use of hormone therapy and Alzheimer's? Well, we do not know the answer to that. And a lot of people message me saying, "If I use hormone therapy, will that decrease my risk for Alzheimer's disease?" Now, a lot of people are studying this, so we're not going to have an answer for a little bit. But the hypothesis is, of course, if you're losing that estrogen, and we see that in the perimenopausal transition, and we then go ahead and replace it, wouldn't it make the most sense that it would keep the brain healthy? And I have to say, my guess is that I think that it will, especially if you start it early, and especially if you take estrogen if you've had premature menopause or early menopause, i.e., menopause before age 45. So more to come on that, but that is going to be my guess.
So thank you guys so much for watching. Please like this video and please subscribe to the channel. That's really telling YouTube that this channel is the premiere place for evidence-based information on all things menopause and midlife. Your subscription really means a ton to me, and if you do subscribe, you'll be notified every time I post a video. Most of the time, I do post on Saturdays, and I'm trying out a new thing where I'm trying to answer all your questions within the first hour of posting. So if you subscribe, you'll know when videos upload, and hopefully, I can answer your question. Thank you guys so much for watching, and I'll see you again next week. Bye everyone.