Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition

‘Brain fog’, MHT and dementia

“…Cognitive problems (often referred to as ‘brain fog’) may provoke concern in women fearful that such changes might predict dementia as they age, and trigger a discussion with their general practitioner about MHT as a means of reducing the risk of long-term memory problems. While there is some evidence that small changes in cognitive performance (eg, learning and verbal memory) do occur during the menopause, studies have also reported that changes in some cognitive function tests resolve in the postmenopause period 4 5. Questions remain about the extent of the link between the menopause and cognitive problems.…”

“…Recent guidance commissioned by the International Menopause Society and published at the end of September to coincide with World Menopause Day 2022 has attempted to address these issues 5. The authors discuss the limited evidence base for MHT and changes in cognitive function around the menopause and detail the uncertainty surrounding the pathophysiology of cognitive symptoms and the role of MHT in managing it.…”

“…The authors discuss the limited evidence base for MHT and changes in cognitive function around the menopause and detail the uncertainty surrounding the pathophysiology of cognitive symptoms and the role of MHT in managing it. The authors also point out that while it might therefore be tempting to use MHT as cognitive difficulties emerge, there is a paucity of evidence on which to base a decision 5. Studies that have been done in the early postmenopause suggest no benefit on cognition while those in the late postmenopause have shown a variable effect, perhaps depending on the regimen of MHT used.…”

“…Studies that have been done in the early postmenopause suggest no benefit on cognition while those in the late postmenopause have shown a variable effect, perhaps depending on the regimen of MHT used. The guidance suggests that women who are concerned that their cognitive issues indicate an increased risk of future dementia should be reminded of lifestyle changes they can make to address known modifiable risk factors (eg, obesity, diabetes, smoking, hypertension and alcohol intake) to help lower their risk of dementia 5…”

“…For the majority of women, cognitive problems normalise postmenopause and they can be reassured that the symptoms do not indicate that dementia is developing. Women with a number of symptoms of the menopause can be offered MHT confident that it may help to improve vasomotor symptoms and low mood associated with the menopause, which may result in improved cognitive function 4–6. However, MHT is not recommended for cognitive problems if these are the sole presenting symptoms as there is insufficient evidence to support such use.…”