Postmenopausal confusion, also commonly referred to as postmenopausal brain fog, is a group of symptoms of menopause in which women report problems with cognition at a higher frequency during postmenopause than before.
Multiple studies on cognitive performance following menopause have reported noticeable declines of greater than 60%. The common issues presented included impairments in reaction time and attention, difficulty recalling numbers or words, and forgetting reasons for involvement in certain behaviors. Association between subjective cognitive complaints and objective measures of performance show a significant impact on health-related quality of life for postmenopausal women.
Treatment primarily involves symptom management through non-pharmacological treatment strategies. This includes involvement in physical activity and following medically supervised diets, especially those that contain phytoestrogens or resveratrol. Pharmacological interventions in treating postmenopausal confusion are currently being researched. Hormone replacement therapy (HRT) is currently not indicated for the treatment of postmenopausal confusion due to inefficacy. The use of HRT for approved indications has identified no significant negative effect on postmenopausal cognition.
Although much of the literature references women, all people who undergo menopause, including those who do not self-identify as women, may experience symptoms of postmenopausal confusion.
History
Research on menopause as a whole declined with the end of the Women's Health Initiative (WHI) studies, but research on the treatment of symptoms associated with menopause—especially the treatment of cognitive decline—continues. The Study of Women's Health Across the Nation (SWAN), first started in 1996, continues to publish progress reports which include cognitive symptoms associated with menopausal transition, including those in postmenopause. , SWAN indicated, "Approximately 60% of midlife women report problems with memory during the [menopause transition], yet studies of measured cognitive performance during the transition are rare."
Although there are many relationships between hormone levels in postmenopause and cognitive function, the previously favored HRT therapies (estrogen therapies) have been shown to be ineffective in specifically treating postmenopausal confusion. The use of hormone replacement therapies, once considered detrimental to cognition in postmenopausal women, has now been shown to have no negative effect when used properly for approved indications. There are no conclusive studies to support any pharmacological agents, but several potential drug candidates are still being explored.
Presentation
Menopause is a natural decline in the ovarian function of women who reach the age between 45 and 54 years. "About 25 million women pass through menopause worldwide each year, and it has been estimated that, by the year 2030, the world population of menopausal and postmenopausal women will be 1.2 billion, with 47 million new entrants each year."
Postmenopause begins immediately following menopause (one year after the final menstrual cycle). Postmenopausal confusion is often manifested through the following cognitive symptoms: memory problems, forgetfulness, and poor concentration. Confusion which is otherwise unexplained and coincides with the onset of postmenopause may be postmenopausal confusion.
Causes
Risk factors
Hypertension
A 2019 literature review identified hypertension and history of pre-eclampsia as significant risk factors for the accelerated decline of cognitive function in women during midlife. Although the mechanism remains unclear, neuroimaging studies included in the review found that those with hypertension have evident structural changes in their brains; specifically, gray matter brain volume decreased and white matter hyperintensity volume increased.
Atherosclerosis and comorbidities
Atherosclerosis and comorbidities such as hyperlipidemia and diabetes mellitus have long been considered risk factors for cognitive decline because they have the propensity to cause the formation of amyloid plaques (aggregates of misfolded, deleterious proteins) in the brain.
Insomnia
Many postmenopausal women report insomnia. Studies have shown "associations between poor sleep quality and cognitive decline" in postmenopausal women as those with insufficient sleep, or with difficulty falling or staying asleep, reported decreased cognitive performance including "verbal memory, attention, and general cognition."