Cognitive health

Cognitive health is how well you think: memory, concentration, finding words, keeping track. The British Menopause Society says a substantial share of women report new or worsening problems in perimenopause. The NHS website lists problems with memory and concentration among the symptoms, and says they can feel worse if you are short of sleep.

The Pakistan Menopause Society describes the same thing as the difficulty with memory and concentration commonly called brain fog (1.5.4). The British Menopause Society's guide defines it as a problem you notice yourself, in memory, attention or word-finding, without a significant decline on testing, which can come and go.

The British Menopause Society describes menopausal brain fog as difficulty recalling words, misplacing things, trouble concentrating, forgetting appointments and losing your train of thought. You are usually the one who notices. It tends to show at the busiest moments, juggling work and home, and it can fluctuate with your cycle, your sleep and your mood.

Dementia, by the same guide's account, looks different. It usually starts at older ages, most commonly over 65. The trouble goes beyond memory, to language, judgement and coordinating everyday tasks, it gets steadily worse, and it is often other people who notice first. Losing the independence to manage money, medicines or more complex tasks is the line the guide draws.

The British Menopause Society says brain fog is not always hormone related. Poor sleep and tiredness are common triggers, and low mood, anxiety, nutritional deficiencies and conditions such as thyroid disease can add to it. The European Menopause and Andropause Society (EMAS) adds that some medicines can be linked with brain fog too. So the night sweats that break your sleep may be doing as much to your memory as anything else.

There is a longer-term side too. The British Menopause Society's sheet on ethnic minority women says South Asian women who go through menopause very early may not seek help, which can carry implications for later health, dementia among them. NICE NG23 asks doctors to be aware that women from some ethnic minority backgrounds may reach menopause younger (1.3.3).

• Sleep, mood and hot flushes. The British Menopause Society asks doctors to manage these, since each can worsen thinking, and lists talking therapies such as CBT among the options.
• Heart health. The same guide asks doctors to assess and treat high blood pressure, cholesterol and diabetes. The NHS website lists vascular dementia among the risks of untreated high blood pressure.
• Everyday life. The guide's brain-health tips include physical activity, not smoking, avoiding too much alcohol, staying socially connected and learning something new.
• Work. It suggests workplace support such as a quieter space, digital aids, regular breaks and flexible working.

The British Menopause Society says the effects of HRT on thinking have not been well researched. Findings so far suggest a positive or neutral effect in perimenopause and early post menopause, and a recent meta-analysis found no evidence that HRT raises or lowers dementia risk after menopause. It also says there is not enough evidence to recommend testosterone for brain fog.

Where HRT helps, the guide describes it as easing the triggers, such as poor sleep and tiredness.

NICE NG23's line on combined HRT started at 65 or over is at the top of this page. Whether HRT is right for you is your doctor's decision with you.

If forgetfulness is getting in the way of work or home, book an appointment. Bringing a note of what happens, and when, helps.

The British Menopause Society lists the signs that need a closer look: memory problems that are getting steadily worse or interfering with work, relationships or daily life; a significant or sudden decline; seizures or other neurological signs; and a family history of dementia starting before 65. The Pakistan Menopause Society lists marked cognitive decline among its red flags (section 2.3).

Women describe losing count in salah, or forgetting whether they have already prayed, and the worry that brings. Questions about how to handle that in prayer belong with a qualified scholar. The forgetting itself is a symptom worth telling your doctor about.

If you are caring for a parent with dementia while noticing your own memory slip, the fear can feel close. Say that out loud at your appointment. Family history is something the guide asks doctors to check.