As part of our Lunch & Learn webinar series, we were joined by Dr Shahzadi Harper of The Harper Clinic.
In this session we discussed how menopause can affect mental health, in particular brain fog, and what you can do about it.
Henpicked: Is brain fog a common symptom of menopause?
Dr Shahzadi Harper: Yes, 60% of women do experience it around perimenopause, which is the time women go through hormonal change before their periods end. In your late 30s or 40s your hormones change, and one of the lesser-known symptoms is brain fog. You may become forgetful, lose your train of thought, or find it harder to concentrate. Women sometimes ask if they’ve got early dementia.
It may be funny once in a while to find your keys in the fridge. But when you miss a meeting or appointment or forget what you’re meant to be doing, it can get embarrassing. It really impacts on a woman’s confidence, especially in the workplace.
Henpicked: What’s going on in our body that triggers these psychological symptoms?
Dr Shahzadi Harper: Brain fog isn’t a medical term. It’s an umbrella term to encompass things like memory loss, forgetfulness and difficult in concentration. I like this analogy. Oestrogen acts like wifi in our brain to help with connectivity. In perimenopause our ovaries produce less oestrogen, so our wifi goes down or it’s not as connected as it used to be. When the wifi goes down at home things can go a bit haywire, and brain fog is the same kind of thing.
We also need to consider the ageing process. We’ve often got a lot of things to juggle, family, children, work, parents, so many things to remember. We can often be a bit hard on ourselves.
Henpicked: Perimenopause can often be a mysterious time. We don’t get notification – but this is when things can get problematic, isn’t it?
Dr Shahzadi Harper: Perimenopause is different for each woman and can start ten years or so before your periods stop. You don’t get a notification, things just start to change. Maybe your periods become irregular, or your cycle gets shorter. One of the big symptoms is insomnia, which also doesn’t help with memory issues. Women also report feeling anxious, getting panic attacks or noticing a flatness in mood. They aren’t always putting two and two together and considering them as menopause symptoms.
We’ve been told menopause is hot flushes and irritable grumpy women. We’re not really told symptoms can start so early on, that they can be psychological and can have a wider impact than people think.
Henpicked: So you may not experience the physical symptoms but the psychological symptoms can show up first. What can we do about it?
Dr Shahzadi Harper: We need to take stock at this point to improve our lifestyle habits. Exercise is great. It helps to improve circulation to our brain and can help with brain fog and mood. It can also release the feel-good hormones serotonin, dopamine and noradrenaline. You don’t have to be running marathons but just get a bit of a sweat on and get the heart pumping.
Maintain hydration, so you’re not getting headaches. And look at stress management. We often forget what a stressful life we have. Take some time out for mindfulness, yoga, things that will help you calm down.
Supplements like magnesium, vitamin B12, vitamin D and Omega 3s and fatty acids are very good for the brain and mood. If you smoke, it’s best to quit as soon as you can. Smoking narrows your blood vessels and reduces circulation, which can affect your brain health.
A recent study from UCL says obesity increases your risk of dementia by 30%. So all risk factors that increase weight need addressing. This means eating a Mediterranean diet, stopping smoking, drinking in moderation, taking the right supplements and getting enough exercise.
Henpicked: It’s a difficult time too with Covid. Many women are working at home, have childcare, are thinking about elderly parents… and stress and menopause are not good bedfellows, are they?
Dr Shahzadi Harper: No, and nor is lack of sleep. We need to prioritise ourselves more, putting in coping mechanisms. There’s no shame in making a list. Dump everything down and take out a few things at a time and tick them off. Do things in bite-size chunks and look at what you can and can’t control.
We can’t control the pandemic, other than following safety measures, so will naturally feel some anxiety. But there are things you don’t need to worry about so much. Stay in the here and now and don’t focus too far along.
Henpicked: What about the medical side. Will HRT help?
Dr Shahzadi Harper: Yes, we know that oestrogen helps the memory centre in the brain, the hippocampus, that helps to connect our words and keep our memories at the forefront. But there’s not just HRT to think about. Women may have heavy periods, iron deficiency, anaemia, an underactive thyroid… these can make you feel tired and sluggish and affect your concentration, and you could gain weight. Women might be deficient in vitamin B if they’re eating a plant-based diet. Look at what else it could be. But if it’s affecting you on a day-to-day basis then HRT can help, along with lifestyle and holistic changes.
Hormones aren’t the answer for everyone. An SSRI can help with anxiety, for example. There are different tools in the toolbox for each woman. We all have our own individual choices, priorities and needs.
Henpicked: Does brain fog disappear post menopause?
Dr Shahzadi Harper: Usually. Because you’ve got it now doesn’t mean it’ll lead into Alzheimer’s or last forever and it often does improve post menopause.
Your memory may well not be the same as in your 20s, though. Again, we can attribute this to ageing, lifestyle and stress. There has to be a level of acceptance. You might need a list when 20 years ago you could remember everything. Go easy on yourself. Life is busy and complicated.
If you do have a ‘brain fog’ moment, own it. Don’t get embarrassed. The more we talk about it, the more we’re raising awareness.
Henpicked: Is there any way to know if brain fog is down to hormones or is a sign of dementia?
Dr Shahzadi Harper: This is an important question as not everything is down to your hormones. Just because you’ve got this symptom and happen to be in this point of life, let’s not forget it can be caused by something else. One thing with women in this transition is that symptoms fluctuate, some days are better than others. But with dementia it’s a consistent decline.
If you have a family history of dementia, be a bit more aware. There are tests you can have from a specialist, or your GP can do blood tests for anaemia or thyroid issues and check your blood pressure and cholesterol levels.
Henpicked: Will lifestyle changes pre menopause help?
Dr Shahzadi Harper: Absolutely. You’re preparing for your future, it’s not just about waiting until you turn 40. If you smoke stop as soon as you can, and be more considerate about alcohol. Incorporate oily fish and antioxidants like blueberries, pomegranate and dark chocolate into your diet. Playing classical music has been shown to help with neuronal activity in brain. Essentially, it’s about getting your brain to think about things in a different way.
Henpicked: What exercise do you recommend, and how much?
Dr Shahzadi Harper: I usually say think of exercise as a prescription like medication. Instead of one long session try to do two 15-minutes sessions, one morning one evening, to break it up.
NHS guidelines are 150 minutes of moderate exercise per week. This is walking fast or jogging, so you can keep a conversation going but wouldn’t be able to sing. Essentially, getting your heart pumping.
Or 75 minutes of higher-intensity exercise, like running or dancing. Again, break this up into shorter sessions. It’s also important to include two 20-30 minute sessions of strength training a week. This is gentle weights, yoga, or using your natural body weight. This can help maintain muscle bulk as well as keeping our brains sharp.
Henpicked: Can Cognitive Behavioural Therapy (CBT) be helpful?
Dr Shahzadi Harper: Yes, it’s about rewiring your brain and rethinking. Anxiety can be irrational and we often know this. CBT can help you understand what your triggers are and help you reorganise our thoughts. Anxiety often means we don’t sleep well, and we find small things feel like climbing mountains. CBT can help us de-escalate and and calm those demons.
Dr Shahzadi Harper is an innovative doctor interested in optimising women’s wellbeing and health and empowering them to look and feel their best. She looks after women of all backgrounds and ethnicities enabling them to make informed choices for their optimal health. She has an understanding of the symptoms and concerns that women face as she herself is one of six sisters and has a grown up daughter.
Her areas of expertise include Perimenopause and Menopause, Polycystic Ovarian Syndrome, Premenstrual Stress disorder, Healthy Ageing and Weight Management.