You see a familiar face but you realize, in horror, that you can't recall the person's name. Although it may be a normal part of juggling a hectic life, many women worry about their memory as they age, and memory loss is a common and frustrating symptom experienced in conjunction with perimenopause.
While some women reaching midlife say they have forgetful moments, for pre-school teacher Louise Woods of Winston-Salem, N.C., it's all about forgetting names. "Sometimes I'll forget a name of a student that I've had in class all day-a child I've known for months. I'll recognize their face, but the name just won't come to me." As someone whose day revolves around her ability to remember her students' names, Woods, 53, finds the adjustment unsettling. "Every time my mind goes blank, I feel like I am losing my mind," she says.
Woods is not the only woman going through this struggle. In fact, 62 percent of women in the transition to menopause complain of "fuzzy thinking" or "cotton brain"-undesirable changes in memory and other mental processes by which knowledge is acquired and used (collectively known as cognition), according to a 2001 study published in the Journal of Women's Health.
The Role of Hormones
Although declining levels of estrogen at menopause have long been linked with forgetfulness, the results are conflicting as to the role that hormones play. "There is still some controversy as to what extent estrogen affects cognition," says Victor Henderson, M.D., a professor of neurology and neurological sciences at Stanford University in California. "There's no clear answer to whether or not it does so positively or negatively in all or some situations."
Scientists do know that estrogen influences tissues through interactions with receptors in the ovaries, kidneys, uterus, and many other areas throughout the body, including the brain. That implies the hormone might have some "fairly specific actions" in the brain, says Henderson. Estrogen receptors are plentiful in the hippocampus and the basal forebrain, two regions involved in learning and the formation of new memories. "Estrogen also appears to raise levels of certain brain chemicals, including the neurotransmitter acetylcholine, which is implicated in memory," he notes.
Yet studies linking estrogen to actual cognition are inconsistent. Take, for example, the results of the 2003 Study of Women's Health Across the Nation (SWAN), sponsored by the National Institute of Aging. In this study, 803 perimenopausal women were given two standard memory tests a year for about two years. One test asked them to reverse a string of numbers from memory; another to read rows of symbols and recall numbers previously assigned to each symbol. Although researchers were expecting a decline due to falling estrogen levels, they found just the opposite: the women's scores improved slightly over time. Essentially, the tests showed that the women's memories were just fine and perhaps even that practice helps.
Challenging Times
Stanley Birge, M.D., a professor in the division of geriatrics and nutritional science at Washington University School of Medicine in St. Louis, Mo., calls the results of the SWAN study "one of the great challenges of our time."
"I have patients complaining of memory changes they consider to be profound. If you're a lawyer, for example, these changes can be devastating. Yet when we examine these women using neuropsychological tests, we can't detect any deterioration in memory," he says. "Even when they are given estrogen therapy and they say their memory problems have gone away, those changes can't be measured."
Scientific evidence is inconsistent concerning the effects of hormone therapy (HT) on cognitive abilities. Some studies found that postmenopausal women on HT scored higher on cognitive tests compared with women on no therapy. But others found the reverse. The Women's Health Initiative Memory Study (WHIMS) conducted research on healthy, postmenopausal women aged 65 to 79 and found that the risk of dementia was doubled for women using estrogen-progestogen therapy. For women without a uterus using estrogen-only therapy, the risk of dementia increased by half.
Conflicting Research
So what explains the discrepancies? They may be related to the tools used to measure memory changes, says Birge, or because of study design. "It's possible that certain forms of cognition are less affected by estrogen loss, so if we measure for only these types of cognition, we're not going to find any major changes."
While using long-term estrogen therapy shows some theoretical promise in helping postmenopausal women preserve cognitive abilities, it is still uncertain what the benefits are and if they outweigh the potential health risks.
To date, much of the research on cognition and estrogen has focused on animals or premenopausal women. A small study at Northwestern University, for example, found cognitive function in premenstrual women varies across the 28-day menstrual cycle. The results showed that when estrogen is highest (before ovulation), there's an increase in a woman's language ability.
While some findings suggest that estrogen therapy in perimenopausal or postmenopausal women might help with memory loss, they're far from conclusive. "The research offers a reasonable first guess as to what one might expect to find," says Henderson. "But chronic loss versus something that's occurring during short intervals may not be the same thing."
A study by Barbara Sherwin, M.D., at McGill University in Montreal, looked at women who had undergone medically induced menopause (from surgery or chemotherapy). These women, whose estrogen levels plummeted after the procedures, showed little change in memory tests when given monthly estrogen injections. Memory test scores declined dramatically for women given placebo injections. "But the study didn't look at women who had experienced natural menopause, where estrogen levels fall gradually over a period of years, rather than suddenly," says Birge.
The jury is still out as to what extent estrogen therapy may help perimenopausal and postmenopausal women preserve cognitive abilities, such as memory. But studies suggest relaxation, regular exercise, getting the right amount of sleep, and mental challenges (see box, left) will help keep your mind functioning at its optimal level.
Help Yourself
Learn to relax. Stress is a well-known memory stealer. Practicing mind-body techniques, such as yoga, can help you feel less frazzled.
Rest well. Getting a good night's sleep can also help. Studies show fatigue makes concentration more difficult.
Keep fit. Brisk walks and other activities that get your heart rate up are important in keeping your brain at its best, according to research.
Testing, testing. Memory tests can help keep your brain active. For memory test see below.
Exercise Your Mind
Just as our bodies benefit from exercise, so do our minds. Challenging your memory by completing crossword puzzles, working Sudoku puzzles, and doing tongue-twisters-as well as participating in new and demanding mental activities-may help keep your mind sharp, no matter where you are in the transition, experts say. Build mental activities into your daily physical activities-for example, while walking the dog or sitting in the car, complete a memory test.
Memory Test Suggestions
Closet diary. Can you remember each shirt or blouse you have worn over the past seven days? Try to get as detailed as the color and fabric of the garment
Upcoming holidays. Try and recall any holidays that are coming up over the next three months.
Family checklist. Is there anyone in your immediate and extended family who has a birthday coming up? Attempt to remember the date and the age they will be turning.
Gift list. Think of someone for whom you want to buy a gift. Try to recall something they've mentioned recently that they would like.
Art. Think of a favorite piece of art. Can you remember the details of the piece? Write a list of every detail you can remember, from the colors used to how the piece made you feel when you first saw it.
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