I often hear women joke about forgetfulness or loss of focus around the time of menopause. Menopausal brain fog seems to be an accepted fact of life. But is it real? You may be surprised to learn that this topic is pretty controversial among the experts. I don’t blame them. It’s difficult to tease apart the effects of aging from hormonal effects specific to menopause. So far, researchers haven’t found a change in reasoning ability, decision making, or memory at menopause. There may be a decline in verbal fluency, however. It’s also possible that the tests of mental function used in studies don’t fully capture the changes that women notice at menopause.

Levels of the female hormones produced by the ovaries decline dramatically at menopause. Loss of the body’s most important estrogen, called estradiol, is responsible for the majority of mind-body changes we experience at this time. Scientists now believe that our reproductive age, more than chronological age, impacts our individual risk of developing many age-related conditions. Early menopause is associated with coronary artery disease and stroke. Early menopause is also associated with earlier age at death. But the relationship is complex. Replacing the body’s missing estrogen with hormone therapy may provide some blood vessel protection, but only when used in the early years of menopause. After age 60, the risk of stroke clearly increases with the use of hormone therapy. And more likely, it is an individual woman’s age at menopause that determines her “window of opportunity” for the benefits of hormone therapy. Many women decide that the health risks associated with hormone use outweigh the benefits, and forgo hormones altogether.

Recent neurobiological research shows that the long term lack of estradiol after menopause could impair the brain in several ways. Without estradiol, neurons switch their main source of energy from glucose to ketones, a less efficient fuel. Long term lack of estradiol leads to erosion of some of the estradiol receptors in the brain. This makes them less responsive to estrogen even if it is reintroduced later, which means that the neuroprotective effects of the hormone are lost. Lack of estradiol also leads to decreased acetylcholine, a neurotransmitter important to learning and memory. Decreased acetylcholine is associated with Alzheimer’s disease and other cognitive problems.

So what can we do to nourish our brains at this time of life, whether or not we choose to use hormones? Here are some holistic considerations:

1. Increase sleep, decrease stress

Poor quantity and quality of sleep lead to impaired mental performance. Address any barriers to a good night’s sleep. Common barriers to sleep include drinking alcohol or using stimulants like caffeine in the 4 to 6 hours before bedtime and having electronic devices  in the bedroom. Don’t exercise before sleep and don’t spend screen time with your TV, computer, or phone. If night sweats are waking you up every night, they should be treated. Whether to choose conventional (hormone therapy, SSRI drug, etc.) or alternative means is up to you. Excessive stress and anxiety also impair mental performance. If you’ve never managed your stress before, menopause will make you do it. Start yoga, walking or swimming. Learn how to meditate or journal, and do it every day. I teach women to begin with a 5 Minute Ritual, such as a cup of herbal tea or a quick aromatherapy massage, and expand from there. Few of us feel that we have enough time to relax, but we can’t use this excuse. Do you have enough time to lie awake in the middle of the night held hostage by anxious thoughts? Do you have enough time for a chronic disease that was aggravated by years of self-neglect?

2. Use it or lose it!

There’s no debate about this one. Continuing to exercise the brain protects its long term performance. As we age, we must engage. Learn a new skill or hobby, keep physically active to protect blood vessel health, and stay connected with others. Being involved in the world and in human relationships enhances our mental and physical health.

3. Healthy Gut, Healthy Brain

In the West, we compartmentalize the systems of the body and treat their functions as independent. Eastern approaches like Ayurveda have always recognized that this is not so. In fact, a healthy brain may start in the gut. Poor digestion is linked to fatigue, poor sleep, and foggy thinking. There is nothing normal about experiencing heartburn, constipation, abdominal cramps, or bloating. The pharmaceutical drugs we use to manage these symptoms often impair digestion and absorption or lead to dependence. Address the underlying problem! Changing your diet one step at a time or trying an elimination diet to identify sensitivities is a good place to start. If you’ve recently taken antibiotics or have longstanding diarrhea or constipation, consider a probiotic.

4. The Healthy Brain Diet

You probably already know how to eat for your brain. The same anti-inflammatory, antioxidant foods that are good for the rest of your body are particularly good for your brain. Spices like turmeric, cumin, ginger, cinnamon, and sage should be prominent in your cooking. Eat lots of dark leafy greens, cruciferous vegetables like broccoli, and a variety of beans, root and vine vegetables. Buy blueberries, other dark berries, cherries, and grapes. Eat a wide selection of nuts and seeds, including flaxseed or flaxseed oil. Eat cold water fish like wild caught salmon and trout for omega 3 essential fatty acids every week. Select minimally processed whole grains whenever possible, and cook with extra virgin olive oil and grapeseed oil.

5. Stimulating Aromas

Aromatherapy has long been used to enhance attention and learning. Rosemary (Rosmarinus officinalis) is the best known essential oil for this purpose, but many scents have invigorating properties. Stimulating scents include lemon, basil, thyme, and peppermint. Use a diffuser or cool mist vaporizer in the room where you work or study. A little goes a long way! Five drops is usually plenty. Try aromatherapy in place of your final caffeinated beverage of the day. Remember not to substitute a pure essential oil with a “home fragrance blend” or synthetic scent.

6. Botanicals for the Brain

Both the East and the West have rich herbal traditions for enhancing mental function. Modern research is beginning to illuminate this traditional wisdom. There is great interest in deriving pharmaceuticals from traditional herbs for the prevention and treatment of Alzheimer’s type dementia, Parkinson’s disease, and other conditions. Vinpocetine, a synthetically produced molecule that mimics what’s found in the lesser periwinkle plant (Vinca minor) is a common example. Herbalists have used extracts of periwinkle for centuries. Curcumin from turmeric is the latest media darling in the West, as supplement companies scramble to promote versions that are better absorbed or customized for different purposes in the body. Many other whole herbs and derivatives are used based on traditional experience around the world, from ginkgo to ginseng, bacopa to gotu kola. As modern evidence slowly mounts, the ultimate decision rests with consumers. Often, it is the fringe benefits of an herb that tip the scale in its favor. Do you know which “mental function” herb alleviates joint pain, benefits sleep, or increases physical stamina?

7. A Final Consideration

Not all changes in brain function are bad. Some hormonal changes may actually help you change your life. Oxytocin levels typically drop with menopause. Oxytocin plays an important role in labor and birth, breastfeeding, and orgasm. It is also dubbed the “bonding” hormone for it role in promoting physical and emotional closeness, concern and care for others. In other words, those behaviors that we think of as traditionally motherly or nurturing. Many women at menopause discover a new freedom to pursue their own interests. New relationships, new careers, and other new passions can flourish. It may be more socially acceptable to joke about brain fog, but perhaps what gets foggy is simply old priorities, habits, and expectations as women hone in on what will matter to the second half of their lives.

April Ward, MSN, CNM is an integrative women’s health specialist in Skaneateles, NY. To learn more, call 315-200-2349.

Periwinkle (Vinca minor)