Supplements for menopause brain fog?

Brain fog, moodiness, fatigue, hot flashes, and nighttime trips to the bathroom. None of the changes associated with menopause are especially welcome. Fluctuating estrogen levels have a tremendous impact on your body. You may wonder whether these changes are a “deal with it” situation or whether you can act proactively to minimize their impact on your life. Hormone therapy, a supplement that has been in and out of favor for treating symptoms associated with menopause such as vasomotor symptoms and brain fog, is worth considering. It is also worth considering whether other supplements or vitamins effectively alleviate post-menopause brain fog.

The symptoms associated with menopause

There are many signs and symptoms associated with menopause, mostly due to fluctuating estrogen levels:

• Difficulty sleeping: Difficulty sleeping can be due to changing hormone levels, a need to get up in the middle of the night to urinate, or night sweats. Changing hormone levels and weight gain can also cause sleep apnea.
• Weight gain: While many women gain weight during menopause, it is unclear whether it is secondary to a decrease in estrogen levels or a change in lifestyle and dietary habits. Aging leads to a natural decrease in muscle mass, which can be a vicious cycle of decreased strength leading to decreased activity levels and weight gain. Poor sleep habits may compound the problem. Fat around the abdomen is more highly associated with metabolic syndrome and cardiovascular disease than is subcutaneous fat. Menopause does not increase the risk of cardiovascular disease, but changes such as increased abdominal fat and decreased exercise can.
• Vaginal dryness: Estrogen receptors are found throughout the vulva and vagina. When estrogen binds to these receptors, the result is increased blood flow, increased collagen development, a moist internal environment, and a healthy microbiome. When estrogen levels decline, there is a thinning and drying of the vagina and a loss of nutrients to support the bacteria that make up the natural microbiome in the vagina.
• Increased risk for urinary tract infections: Decreases in estrogen levels can lead to atrophy of the vagina and vulva. Women may notice vaginal and periurethral dryness, irritation, and burning. Approximately five percent of women have severe urinary incontinence post-menopause, and 60 percent report mild incontinence (Hunskaar et al.,2000).
• Breast tenderness: Many women notice changes in their breasts post-menopause, including increased tenderness and sagging.
• Hot flashes, night sweats, and flushing: Vasomotor changes are the most common symptom women report, affecting over three-fourths of women in perimenopause. Symptoms can last five to seven years or more. Frequent fluctuations in temperature lead to flushing and sweating both during the day and night. Noting your triggers, wearing multiple layers, controlling your environment, and avoiding alcohol and spicy foods are all strategies that may help.
• Depression, anxiety: There are estrogen receptors throughout the brain, so it comes as no surprise that decreasing estrogen levels would affect mood. While studies show a higher level of depressive symptoms in postmenopausal women when compared to premenopausal women, the cause has not been fully worked out (Schmidt, Haq & Rubinow, 2004). Lifestyles changes, sleep disorders, and changes in sexuality may also contribute.
• Brain fog and cognitive symptoms: Brain fog is a term used to describe the problems with word finding, attention, and memory that many women notice after menopause. Estrogen specifically affects two key areas of the brain involved in memory and recall: the hippocampus and the prefrontal cortex (NAMI, 2019).
• Skin changes: Decreased estrogen leads to skin thinning, reduced blood flow, dryness, and decreased production of new skin layers. These changes can cause lines and wrinkles to form, along with skin sagging, increased bruising, decreased skin elasticity, and impaired healing.

Supplements and vitamins for post-menopause symptoms, including brain fog

The only expert on how symptoms associated with menopause are affecting you is you. Of course, the first stop you should make when you have any concerns about your health is your doctor’s office.

The sex hormones — estrogen, progesterone, and testosterone — are all involved in brain function. Sex hormones influence the network of nerves involved in attention, memory, and other cognitive functions. When key areas of the brain such as the hippocampus and the prefrontal cortex are exposed to fluctuating estrogen levels, symptoms can result.

Many gynecologists recommend a holistic approach to treating the symptoms of menopause. Several studies have looked at hormone therapy, the pros and cons. As you will see next, there are also many studies on lifestyle changes and their impact on menopausal symptoms. Besides discussing hormone replacement with your doctor, consider adding lifestyle and dietary changes to your list.

Exercise

Estrogen increases blood flow to the brain, but so does exercise. Aerobic exercise increases the amount of oxygen your brain cells receive, which translates into optimal brain function. Does exercise improve the symptoms associated with menopause? When NAMI reviewed three Cochrane reports that summarized studies on the benefits of exercise to reduce or prevent menopausal symptoms, the authors concluded that the evidence was insufficient to determine whether exercise is an effective treatment for menopausal symptoms. They rated the overall evidence as poor. Exercise is beneficial to overall health and mood, but as far as symptoms of menopause, especially vasomotor symptoms, the randomized trials do not support the benefit of exercise for controlling symptoms (NAMI, 2015).

Hydration

Exercise increases blood flow to the brain and ensuring that you drink plenty of water does as well. Staying well hydrated maintains blood flow, keeps metabolism running optimally, and removes toxins from the brain and body.

Cognitive Behavioral Therapy, Mindfulness, and Hypnosis

Two randomized, double-blinded studies showed that cognitive behavioral therapy effectively reduced the way women rated the severity of their vasomotor symptoms, but not the frequency. The cognitive behavioral techniques included psycho-education, paced breathing, and cognitive and behavioral strategies. A follow-up study showed that beliefs about coping and control over vasomotor symptoms likely explained why women in the study rated their vasomotor symptoms as less severe. In another study, women used mindfulness-based stress reduction. They rated their vasomotor symptoms less severe and less frequent after therapy, but the results were not statistically significant (NAMI, 2015). In two randomized trials, women reported that hypnosis decreased the frequency of hot flashes, with a 17% reduction reported in the control group and 74% reduction in the treatment group, and hot flash score, frequency times severity, with a 15% reduction in the control group and 80% in the treatment group (Elkins et al., 2013)

Omega-3 Fatty Acids

Omega-3 supplements contain polyunsaturated fatty acids, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and a-linolenic acid. In an 8-week trial with 91 women, the frequency and intensity of vasomotor symptoms significantly improved in the treatment group when compared to the control group. However, in another 12-week trial, women in the treatment group did not significantly differ in hot flash frequency or intensity compared to the control group (NAMS, 2013).

Mediterranean diet

Dr. Pauline M. Maki, professor of psychiatry and psychology who has studied menopause, and the changes associated with it, recommends a Mediterranean diet to help alleviate the symptoms associated with menopause.

Soy and Genistein

Soy is the most widely used isoflavone-containing food. Isoflavones are nonsteroidal compounds that bind to estrogen receptors in animals and humans. Isoflavones bind better to ER-beta receptors than ER-alpha. Estrogen receptor alpha (ERα) is primarily in the endometrium, breast tissue, and ovaries. Whereas, Estrogen receptor beta (ERβ) is in other parts of the body such as the brain, heart, kidneys, bones, and lungs. The locations can overlap.

The isoflavones include genistein, daidzein, glycitein, biochanin A, and formononetin. Genistein and daidzein are found in high amounts in soy products. About 30% of women in North American can metabolize daidzein to equol. Equol binds to both types of estrogen receptors with a higher affinity for ERβ. According to the North American Menopause Society, the results on soy use for relieving menopausal symptoms, especially hot flashes, have been mixed. Soy that contains higher levels of genistein or equol seems to be more beneficial. Preliminary findings on cognitive benefit from isoflavone therapy suggest that there is a critical window in which younger women derive more benefit than older women (NAMS, 2010).

Black Cohosh

The active ingredients in black cohosh are unknown, as is its mechanism of action. A 2012 Cochrane review analyzed 16 randomized controlled trials and found there was no significant difference between using black cohosh and placebo when it comes to reducing the frequency of hot flashes. Black cohosh seems not to affect circulating hormones such as luteinizing hormone, follicle-stimulating hormone, or estradiol (NAMS, 2013).

Hormone Replacement Supplements for Brain Fog?

Since none of the supplements investigated thus far seem to have significant benefits for controlling the symptoms associated with menopause, it would seem that hormone replacement would be standard treatment. Estrogen therapy, as do all medications and supplements, has risks and benefits. Using estrogen therapy more than ten years after menopause, at a higher dose or for a longer period, can all increase risk. Each woman experiences menopause differently. Each woman has a unique combination of genetics, past medical history, and comorbidities that may increase or decrease her risk from using estrogens and other hormone therapies.

In the past, estrogen therapy was widely prescribed. In 2002, a large clinical trial called the Women’s Health Initiative changed prescribing practices. This trial found that Pempro, a pill that combined estrogen and progesterone, increased women’s risk for heart disease, breast cancer, stroke, and blood clots. The trial was designed to look at the effects of estrogen on chronic disease. Study results state that most risks and benefits dissipated after the hormones were discontinued. However, the risk for cardiovascular disease remained borderline elevated, as did the risk for breast cancer, while the risk of endometrial cancer decreased in women who were taking a combination of estrogen and progesterone and had an intact uterus. There was an increased risk for strokes and blood clots for women taking estrogen alone, a reduced risk for fractures, and a borderline reduction in risk for breast cancer (Manson et al., 2013). Newer studies are taking a second look at the risks and benefits of hormone therapy.

A Closer Look: A Study on Menopause-Associated Symptoms and Cognitive Performance

Dr. Greendale et al. (2009) studied 2,362 participants from the Study of Women’s Health Across the Nation for four years. Women were in the premenopausal, perimenopausal, and postmenopausal phases. They found that perimenopausal women did have a decrease in cognitive performance. However, improvement in their cognitive performance rebounded to premenopausal levels in post-menopause, suggesting that the cognitive effects may be time-limited. Hormone initiation before the final menstrual period seemed to have a beneficial effect, whereas initiation after the final menstrual period seemed to have a detrimental effect on cognitive performance. These results suggest that the timing of supplements for menopause brain fog may be as important as what is used.

A six-year longitudinal study that involved 1,903 women studied whether symptoms from menopause negatively affected cognitive performance during the menopause transition. The authors studied four symptoms and three measures of cognitive function. The four symptoms were depressive, anxiety, sleep disturbances, and vasomotor symptoms. The three cognitive domains including processing speed (SDMT test), verbal memory, and working memory. The authors found that depressive and anxiety symptoms had a small, negative effect on cognitive processing speed and that the four symptoms they studied did not account for the transient decline in symbol digit modalities test (SDMT) results that were reported in the SWAN study (Greendale et al., 2010).

In another review, Maki and Thurston (2020) found that physiological evidence of vasomotor symptoms, not subjective reports, was associated with brain health. Vasomotor symptoms have been linked to:

• Multiple indicators of cardiovascular risk
• Elevated levels of cortisol
• Sleep problems

The authors conclude that research has focused on the link between hormone levels, particularly estrogen, and brain health, but research should be extended to look at menopausal symptoms as well. Many women experience vasomotor symptoms for a decade after their last period. The authors conclude women may experience an improvement in cognition once vasomotor symptoms are treated, though more research is needed.

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DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References:

1. Hunskaar, S., Arnold, E.P., Burgio, K., Diokno, A.C., Herzog, A.R., & Mallett, V.T. (2000). Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 11(5):301-319. https://pubmed.ncbi.nlm.nih.gov/14550833/
2. Schmidt, P.J., Haq, N., & Rubinow, D.R. (2004). A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry. 161(12):2238-2244. https://pubmed.ncbi.nlm.nih.gov/15569895/
3. The North American Menopause Society (NAMS). Crandall, C. [Ed].  (2019). Menopause Practice. A Clinician’s Guide 6^th Edition. https://www.menopause.org
4. The North American Menopause Society (NAMS). (2015). Position Statement. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of the North American Menopause Society. Menopause: The Journal of The North American Menopause Society. Vol. 22, No. 11, pp. 000-000. https://pubmed.ncbi.nlm.nih.gov/26382310/
5. Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause 2013;20:291-298. https://pubmed.ncbi.nlm.nih.gov/23435026/
6. North American Menopause Society (2011). The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010). Menopause (New York, N.Y.), 18(7), 732–753. https://doi.org/10.1097/gme.0b013e31821fc8e0
7. Maki, P. M., & Thurston, R. C. (2020). Menopause and Brain Health: Hormonal Changes Are Only Part of the Story. Frontiers in neurology, 11, 562275. https://doi.org/10.3389/fneur.2020.562275
8. Greendale, G. A., Wight, R. G., Huang, M. H., Avis, N., Gold, E. B., Joffe, H., Seeman, T., Vuge, M., & Karlamangla, A. S. (2010). Menopause-associated symptoms and cognitive performance: results from the study of women’s health across the nation. American journal of epidemiology, 171(11), 1214–1224. https://doi.org/10.1093/aje/kwq067
9. Greendale, G. A., Huang, M. H., Wight, R. G., Seeman, T., Luetters, C., Avis, N. E., Johnston, J., & Karlamangla, A. S. (2009). Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 72(21), 1850–1857. https://doi.org/10.1212/WNL.0b013e3181a71193
10. Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., Anderson, G., Howard, B. V., Thomson, C. A., LaCroix, A. Z., Wactawski-Wende, J., Jackson, R. D., Limacher, M., Margolis, K. L., Wassertheil-Smoller, S., Beresford, S. A., Cauley, J. A., Eaton, C. B., Gass, M., Hsia, J., … Wallace, R. B. (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA, 310(13), 1353–1368. https://doi.org/10.1001/jama.2013.278040

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