Hello and welcome back to Making Sense of Women's Health. I am Roberta Bass, I'm a physiotherapist, a Pilates instructor, menopause mentor and founder of Thrive and Shine Women's Wellness. Today's topic is one that so many of my clients bring up with a mixture of frustration and concern and that is brain fog.

It's not just getting older or being forgetful. And if it's affecting you during perimenopause or postmenopause, you're definitely not imagining it. So in this episode, we're going to break down what brain fog actually is, why it happens during menopause, and most importantly, what the evidence tells us about how to manage it and improve it.

So firstly, what is brain fog?

Brain fog isn't actually a medical diagnosis, recognised cluster of cognitive symptoms, which can include difficulty concentrating, word finding issues, memory lapses, short term, slower thinking or mental fatigue, feeling like you're in a haze or constantly distracted.

In fact, in a 2021 study published in Menopause Journal, about 60 % of perimenopausal women reported cognitive difficulties, especially with memory and attention.

These symptoms can have massive effect on you day to day, including confidence, relationship and your performance at work.

So why does it happen in perimenopause? There are multiple contributing factors, with hormone playing a major role.

Estrogen, especially estradiol, which is one type of estrogen, supports areas of the brain like the hippocampus and the prefrontal cortex, and these are crucial for memory, learning and focus. When estrogen fluctuates or drops, it can reduce neurotransmitter activity, including acetylcholine, which helps with memory.

Our progesterone and testosterone also play a role in our brain health. Progesterone has calming effects via GABA pathways, while testosterone can support motivation and focus. But hormone changes are only part of the story.

Other contributors include poor sleep, especially when we're woken regularly with night sweats or with insomnia, chronic stress and high cortisol levels. Now this impacts the hippocampus and can cause brain fog as well. Blood sugar imbalances. Now this can lead to energy dips and foggy thinking. Inflammation and changes in our gut brain communication.

thyroid dysfunction, which is more common in women aged 40 to 60, and can mimic or worsen brain fog.

So how can we improve brain fog? Now, based on both clinical evidence and my expertise in menopause care, there are several things that we can do to help with brain fog.

Firstly is to optimize your sleep. Now I've done several episodes on sleep, so go back and look at those if you want a bit more detail.

A lack of sleep disrupts memory consolidation, emotional processing and attention span.

We need to aim for about seven to nine hours of sleep and we need to try and have a consistent sleep time and wake up time, reducing blue light in the evenings to help increase our melatonin production, and maybe considering a magnesium glycinate supplement if your sleep is poor.

Also we need to address night sweats. Now this may be a combination of things to improve this.

it might be worth considering HRT. Changing some lifestyle factors or cooling aids can help as well.

Doing things like paced breathing exercises throughout the day has been shown to be really helpful for hot flushes and night sweats.

We need to look at stabilising our blood sugar because glucose is the brain's main energy source, so rapid spikes and dips can really affect focus.

As trying to eat protein and healthy fats every meal can be really helpful to stabilise blood sugar, but also avoiding high sugar snacks. Opt for things like nuts and berries or hummus with vegetables that are much better for also including complex carbs like oats, brown rice and legumes. Also think about

whether trying some time restricted eating. So this is when you keep all of your eating to a certain time within the day, that might be eight hours, 10 hours, but that can be really helpful for your gut to repair itself, but also helps to stabilize our blood sugar.

exercise, moving your body, I go on about the importance of exercise, but it is true, especially aerobic and strength training. this has been shown to increase our neuroplasticity and it boosts our mood regulating neurotransmitters like our dopamine and our serotonin

It also improves our executive function. We need to aim for about 30 minutes most days. Now this could be a brisk walk, it could be strength training, and we need to aim for about twice a week for our strength training, because this can be really helpful for our hormonal balance, but also our brain health.

Pilates and mindful movement can also really help to improve our focus and our stress resilience. I've mentioned stress previously in cortisol. Now high cortisol can disrupt memory, mood and our sleep and all of those can make our brain fog worse.

So things like breathing techniques, journaling, creative outlets, which I'm going to talk about a bit more next week. But all of these things can be really helpful to reduce our cortisol levels. And also consider some guided visualizations or using the control method, which is a type of hypnosis I do, as this can help to retrain how your body responds to stress and how

you respond to certain situations so you don't get as stressed. Also things like going outside. So I've mentioned exercise and the benefits of exercise, but if we go outside in nature to do exercise, so going for a walk outside, particularly if there's lots of greenery around, can be even more beneficial because we get the benefits of exercise, but also we help with our stress and can lower our

cortisol levels.

training your brain can be really helpful. I remember years ago when I think it's the DS came out and one of the biggest games on there was training your brain because it really helps to keep the brain active. But that really is beneficial however you do it because cognitive stimulation can improve your neuroplasticity.

So whether it is a computer game, whether it's puzzles, crosswords or memory games can be really helpful. Try learning new things, so maybe a new language or doing some art or even just taking a different route to work can be really helpful to challenge your brain. Because if we do the same thing in and out every day, it becomes more like an autopilot. If we just change it a little bit.

the brain then has to activate a little bit more. And by challenging your brain, you challenge your body and it's really helpful for things like brain fog, but just cognitive function, full stop. So take something up new or do something that challenges your brain every day.

The other thing is if you've tried all these things and brain fog is really impacting you day to day, it might be worth going down the medical route.

Now I'm not pro or anti HRT, I think it is really helpful and some women get on really well with it and it is life changing. Some women actually find it makes their symptoms worse and it's not for them. However, if your symptoms are affecting your quality of life, I would definitely suggest going to speak to your GP to try it because HRT can help significantly with brain fog.

and for some women, particularly those under 60 and within 10 years of menopause, it can be, like I say, life-changing. It is also important if you are getting brain fog that you get some other things checked. So checking your thyroid function, your iron, your B12 and vitamin D, because deficiencies in those are common.

but they are also causes of cognitive symptoms, but they are reversible. So it is worth getting all those things checked. So if you're going to the GP, get all those things checked. If they are all fine and you are still struggling, then it might be worth looking at some HRT, but certainly trying to improve your sleep, trying to do some exercise, particularly some strength exercise.

look at your diet to stabilise the blood sugar, all things that you can do, even if you are taking HRT. If you are concerned about cognitive decline, then it is definitely worth speaking to your GP or a healthcare professional. It is very rare for brain fog and menopause to be a sign of dementia, but it is worth getting checked out. And if you can get peace of mind to rule all those things out.

then great. But remember, you don't just have to live with it. There are lots of things that you can do. If you are experiencing brain fog, please know there are clear manageable steps that you can take. And your brain is not broken. It's just adjusting to that change in hormones.

So if you found this episode helpful, please do share it with a friend.

if you can leave a review that would be great. It does help more women discover the support that they need.

So thank you so much for listening and I will see you again next week.