Especially as limited abortion access continues to threaten bodily autonomy across the country, it is crucial to consider other ways in which anyone with a uterus may experience challenges relating to the reproductive system, including the effects these changes have on cognition.
Understanding the Research
For this longitudinal study, data were collected from 85 people aged 40–60, with self-reported menopausal symptoms, hormone level measurements, and cognitive test completion twice annually for up to 9 years. Researchers found that strength in either verbal learning and memory or attention and executive function was associated with fewer depressive symptoms and hot flashes, while those individuals who reported cognitive weakness indicated more sleep issues and depression symptoms. While four cognitive profiles were identified for participants, significant evidence of cultural bias with cognitive tests is a limitation of this research.
Cognitive Changes May Accompany Menopause
Miriam Weber, PhD, assistant professor of neurology and obstetrics and gynecology at the University of Rochester Medical Center, and lead researcher for this study, says, “The takeaway is that some women do experience cognitive changes during the menopausal transition, that these changes are not uniform across all women (there are individual differences), and that these cognitive changes are related to sleep disturbance, depression and changing hormones.” Since cognitive changes during the menopausal transition and possible treatments for difficulties are rarely covered, Weber believes that more research is needed to see if these cognitive changes ameliorate over time. “This work suggests that there are more distinct profiles within groups—with some women showing relative strengths in certain cognitive domains, and others showing relative weaknesses,” she says. Weber says, “In my experience with research participants and patients, women often notice changes in their thinking during the menopausal transition (word-finding difficulties, difficulty multi-tasking, forgetfulness). Often, they are subtle. Women can still do their jobs, manage their homes, etc. but find that they are working ‘harder.’ At times, this may cause concern that there is something wrong, or they are in the early stages of neurodegenerative dementia such as Alzheimer’s disease.” So far, Weber highlights that the data in this area suggests that these changes are real, as women are accurate reporters of their experience, and these changes are in part related to some treatable symptoms of menopause, such as sleep disturbance, depression, etc, but symptoms do not solely account for the changes. “For many women, these problems generally resolve in the post-menopausal period,” she says. Weber says, “Lifestyle modifications can help. Making sure you get adequate sleep, and maybe have sleep evaluated by a specialist if sleep hygiene techniques are not working. Physical exercise is very beneficial for cognitive and psychological well-being. If you have symptoms of depression and/or anxiety, this can be treated with medication and/or psychotherapy, usually cognitive-behavioral and other forms of talking therapy.” With cognitive difficulties, Weber recommends lists and calendars to keep track of important information, as well as trying to work on one task at a time rather than multitasking, and minimizing distractions when working on complex tasks. “For instance, I often suggest that people close their email browser rather than just minimizing it—so they can remain focused—then just check email at certain times throughout the day,” she says.
Menopause Symptoms are Often Dismissed
Elisabeth Netherton, MD, a psychiatrist with MindPath Care Centers, a Community Psychiatry Practice, says, “This study does not mean that any individual going through menopause is going to experience cognitive changes; it finds that a subgroup of women may be at higher risk of cognitive changes as they progress through menopause and that for this subgroup these shifts may be more significant than previously described.” Since this is only one study that investigates a complex hormonal event, Netherton cautions that research studies are not necessarily generalizable across populations. “We as providers have more and more information to help us guide decision-making with our patients,” she says. Netherton says, “Women often have experiences of finding their symptoms dismissed by providers or understudied in the medical literature, and menopause is understudied in general. I hope that women reading this article or learning about these findings feel empowered to discuss any symptoms they might have with their providers so that they can talk through monitoring, treatment, and mitigation strategies.” To support cognitive function and mood, Netherton recommends good nutrition and physical exercise as an important means of maintaining wellness across the lifespan. “We know that women experience mood and health benefits from investing in their relationships with others and experiencing a sense of community. As we age our relationships may shift and the communities in which we are most invested may change, so these are important areas for women to explore and be active in,” she says.
